Mental health services ‘often inhumane’

Report for Mind charity calls for ‘culture of service and hospitality’ in place of dirty wards and lack of respect for patients

Patients using acute mental health services are often treated inhumanely by staff, and have to endure dirty wards, undue use of force, and a “lack of respect bordering on rudeness”, according to a report by an inquiry for Mind.

A sea change is needed in acute and crisis care, states the panel that investigated the services inEnglandandWales. Those in need often could not find a hospital place and emergency helplines were going unanswered, it said. One psychiatrist told members of 10 “avoidable” suicides because bed shortages had denied patients access to hospital.

The report of the inquiry, calls for “a culture of service and hospitality – not least for the inpatients … who are held against their will”.

Grey, who was co-founder of the I and I (Inspire and Influence) black users’ group, and who also lectures at Queen Mary University, London, says in the foreword: “What people call for is for humanity, for care to be humane. I believe people can deliver this and more because we are each other’s keepers.” Residential acute care, says the report, should shift from being on “a medical ward, to that of a retreat providing humane, respectful, personalised care in a comfortable environment”.

The report urges an end to face-down restraint, judged “dangerous and potentially life-threatening”, and moves to ending seclusion and restraint altogether.

More than 400 people contributed to the inquiry, 250 of whom had had direct experience of care.

The verdict of the inquiry echoes concerns raised in June by Dinesh Bughra, outgoing president of the Royal College of Psychiatrists, who told the Guardian that widespread failures in care were leading to fears for the safety of patients.

The report, which says that mental health services need to be protected in the drive for NHS savings, makes more than 90 recommendations for improvement.

At the end of March, 16,647 people were detained in hospital in England; in 2009-10, a total of 107,765 people had been inpatients, nearly 40% detained under the Mental Health Act. InWales, on 31 March 2010, there were 1,820 mental health inpatients, a third detained. More than 1.25 million people a year use NHS mental health services.

The Mind report follows criticism of the lack of dignity and care given older people in the NHS, most recently from the watchdog Care Quality Commission.

Frequent complaints from the public concerned the difficulty of contacting adequately-trained people in times of crisis. Where contact was made by telephone “numerous people cited the advice [given] to have a bath, hot drink, or go for a walk, as being completely inadequate” to the situation of people at the end of their resources.

“The absence of direct help and feelings of rejection are both a risk to people who may be on the verge of self harm. In some cases, the advice itself may be risky.”

Lack of therapies with discussion, and counselling, verbal abuse by staff, assault by other patients, mixed sex wards, and lack of security for personal belongings. were among other failures reported.

Although the inquiry heard about good examples of care, and courteous and helpful staff, and well-designed environments, it added: “We should not, as a society, be leaving people with urgent mental health needs isolated, frightened and unsupported in impersonal hospital settings. We should not be traumatising those who use these services to such an extent they would do anything not to return.”

Paul Farmer, Mind’s chief executive, said: “Our investigation found that far from receiving the instant, 24-7 response we expect for physical health emergencies, people experiencing mental health emergencies can be faced with long waits, poor quality care, and, in some cases, unable to access help at all.

“The distressing and highly sensitive nature of mental health crisis means that it is even more important that people are given a seamless emergency response, safe environments, and that staff have the time to give them care and emotional support.

“The sheer simplicity of what is missing shows there is some way to go before all mental health services [will be] delivering on the fundamentals of good care for people in mental distress.”

Paul Burstow, care services minister inEngland, said the report shone “a light on the good, the bad and the unacceptable”. Calling for dignity and respect at all times, the minister said he wanted to work closely with Mind and others to take forward work on the report’s recommendations.

Burstow said: “We are fully aware that the use of control and restraint continues to be an issue for patients experiencing acute and crisis mental health care, and will be considering how best to address this in the near future with key stakeholders.”

Peter Carter, general secretary of the Royal College of Nursing, said: “We recognise that there can be problems, and areas of provision which simply are not up to scratch, and these should be addressed as a matter of urgency… for all services to reach the level of the best, there must be enough nurses with the right mix of skills and experience.”

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