Audit throws spotlight on violence in mental health units and highlights areas for action

More than half of nurses on mental health wards report being physically assaulted at work. Published: 13 February 2008 More than half of nurses on mental health wards report being physically assaulted at work. The figure rises to almost three-quarters for mental health nurses working on wards for patients with disorders such as dementia. The findings were published today (Wednesday) in the second national audit of violence in mental health services conducted on behalf of the Healthcare Commission by the Royal College of Psychiatrists. There are about 30,000 in-patients in mental health units in NHS and independent organisations in England and Wales. The audit involved 211 units at 69 of those organisations and for the first time looked separately at services for working-age adults and wards for people over 65. The Commission and the Royal College joined forces to highlight the high levels of violence on mental health wards, saying the impact on staff and patient can be “constant and intolerable”. They said that improvements had been made to the way violence is managed on wards for people of working age, particularly in providing effective alarm systems, reporting incidents and having an appropriate mix of skills among the staff team. But the Commission and the Royal College said more improvements were needed, particularly on wards for older people, where physical environments, activities for patients, training and staffing levels were particularly poor. Sixty-four per cent of nurses in wards for older people said they had been physically assaulted, compared to 46% of nurses on wards for adults of working age. Some described serious injury such as fractures, dislocations and black eyes. When looking specifically at wards for older people with organic disorders such as dementia, the number of nurses reporting physical assaults rose to 73%. But patients on wards for older people were less likely to be physically assaulted. Six per cent of patients on wards for older people reported being physically assaulted, 14% said they had been threatened or made to feel unsafe and 29% had been made to feel upset or distressed. On wards for working-age adults, these figures were 18%, 34% and 45% respectively. Dr Paul Lelliott from the Royal College of Psychiatrists commented: “Those working on psychiatric wards, and in particular the nurses, are the unsung heroes of mental healthcare. Their every working day is a challenge and this audit once again highlights the danger to their personal safety. Despite this, ward staff continue to provide care to the most severely ill people in a professional and compassionate manner. “The re-audit involving wards for adults of working age shows that improvements can be made. We have learnt from working with hundreds of wards involved in the audit over the past five years that good leadership is the single most important ingredient for quality and safety. Mental health services must give ward managers the authority to manage their wards effectively and must ensure that they have the resources they need to create as safe an environment as possible. “The Royal College of Psychiatrists is committed to continuing its work with inpatient units throughout the United Kingdom through its accreditation system for psychiatric wards. This publicly recognises excellence in this most challenging of environment and encourages all wards to constantly work to improve the quality of care they provide and their safety.” Anna Walker, chief executive of the Healthcare Commission, said: “This audit reveals worrying levels of violence against nursing staff in mental health units, particularly on wards for people with disorders such as dementia. It is a testament to the commitment and compassion of nurses that such a high number of patients in their wards say they are treated with dignity and respect. “The report highlights areas where if acted on, we know can make a difference in reducing levels of violence. Services need to concentrate on giving people meaningful activities in an environment that is designed to ensure that patients, staff and visitors are as safe as possible. They should ensure that staff have the proper training and skills and that patients get good continuity of care, without the overuse of bank and agency staff. Finally, they should have proper systems to report and manage incidents when they do happen. “We urge all organisations to look at these areas. We will be checking on performance through our assessments, including the annual health check ratings. We will also carry out this year a national study of mental health services for older people. “Leaders of mental health providers must check that they are not allowing a culture to develop that accepts daily violence as part of the norm. I doubt any patient in an acute hospital bed would put up with physical violence and there’s no reason why patients or staff in mental health services should either.”