Safety in mind

Mental Health Nursing,  Sep 2006  by Donaghy, Gerard

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A new report from the National Patient Safety Agency has revealed startling figures about the numbers of alleged sexual assaults on mental health inpatients. Gerard Donaghy examines the report, With safety in mind: patient safety in mental health services, and asks why such attacks are taking place and what can be done to prevent them.

A new report from the National Patient Safety Agency (NPSA) has revealed startling figures about the incidence of alleged sexual assaults against mental health inpatients.

The report, With safety in mind: patient safely in mental health services, was finally published in July 2006 after being leaked to The Times newspaper. The data for the report were collected between November 2003 and September 2005 and reported to the NPSA's National Reporting and Learning System (NRLS), but the publication of the information was held up, allegedly due to the NHS gateway system.

The NPSA publication reveals that there were 122 incidents that concerned patients' sexual safety. Of these, 19 were allegations of rape, eight perpetrated by a fellow patient and 11 by a member of staff. The report adds that longer-term data from the NHS Litigation Authority from the ten years up to August 2005, reveals three known cases of unwanted pregnancies.

Further findings in the NPSA report include: 20 cases of consensual sex; 13 cases of exposure; 18 alleged sexual advances; 26 cases of touching; and 26 other incidents concerning patients' sexual safety.

In the wake of the report, representatives from the voluntary sector have hit out at the level of security afforded to mental health inpatients, but Andrew McCullough, chief executive of the Mental Health Foundation, believes that these figures are worryingly, merely 'the tip of the iceberg'.

'We welcome this report', said Mr McCullough, 'which is the first of its kind to explore the issue of patient safety within mental health services. However, we believe that these levels of violence and abuse are the tip of the iceberg and it is scandalous that such abuse is allowed to take place.'

This admission is also made by the authors of the report, who say, 'it is likely that there is under-reporting [of sexual abuse]. The reports and follow-up with trusts suggests that services may not have a consistent approach to dealing with such allegations and would welcome further guidance' (National Patient Safety Agency 2006, p 40).

However, the report does acknowledge the efficiency and frequency with which mental health nurses report incidences of assault, compared to other mental health professionals.

'Nurses are more likely to have seen an error or a near miss; are most likely to know how to report it; and are most likely to believe that their employer encourages reporting, treats reports confidentially and acts to prevent recurrence' (National Patient Safety Agency 2006, p 21).

Like McCullough, Cliff Prior, chief executive of the mental health charity Rethink, was deeply worried by the report's revelations. 'The findings of this report are extremely disturbing, and confirms the need for an urgent review of patient safety on psychiatric wards', he said.

Why are attacks happening?

Despite the efficiency with which mental health nurses report incidences of assault, the NPSA report admits other mental health professionals have a lower awareness of incidents, have less knowledge of the systems for supporting incidents and feel their employer does not encourage the reporting of incidents (National Patient Safety Agency 2006, p 21). Such laxity in mental health services may create an environment in which attacks can be perpetrated, and even if uncovered, may go unreported, generating a climate of tolerance towards assault.

It is also possible that the much-highlighted financial cutbacks experienced by mental health services have compromised the level of security and supervision afforded to mental health patients. At the very least, these cutbacks - made to compensate for overspending elsewhere in the health service - won't help in trying to rectify the problem. If a failure to protect mental health inpatients is attributed to financial restrictions due to overspend elsewhere, it is all the more galling considering these inpatients are among the most vulnerable people under NHS care.

This disregard for mental health services and inpatient care, coupled with the low-key reaction to the report's publication, appear to indicate once again that mental health is indeed the 'Cinderella' of the NHS and its service users stigmatised.

'If a woman went into hospital for a heart operation and was raped during her stay, it would be a national scandal', added Andrew McCullough. 'But women who are raped while in mental health services are simply not believed. People with mental health problems are treated as second class citizens and this discrimination is unacceptable in this day and age'.

Cliff Prior holds a similar view. 'In a recent survey for Rethink', he said, 'service users and carers identified hospital inpatient care as among their worst experiences. If cancer or heart patients had to contend with the same levels of patient care, there would be a national outcry. Yet psychiatric wards are the only place in the NHS where people can be compulsory treated. That's why the state has a duty to provide all inpatients, particularly those who are sectioned, with a safe and secure environment.'