Let’s look at what the media say
Both the Guardian and the BBC recently wrote about the need for more mental health beds. The Guardian said “Cuts in mental health beds have gone too far, leading to the ‘shameful practice’ of patients being sent hundreds of miles from home to be treated, according to psychiatrists.”
“The Royal College of Psychiatrists is calling for the NHS to urgently create hundreds of extra beds for people who are seriously mentally unwell in order to tackle a damaging shortage” wrote Denis Campbell, The Guardian (2019).
The Department of Health states that they aim to end these inappropriate far-away placements by 2021. They’ve only got one year left to reach their goal and I haven’t read anywhere yet that they’re on target.
Mental health bed crisis — closer to home
As far back as 2003, despite the increasing population (approx 210,000) in our area, we always had a distinct shortage of beds. Apart from offices, our mental health unit housed the following:
Image by ITV News Calendar
- 4 x (mixed occupation = male and female) 20 bed acute in-patient wards, for for each area of the borough i.e. North, South, East and West.
- 1 x 15 bed Female Ward
- 1 x 5 bed Mother & Baby unit
- 1 x 20 bed PICU (mainly men) but sometimes women had to go into their only seclusion room in the building
- 1 x 18 bed (mixed occupation) Rehab ward
- 1 x 25 bed Elderly ward (ditto)
- 1 Day Hospital which had around 60 patients attend each day
- Emergency department where people attended when in crisis and were either sent home, allocated to the Home Treatment Team or admitted to an acute in-patient ward
- Home Treatment Team (HTT)
That’s roughly 120 beds and we never seemed to have enough, especially when we know that 1 in 4 people were experiencing mental illness at any given time.
Image by Kim Kyung-Hoon
NHS data showed some mental health trusts were operating with all or almost all their beds full, despite the College’s belief that they should never exceed 85% capacity.
Let’s look at the reality
Once (before my time on that ward), following a hugely publicised incident (Clemence, who’d been diagnosed as having schizophrenia, had been given leave by a new Consultant, despite the fact that he’d said in ward round that he felt like killing someone), we were running at 110-120% capacity.
That meant each acute in-patient ward was regularly 2-4 patients over. The Rehab ward generally had 1-3 spare beds when patients went to try out new accommodations or went home on leave. The elderly ward normally ran at 80-85% so regularly had 2-5 spare beds.
A terrible critical incident
Anyway, Clemence had been given a few hours leave — he left the ward for a while then came back and went to bed early evening. The police arrived a few hours later with a grainy picture (snipped from a cctv recording) and asked if anyone knew this person.
Yes, it was Clemence and a staff member went to his room to get him. He just muttered, as calmly as you like, “Are the police here yet?” This patient had gone to a train station and pushed a female in front of a train — this poor lady, just in the wrong place at the wrong time, died instantly.
Of course, the new Consultant was devastated but he got to keep his job. Afterwards, he barely dared to discharge anyone. This spread around other wards and junior doctors in particular weren’t keen on discharging patients.
Mental health patients forced to sleep out every night
From then on in, our beds were constantly over-subscribed. Some dimwit pen pushers decided; each night around 7pm, the nurse in charge on each ward had to identify at least 1 or 2 more settled patients to sleep out on another ward that had spare beds i.e. the rehab and the elderly wards.
Remember, these were our acute mental health inpatient wards and if you didn’t know already — Acute mental illness is characterised by significant and distressing symptoms of a mental illness requiring immediate treatment. This may be the person’s first experience of mental illness, a repeat episode or the worsening of symptoms of an often continuing mental illness.
Can you imagine — after night time medication on their own ward (around 10pm), these unfortunate acutely unwell patients were traipsed down corridors with their belongings to spend a night on another ward? Once they woke they had to wait around til after the morning handover (which ended after 8 am) before being escorted back up through corridors to their own ward for breakfast.
This went on for many months and the ‘sleep outs’ hated having to move lock stock and barrel each night, return each morning then walk around their own ward all day with their belongings. So, not only might they have already been unsettled in the community, homeless or neglected and now acutely unwell, they were being pushed from pillar to post — yet again.
Mental health patients forcibly bussed out every night
As patients returned from leave to the rehab or elderly wards, beds were becoming even more sparse. So, the dimwit pen pushers thought “Oh — let’s bus them all out to our other hospitals each night — that’s a good idea.”
Now the identified patients were traipsed down the old and dingy winding corridors, with their belongings, to the minibus waiting at the back of the hospital. If one ward was particularly late giving out medication or there was an incident on the ward, the patients downstairs on the bus were delayed and had to sit in the minibus for up to an hour.
The risks in sleeping patients out every night
Only one member of staff (taken from a ward) was allocated to accompany the bus driver to our other hospitals which to me was a huge risk. Imagine sitting with 4-10 tired and thoroughly p’d off patients. I would have refused to do it but was fortunately never allocated that task as it tended to be a support worker role.
Never mind that (1) if a patient became unwell (physically or mentally) or aggressive, there was no qualified nurse to help them, (2) as a rule, on the wards, staff normally had only 4-5 patients to look after and (3) remember that one ward was missing a support worker for around 3 hours. Risk. Risk. And more risk!
Everything about this was wrong. With me now at the helm (Acting ward manager), staff were encouraged to put in incident forms each night, letting the dimwit pen pushers (who saw me as trouble) know that patients’ refused to be slept out. We’d already told every patient on the ward that they had a right not to be slept out and the right to stay on their own wards. Our staff were also advised not to let one of our support workers leave the ward to accompany the bussed out patients as it left our ward at risk.
We’d previously informed patients that Patient Advice and Liaison Services (PALS) was available if they wanted to complain. However, despite our reassurances, many declined because they didn’t have the wherewithal (too worn down from being ill) or for fear of being singled out further.
Nurse documentation is everything
Ambinsurance.co.uk
It was important that staff continued completing incident forms each night. They had my full support, as did the patients. Staff were to document in patients’ notes and on the incident report — how the Duty Senior Nurse (DSN) called each night for the identified sleepouts and how staff were not prepared to take the risk.
In hospital/medical care, if it’s not documented — it didn’t happen. This was my motto and I continually encouraged staff to document everything verbatim — even if they were requested/ordered by senior staff to do something they weren’t comfortable with — I had their backs.
It couldn’t get any worse. Or could it? That’s another absolutely shocking post — next time.
In the meantime, I’d really appreciate your thoughts on sleeping patients out. Have you ever come across it? How do you think you’d feel if, as an acute mental health inpatient, you were bussed out to another hospital every night?
Dammint it that’s some screwed up shit. Excuse my language but the hell? What were those idoits thinking.
You’re right — they were idiots. But they got even more so! I’ll follow up on my next post. Thank you for passing and commenting Lily, much appreciated 🙂
Well I’m glad you informed me of this. I wasn’t sure about it and didnt known it was a thing.
That’s horrific about the train. 🙁
Yeah, when I was last hospitalized, in 2006, they put me on the old person’s ward because of a bed shortage. The ward was connected to the regular adults’ ward via a central locked door, and I was allowed to come and go as often as I wanted to or needed to. So if they were having day activities, I’d leave the old person’s ward. In the evening, if I wasn’t feeling like socializing with the other adults, I’d just go back to my room in the old person’s area. I have to admit that they handled it quite well, with no inconvenience to me at all, given the layout. And the other patients weren’t allowed access to both wards, so that was… special. For one thing, the old person’s ward had a piano, which the regular adults’ ward did not. So I was able to play piano during daytime hours. Everyone liked my piano playing. (That’s not saying much, but we were hard up for entertainment.)
This is totally off the topic, but I’m remembering things about that hospital stay now. There was a woman there in horrible pain, due to fibromyalgia (or something like that), and she couldn’t get any doctors to give her strong enough pain meds. She wound up throwing herself onto the highway as a suicide attempt or plea for help (however you want to look at it), and when they brought her into the hospital, they FINALLY took her pain seriously and gave her some strong meds. During all of our group meetings, whenever someone would ask her how she was going to follow up with her mental healthcare, she’d say, “I’m pain-free now, so I’ll be fine! Thank God!” Anyway, there was always a camaraderie among us patients. It was sort of nice.
I’m glad to hear that your experience of moving between wards was better than our patients. They weren’t actually given a room on the elderly ward where they could pop in during the day if they fancied a lie-down — they just slept there overnight. Great you got to play the piano and I’m sure the patients love it.
Wow, isn’t it terrible the lengths some people have to go to – to get them to take her seriously? It’s a positive ending tho’.
That’s atrocious. Back when I worked inpatient we had an “over-capacity protocol,” which mean patients having to sleep in the common rooms or in hallways.
That was their first system of choice. But the Consultants were p’d off cos they couldn’t get into the common rooms for ward round because of mattresses and patients’ belongings!
Oh dear, life is tough, isn’t it… Funny how oblivious some people can be.
Oh yes, but if it was them?
You’d think that with somebody as risky as Clarence, it would be more than one doctor’s decision to release, wouldn’t it? If he had already been heard on the ward, then the ward staff should’ve had a veto.
Oh definitely! If I was in ward round that day, I’d have raised concerns, as I have in the past, and argue that the patient will not be allowed to leave. Nurses have a short window where we can Section patients.
The Nurses’ Holding Power under Section 5(4) of the Mental Health Act 1983 is used as an emergency measure. It is used by the nurse at their professional discretion and allows them to lawfully prevent an informal inpatient, who is receiving treatment or assessment for a mental disorder, from leaving hospital.
Fortunately, I never had to implement this Section — Consultants didn’t like to argue with me because I knew all our rules, regulations, policies and procedures – some skills left over from my days as Human Resource Manager 😉
I’ve not heard of this practice in the states, but our psychiatric wards are all on a separate locked ward, they would not risk liability issues letting them mingle loosely in other wards. I mean, if they’re saying they feel like they could kill, how wise is it to place them near an elderly person or whatever who is helpless?
Shameful practice and furthermore, it stresses to the maximum minds that are already beyond the breaking point due to their disorders so it seems counterproductive. How is tramatizing them more going to aid in their mental health improving?
But here unless you have mega insurance, even if you sign yourself in, they keep you maybe 3 days and as long as you aren’t dangerous to self and others…out you go, bed open,next,. Like a bloody fast food drive thru.
Of course there’s risk when you allow them to mingle on the elderly wards. When I was manager on the elderly ward, I insisted they had their own allocated nurse sitting outside their rooms. I wouldn’t risk them harming or stealing from our elderly.
It was a shambles for years and Senior management weren’t keen on me ‘causing trouble’ my manager told me lol.
We had the opposite here, patients stayed for an age and eventually became bed blockers because the Doctors were too scared to discharge anyone!
The doctors here could use a little of that fear, they’re so busy pushing people through to appease the insurance companies who say ‘no more than three days will be approved’.
It is sad that doctors are more intimidated by insurance companies and not getting paid than they are being sued for malpractice.
That’s true!
I’ve never seen something like this, nor I wish to witness it. It is completely silly, stupid and out of line! What a waste of time, resources and patients trust and their recovery being on hold with all the unnecessary stress. No, no, no!!
What did happen on my job is that sometimes patients only did sleep with us (when they were better of course) and during the day they went to school (!), a special workplace or to another ward to make the transition to that ward more easy. I believe for mental stability the mind needs also a place to call its own, your own room and your own bed, that is so important.
As for the incident, that is on the psychiatrist, he/she takes the responsibility (listening to advice from his team or not). Mental health is not an exact science, we do not have a crystal ball to foresee everything. When they diminish staff and resources, it gets just harder to think things trough and to make the best informed decision.
I agree it’s a big No – NO! But worse was to come… And of course, the Psychiatrist has overall responsibility but like you say, they need to listen to the rest of the multi-disciplinary team and then make an informed decision.
Terrible. Unfortunately I’m sure a lot of it comes down to money. 😕
As always 🙁
That is just horrible! These are clearly people who are in need of professional ’round-the-clock care, not some sort of adult daycare! I’m so glad you encouraged your colleagues to document this. Hopefully, that documentation will help bring some improvement!
When I was a junior nurse, I learned how not to be a manager lol and I suppose that helped me become a better manager. The kind of manager I would have liked.