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:
- 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.
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
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?