Shock as mental health patients are ‘bussed out’

In my last post I wrote about how our patients, having gone from being slept out on other wards within our unit, to being bussed out to spare beds in our other mental health hospitals every night. I ended with things couldn’t get any worse.

Documenting risk in ‘bussing out’ patients

Safe Staffing Now — RCN Nurses — Image from

Our ward staff had been completing incident reports for weeks, months even, documenting the risks of bussing patients out but were wondering what the point was. Staff were reminded, “if it’s not documented — it didn’t happen.”

Unfortunately, our local Service Managers weren’t listening and were ignoring the risks and the quality of patient care by bussing them out like cattle going to slaughter each night.

We needed these incident reports to show that even under these extreme circumstances, we were doing everything possible to maintain high standards of patient care and reduce any risk.

We also needed Senior Management at Head Office to be aware that our verbal complaints were being ignored by middle management, who were essentially putting patients and staff at risk.

While we often had to sleep out 4-5 patients each night (20-25% over our regular capacity), those patients returned each morning and had to be cared for all day with the same number of staff. So instead of two qualified and two unqualified staff for up to 20 patients, we had the same amount of staff for 24-25 patients.

Weekly staff team meeting

Despite our continual complaints, verbal and written, via the minutes from our weekly Wednesday team meeting (which we cc’d to all the powers that be), our concerns were still being ignored. Therefore we invited our Modern Matron (my boss) and the Area Nursing Director (his boss) to attend a team meeting.

Ward staff team meeting — Image

Staff were encouraged to speak for themselves in these meetings — if they wanted change, they needed to express their concerns. They needed to say “we have too many patients to cope with, the patient’s are getting agitated about being bussed out every night and the risks of this practice are too high.”

Our dimwit pen pushers (Dpp’s), who’d decided that sleeping patients out was a good idea, sat silently and had to be prompted for an answer “How long will this go on for?”

Dpp’s glared at me, glimpsed at each other then their shoulders went up in a couldn’t care less shrug and our Nursing Director humphed, “not any time soon.”

“Ah, okay,” I smiled, “We’ll document this in the minutes”. Not another word, just a look of disgust and they both left. “That’s why we complete incident reports, ” I chuckled, addressing the team, “they haven’t got a leg to stand on if anything happens, we have the documentation.”

The dreaded annual cost-cutting in mental health

By now, it was December and the annual cost cutting was announced — our unit had to save money somehow otherwise we’d go over our budget at the end of the financial year, which is end of March in the UK.

Lightbulb moment — Mary Pitzer Blog Image

Our Dpp’s had an amazing idea, which was to cut ward staff at night — immediately. Instead of 3, each ward would have 2.5 which meant that each ward would share a member of staff – who would go back and forth between two wards?

Our concerns were voiced to our Dpp’s in a team meeting and ignored. I would be off for four days now and staff were given strict instructions to complete incident forms each night. Again this was documented in the minutes of the meeting.

Accident waiting to happen on a mental health ward

Just imagine, it’s now Friday night. One qualified nurse is ‘doing’ medication for 20-25 patients, ensuring that the sleep outs were ‘done’ first. The other qualified nurse is checking all our patients are where they’re supposed to be and still breathing. Then she’ll make hot drinks and toast for the patients before they go to bed.

In the meantime, the unqualified nurse is rounding up the identified sleep outs before eventually walking them down the dingy corridors to the bus waiting out the back. It’s our ward’s turn to accompany patients on the bus to our other hospitals and to give a handover to the staff there. This could take 2-3 hours.

By around midnight, the unqualified nurse was on her way back from our other hospital, things had settled and one qualified nurses decided to take her break. Manish, the other nurse, went round the ward to complete the half hourly checks on patients when he saw a young male patient, Iki, loitering near the female area.

High risk patients on acute mental health ward

Breakdown in the community — Image by

Iki was a young lad with a diagnosis of paranoid schizophrenia and had just recently been re-admitted on Section 3 of the Mental Health Act (MHA 1983) following a breakdown in the community.

He told Manish that he wanted to have sex with one of the young female patients and when Manish said that he couldn’t do this, Iki became agitated. Manish suggested some medication to help him sleep and Iki agreed, so they started towards the medication room, down a long corridor. Manish stepped forward to unlock and open the meds room door …………..

I got a telephone call at home around 2 am that morning and returned to the ward before going over the general hospital where Manish now was.

I’m sorry I need to stop here but I’ll continue in the following post. In the meantime, I’d be interested to know what might you and your team have done in the same circumstances. Would you do something differently?

If you or anyone you know is experiencing mental health difficulties, please see your GP. If you are having suicidal thoughts, please talk to someone immediately. In the meantime, this Useful Mental Health Contacts may be of interest.


Mum to two amazing sons. Following recovery from a lengthy psychotic episode, depression, anxiety and anorexia, I decided to train as a Mental Health Nurse and worked successfully in various settings before becoming a Ward Manager. I am a Mental Health First Aid Instructor and a Mental Health Awareness Trainer, Mental Health First Aid Youth and Mental Health Armed Forces Instructor. Just started my mental health from the other side blog.

15 thoughts on “Shock as mental health patients are ‘bussed out’”

  1. Good on the team to document it and to stand together. It’s certainly not acceptable all round, for staff, or patient’s.

  2. Um, can anyone say cliffhanger? Oh my!!

    It’s horrible that there are such awful and frustrating procedures in place! I admire you for speaking up at the staff meetings and being blunt and direct about it! Go you!

    Well, when I worked night shift at the residential treatment facility for mentally ill and abused teenagers, I was often alone on a unit. Just me, all night. Even on the specialized unit (which housed male sex offenders). I don’t think it would’ve helped to have more people on staff, but the hard thing was worrying about physical restraint. I was trained it it, but I have no upper body strength, nor any amazing ability to defend myself. It made me feel uncomfortable, but I couldn’t cop to it, because being able to do the restraint was a job requirement.

    Golly, I hope Manish was okay! In your last blog post, you had a male coworker who got bitten during a lovefest, and now this! 😀 Very entertaining and thought provoking!!

    1. As Manager, I ensured the team stuck together – the senior management wouldn’t be able to beat us!

      Wow, that really wasn’t safe where you were, particularly with male sex offenders – I’d have said “eff off and once you get there, eff off some effin’ more” to the management. I understand not wanting to tell them about restraint but surely if you’d been there a while, they have make amendments to your role.

      I’ll tell you about Manish in my next post. I’m glad you like my tales, and there’s so many more — Meg and thank you for commenting.

      1. I shall remain your captive audience! YAY! You have fun stories indeed!

        Well, the sex offenders’ unit was my favorite one to work on! They had obvious sexual abuse issues, but they were so well-behaved otherwise! The worst unit was the boys’ unit of general behavior problems. Then my middle preference was the girls’ unit (also with general behavior problems).

      2. Lol. I worked with sex offenders in a prison mental health unit – it was really difficult not to make judgements but I suppose I enjoyed the work I did with them there. It wasn’t about curing them but helping them understand perhaps how they got where they were, looking at consequences of their actions and so on. I liked working with younger people too. I think I liked all the areas I worked in mental health.

  3. I like hearing about it from the staff’s side because I’ve only been on the side of a patient or as a patient and it makes it so easy for us to make snap judgments. We assume if you hold the job then you have the power to make things different and chose not when it’s the higher ups tying your hands. That gives me a newfound perspective towards healthcare providers as well as an appreciation for all they do-in their limited powers thanks to the pencil pushers- to help patients.
    Now cliffhangers freak me out, where’s the other part???

    1. Of course it’s easy to make snap judgements, we’re all guilty of it. I always felt that it was giving the power back to patients, helping them to make the right informed decisions – oh and to the staff – made my job easier lol.

      Yes, some of us did try and often managed well, despite the dimwit pen pushers – they just made me try harder. They didn’t like us telling patients they could complain lol.

      To be honest, I couldn’t write the ending yesterday. Hopefully today 🙂

  4. It seems like long-term, it would actually save money to run things in a way that makes sure patients are adequately cared for. I imagine there are costs when things go wrong, though that should hardly be the main motivation to prevent such a turn.

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