Individual care and treatment in adult acute psychiatric wards
One of the ways the Mental Welfare Commission monitors individual mental health care and treatment is through our programme of visits to people who use services.
We visit people in a range of settings throughout Scotland: at home, in hospital or in any other setting where care and treatment is being delivered. As part of our visits programme we visit people in hospital.
This report reflects our findings from a programme of visits to adult acute mental health wards across Scotland. The purpose of these visits is to enable us to assess and compare care and treatment for people across Scotland. Our aim is to help services learn from good practice and to respond to any issues that are identified.
We have made a series of recommendations that will help organisations to respond effectively to the following key messages
Key messages from our visits
- Whilst the majority of people felt they were treated in general with dignity and respect, we found it was quite common for people to have to wait in a queue to receive medication. In our view, this does not afford confidentiality or dignity to the individual and ward managers should change this outdated practice.
- When people's rights to liberty, privacy, dignity or respect for family life are restricted, then it must be lawful and proportionate. Managers need to ensure that staff understand the correct legal procedures for preventing people from leaving hospital and imposing other restrictions on them.
- While most people feel safe, a significant number of people, especially women, continue to feel unsafe in adult acute wards. Many of those who report their concerns to staff are not confident that these are properly dealt with and commonly do not receive feedback about the outcome. Ward managers should ensure that people who express concerns about their safety get support and feedback on what staff have done to address their concerns.
- We found that the level of training and awareness in observation practice in many wards was insufficient to enable staff to comply with national guidelines. Almost half of the 54 staff interviewed had not received training in observation practice.Managers should introduce training in therapeutic observation for all participating staff
- A significant number of wards did not have a process to formally review observation levels on a daily basis including weekends. Doctors and nurses should agree a procedure for the delegation of authority to review observation levels so that any unnecessary restriction can be minimised.
- Many people reported that they were not given sufficient information about their care and treatment. Managers should ensure that a record is kept of when information is given and whether the person has understood the content.
- A significant number of people we visited felt that they did not meet their named nurse often enough, and many did not know who their named nurse was. There was also a lack of feeling of involvement by individuals in their care and treatment. Ward managers should review the named nurse system and ensure individuals have the opportunity to participate in their care.
- Although we found evidence of discharge planning in almost all of the wards visited, many individuals were unaware of their plans for discharge. Doctors and ward managers should consider giving written as well as verbal confirmation of discharge plans to people in their care.
Click here to download the full report in .pdf format
