Focussed visit summary: Visits to intensive psychiatric care and secure units
Number of visits 7
Number of recommendations 25
Recurring themes and areas for improvement
1.Right to privacy and dignity
The risk to individual privacy and dignity can be high in secure units. We wanted to be sure that interference with individual privacy and dignity was lawful and necessary. We made recommendations on:
- Poorly maintained or designed ward environments
- Free access to drinking water
Example of improvements following our visit:
Our recommendation where we found that people in a secure unit did not have ready access to drinking water. (Often, this is because one person has been drinking compulsively, but this does not justify denying everyone free access, especially as many medications cause a dry mouth).
All patients should have ease of access to water and other soft drinks unless contraindicated on an individual clinical basis.
The unit's response:
All patients now have full access to water and vending machines for other soft drinks
2.Least restriction of freedom and lawful deprivation of liberty
People treated in secure units suffer significant deprivation of liberty. This must be lawful and must, in line with the principles of mental health legislation, be the least restrictive of the person's freedom. We made recommendations about:
- Access to outside space
- The use of restraint
- The use of secure wards for informal patients
Example of improvements following our visit:
Our recommendation where we visited people in secure ward who had been restrained but did not understand why this had been done.
The ward manager should review the practice of how the use of restraint is communicated to patients. In addition to providing an explanation at the time, there should be a debrief with the person following use of restraint to discuss the reasons it was felt to be necessary.
The ward's response:
Staff will explain why restraint was use after the event. The use of restraint will continue to be recorded in the patient's care plan and reported through the appropriate system.
3.Provision of information
Principles of mental health legislation include participation of the patient and the provision of information. We expected to find that the people we visited were given appropriate information (and helped to understand it) about the security in the unit and the person's rights under mental health legislation. We made recommendations when this did not appear to have happened.
Example of improvements following our visit
Our recommendation where we found a lack of evidence that some people had been given information about their detention. Section 260 of the 2003 Act requires that hospital managers must give certain information and ensure they understand it. The ward had a checklist for doing this.
The section 260 checklist is not being completed consistently. There should be a review of the completion of case note documentation covering legislation-related matters and clarity provided for staff regarding expectations in relation to this.
The ward's response:
It is agreed that the "Section 260 Checklist" should be completed consistently. A copy of the "Section 260 Checklist" was sent to the Commission.(Ongoing inconsistency regarding this has been apparent on Commission visits across the mental health service in this visiting year.We are following this up to make sure that all people detained in this hospital are given necessary information).
