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Areas for improvement

Individualised care

We are concerned that the blanket implementation of the "specified persons" regulations in some low-secure areas reveals a lack of understanding both of the intention of the regulations and of the relevance of a person centred approach to recovery and care. The 2003 Act and the Code of Practice are clear that the regulations should be applied on an individual basis, with the exception of the State Hospital and the existing two medium secure facilities. We found much more restrictive practices in some low-secure areas and in some cases without the appropriate authority.

Consent to treatment

The lack of understanding in a third of wards about general consent to treatment and the role of the Adults with Incapacity Act in facilitating lawful treatment needs to be addressed through appropriate staff training.

Physical health care

The majority of people we spoke to said that their physical health care was regularly reviewed, however, only half of staff said that health checks were carried out routinely.

As outlined in "Delivering for Mental Health", we would expect to see a greater emphasis being placed on reducing health inequalities by improving general health care of individuals in psychiatric hospital settings.

Smoking, diet and exercise were highlighted as areas of concern. Many recognised the problems associated with their lifestyles but did not feel they were receiving the necessary support to make the changes needed to improve their health. We were concerned to find that half of the people we interviewed were worried about their weight, while only around half of them received dietary advice.

Smoking cessation, dietary advice and physical exercise programmes should be actively promoted in these settings.

Locked doors

People in hospital should be afforded the same courtesy and right to privacy and dignity as anyone else. Accepting that in some environments, there is a need to have a locked door policy, having to constantly seek staff assistance to unlock internal doors such as kitchen and bedroom doors can be a barrier to recovery.

Services should review the need for restrictions to freedom of choice, especially in relation to locking internal doors during the day.

Access to specialist drug and alcohol services

Only 15 people interviewed indicated that they had received specialist help in respect of their co-morbid drug or alcohol problem, yet there were 34 who indicated that this was a significant factor for them.

Access to specialist drug and alcohol services should be available for people in forensic services.