Text size: a | a | a

Quality of the environment

On this programme, we visited 26 wards and a day unit. All catered to some extent for service users with a forensic history. Four of the wards we visited were not exclusively for people who had offended but had a mixed client group. All other wards told us they were specialist forensic care services.

Most of the wards are locked at all times, but two of the 26 wards said they did not lock the ward during the day (Leverndale, Boulevard and Strathmartine, Craigowl).One unit claimed that it was the only in-patient forensic unit placed in the community in Scotland and although the front door is locked, individuals have a key (Great Western Lodge, Aberdeen).

Fifteen of the wards did not lock bedroom areas or (in 4 cases) they locked them but provided a key to enable access. We think this is good practice and in line with the principle of least restriction.

In the other wards we visited, restrictions were in place that limited access to bedroom areas during the day to everyone regardless of their individual need. Some nursing staff felt that this encouraged people to participate in activities; others said they would give access on request.It is our view that access to bedrooms during the day should as far as possible be determined on each individual's care plan and that a blanket policy restricting access to bedrooms does not meet the principle of least restriction.

Many services had difficulty locating policies to cover their door locking practices.These policies should be easily available on the ward for everyone, including relatives and carers, to refer to.

Experiencing mental illness can be very distressing and many service users tell us that at times during the day, they need to have a quiet area for reflection, away from the daily hustle and bustle of an acute ward. Five of the wards we visited did not have a specific quiet room away from TVs and other activity areas that people could use. Of these five, some said interview rooms could be used if available.Staff in one ward commented that:

" the ward was designed for older people services and not suitable for forensic patients"

Access to fresh drinking water is a right that most people would take for granted, but in wards where bedrooms and kitchen areas are locked we found that this was not always the case. This can be a big problem in environments which are kept very warm, especially when many individuals are on medication which might make them more thirsty than normal. We found two wards where there was no open access to drinking water when we visited (Hartwoodhill, Iona; Strathmartine, Bridgefoot 2)

"Staff have to take people to the kitchen to access drinking water - cold drinks used to be accessible in a fridge which patients could use but this has been condemned as unsafe and removed and not replaced."

Arrangements for visitors

Although most wards could point to a room that could be used for visits from family and friends, it was clear that in some hospitals these rooms had a multiple function, doubling up as the meeting, interview, or even dining room, and these other uses would be given priority.This is not ideal and we suggest more should be done to provide visitors with welcoming areas to encourage the maintenance of contact with families and friends.

This is particularly true where the patient is also a parent.There is a general duty for hospitals to take steps to mitigate any adverse effects on the personal relations or contacts between parents subject to any measure under the 2003 Act and their children.

All wards had some arrangements in place for children visiting, though some said this never happened. While some wards had special facilities and seemed well organised for visits from children, others said they did not permit child visitors under 16 but may allow supervised visits outside the ward.We believe that it would be more in line with the requirements of the 2003 Act if, following careful assessments, contact between parents in forensic units and their children were facilitated and where appropriate, encouraged.

Access to garden areas

Out of 23 wards we visited that have a locked door only one did not provide a secure garden area,.All others provided some level of outside area, which people could access; although some were small and basic others could enhance well-being: