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Access to physical healthcare

The majority of individuals we interviewed believed they were receiving physical health checks, but most had difficulty knowing how often these took place. We found it difficult to see from the notes when checks occurred and there were no policies or procedures governing physical health care in place. Of the 26 staff members that we spoke to, half said health checks were carried out annually. It was difficult to determine how extensive the checks were, and who carried them out.

Nevertheless, one patient stated-

'I'm Hep C positive- I probably get better treatment in here than I would outside'

Access to a dentist varied and in some units was not readily available. One person told us that he had been waiting for months, but many did not regard dental needs as a priority for them.

Local hospital policies should be in place to ensure regular physical health checks are undertaken as a matter of routine.This is especially important in view of the increased risk of physical health problems and potential side effects of medication in this group of people. The minimum scope of the health check should be clearly stated in the policy.

Smoking

The majority of individuals we spoke to told us that they smoked, this gives rise to problems for staff who have to work within the provisions of the Smoking, Health and Social Care (Scotland) Act 2005. Further consultation on "Achieving smoke free Mental Health Services" is currently underway and it is already apparent that there are diverse opinions about this. Some health boards already have policies which restrict smoking, even in the grounds of the hospital and this can cause problems for people.

From the 26 wards visited, seven still have smoking rooms while individuals from the remaining 18 wards smoke outside. One ward stated that there were restrictions in place regarding how often people can go out for a cigarette and all those who smoke have to go out together. This appears to be an institutionalised response to implementing policy and removes any element of choice for the individual. .

Weight, diet and exercise

The impact on the general health of the population of obesity, lack of exercise and poor diet is well recognised and there are many initiatives in place to address this. There is an even greater need for these issues to be prioritised for individuals who find themselves in hospital, often for lengthy periods of time.

Of the 68 people interviewed, 34 said they were concerned about their weight but only 18 saying they had received dietary advice. However, another 6 individuals said they had been offered advice but did not believe they had weight problems.

We also asked about activities in relation to the availability of exercise. It is considered beneficial to introduce more activities in your daily routine, such as using the stairs, taking a brisk walk every day. However,people in forensic services have a number of restrictions placed on their ability to freely come and go, therefore activities, even simple exercise such as walking, may need risk assessments and other complicated organisational and safety hurdles to overcome, before the person is able to take part.

Most individuals we interviewed mentioned the difficulty in accessing the simplest of exercise.

Only one unit had exercise as an integral part of the assessment process and care plan. This unit had a physiotherapist working with people who all benefited from one form of exercise or another.

Most people told us they could access a gym, but did not. In addition, one unit was engaging people in activities such as badminton, cycling and walking.

Interviews with staff revealed the majority are trying to promote a healthier lifestyle as part of their daily work routine, without the benefit of specialist advice and support. There would be significant advantage to greater public health/health promotion investment in support for in-patient services.

Substance misuse

We asked individuals if they had previous or current problems with drugs and alcohol and if they had input from specialised services.

Half of the people we spoke to said drugs and/or alcohol had been or were still a problem for them, but only 15 reported that they had been offered specialist services or interventions.

In three units staff reported that psychology provided a service to address drug and alcohol work with individuals. In all other units (22), it was expected that nursing staff would provide it. None had input from substance misuse services.

It is worrying that specialist drug and alcohol services, which are available within every health board area, are not being utilised/being made available for this patient group.We are concerned at this situation. The impact of co-morbidity, in the form of drug or alcohol misuse, is now well recognised and it is clear that this is a significant issue for this group of people. Lack of specialist input may have a detrimental effect on an individual's recovery and prolong their stay in hospital unnecessarily.