Major overhaul of mental health wards needed, says The King's Fund

The King's Fund today called for a major overhaul of adult psychiatric inpatient wards following the publication of an audit showing high levels of violence in mental health and learning disability services.

Speaking in response to the study conducted for the Healthcare Commission by the Royal College of Psychiatrists, The King's Fund chief executive Niall Dickson said:

'This audit adds to the growing body of evidence of serious problems on many mental health wards up and down the country. There are still far too many patients, frontline health professionals and members of the public experiencing violent or threatening behaviour, which is unacceptable. It is not only distressing for the individuals involved, but reflects shortfalls in the way care is provided.

'We know it can be hard providing good quality care to patients in psychiatric wards, but both patients and staff need to know they are in a safe environment. Much of this is obvious and we know what needs to be done to improve mental health services - we need more staff, better training, more activities for patients and a clampdown on people bringing illicit drugs and alcohol on to wards. This has been well highlighted in The King's Fund's mental health inquiry, London's State of Mind, in 2003, as well as in other subsequent reports.

'Mental health trusts now need to take a long, hard look at how they provide inpatient psychiatric services - in cases where violence and aggression are rife, trusts should be undertaking urgent reviews of their services. We very much hope this audit leads to real improvements in mental health wards and staff training.'

Violence and aggression on acute psychiatric wards linked with mental health and substance misuse problems was a key finding of The King's Fund's 18-month inquiry into London's mental health care, published in November 2003. It found that:

  • many nurses on mental health wards had been personally threatened or had
  • witnessed threatening behaviour
    service users are equally affected by violence and aggression on wards
  • patients with drug or alcohol abuse problems, as well as mental health problems, were behind most violent confrontations; some nurses had been threatened by drug dealers.

The King's Fund inquiry recommended that:

  • mental health trusts review conditions, staffing levels and skill mix in acute inpatient wards
  • mental health trusts prioritise training for ward staff on dual diagnosis and complex needs
  • the Government commission an independent, systematic review of acute in-patient care provided for black and minority ethnic service users to address concerns about safety.

The King's Fund is now part of a major collaborative with the London Development Centre for Mental Health to devise and test out new ways of improving patient and staff safety on psychiatric wards in the capital. The collaborative expects to conclude its work in December.

Notes to editors: 

1. For further information or interviews, please contact the King’s Fund media and public relations office on 020 7307 2585 or 07831 554927. An ISDN line is available for interviews on 020 7637 0185.

2. In November 2003, the King's Fund published the findings from its 18-month inquiry into London's mental health care. London's State of Mind: King's Fund Mental Health Inquiry 2003, by Ros Levenson, Angela Greatley and Janice Robinson, warned that the Government’s pledge to modernise mental health services is failing in London. It said that while there are many examples of good services, London remains reliant on admitting people with mental health problems to hospital rather than helping them stay in the community. Media can obtain free copies of the report by contacting the King's Fund media and public relations office on 020 7307 2585 or 07831 554927.

3. The King’s Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through grants. We are a major resource to people working in health, offering leadership and education courses; seminars and workshops; publications; information and library services; and conference and meeting facilities.