Official figures on mental health sexual assault claims do not add up
Posted: 20 July 2006 | Subscribe Online
writes Sally Gillen
A Community Care investigation has cast doubt on the reliability of figures published this week in a government report on alleged sexual assaults within psychiatric wards.
A report by the National Patient Safety Agency said there were at least 122 sexual incidents, including 11 alleged rapes by staff, from November 2003 to September 2005.
But there were more than 300 allegations recorded from 2003 to 2006 by 44 of England's 70 mental health trusts who responded to a Freedom of Information request submitted by Community Care.
Of those, 107 psychiatric patients made an allegation against a member of staff, while 224 said another patient had assaulted them.
This points to more widespread problems than indicated by the NPSA study, which also included information from combined trusts in Wales and from more of England's specialist mental health trusts.
Camden and Islington Mental Health and Social Care Trust had the highest number of patient-against-patient allegations.
However, its procedures were highlighted as good practice in the NPSA report.
Buckinghamshire Mental Health Care Trust - now Oxfordshire and Buckinghamshire Mental Health Partnership NHS Trust - had the third highest number.
In a statement, it said some service users had made more than one allegation about the same incident, and that it was also looking to develop a female-only in-patient unit.
Mind chief executive Paul Farmer said: "Community Care's disturbing research reinforces the NPSA report's message of an unacceptable level of sexual abuse in mental healthcare.
"We must have a reliable and comprehensive reporting system that can give us an accurate, annual picture of the levels of sexual abuse in mental healthcare."
Mental health tsar Louis Appleby has launched a review into the most serious allegations and will ask every mental health trust to review their procedures on patient safety.
The government published the NPSA report after it was leaked to the press (Mind adds to fears over true number of sexual assaults in service units).
Most allegations by patients against patients
22 Camden and Islington Mental Health and Social Care Trust
20 Bolton, Salford and Trafford Mental Health NHS Trust
16 Buckinghamshire Mental Health Care Trust
Most allegations by patients against staff
14 Leeds Mental Health Teaching NHS Trust
13 Lancashire Care NHS Trust
9 Devon Partnership NHS Trust
Mind adds to fears over true number of sexual assaults in service units
Posted: 13 July 2006 | Subscribe Online
writes Simeon Brody
A leaked report that revealed more than 100 incidents of sexual assault and harassment in mental health units over a two-year period could underestimate the problem, according to a charity.
Mind has called on the government to publish the Mental Health Observatory report, which was leaked to The Times this week but has reportedly been with the Department of Health since November, so its findings can be acted upon.
The newspaper claimed that the report, prepared by the National Patient Safety Agency, detailed more than 10 rapes in the two years to October 2005 and three unwanted pregnancies in a single year.
The figures reportedly include staff-on-patient incidents and come in the same week as it was revealed that seven mental health trusts were unable to demonstrate they carried out proper employment checks.
The NHS trust declarations on basic standards, published by the Healthcare Commission, revealed that two mental health trusts admitted they had not met vetting standards and five were unable to prove whether they had or not.
While the vast majority of mental health trusts complied with most of the core standards, three said they did not meet basic patient safety standards.
Four of the 61 mental health trusts listed said they had been unable to provide services in environments which "promote effective care".
Mind chief executive Paul Farmer said it was "absolutely unacceptable" that the NPSA report had remained unpublished for so long.
The charity said further incidents might have been prevented if earlier action had been taken.
A Department of Health spokesperson said a report on patient safety in mental health services was still being prepared.
What the research says
12.00.00am UTC (GMT +0000) Tue 18th Jul 2006
Liberal Democrat Health spokesperson, Sandra Gidley MP has described the National Patient Safety Agency report published today detailing allegations of sexual abuse of patients and staff in mental health settings as "long overdue".
Commenting on the long-awaited report, completed in November but only published now following Liberal Democrat pressure in Parliament, Ms Gidley said:
"This report is long overdue. I question how many more allegations of abuse have been made since November, when it first went to the Department of Health.
"Urgent steps must be taken to stop sexual abuse of any kind in mental health settings and ensure that nobody is being treated on mixed sex wards.
"It is shocking that the majority of the allegations of rape are against members of staff. If true, this would be a terrible betrayal of trust.
"The report highlights the need for a systematic and regular system of gathering data on patient abuse. We still need to know how many of the reported incidents occurred in mixed-sex settings and how many incidents led to police involvement."
Policing sexual relationships on mental health wards
Posted: 18 August 2006 | Subscribe Online
Stories of sexual abuse on mental health wards have left trusts in a dilemma over how to police consensual relationships, reports Sally Gillen
By the time Louise* discovered her son was having a sexual relationship with Julia* the latter was six months pregnant.
Not an unfamiliar story. Except Louise was not the mother of an adolescent faced with the product of a doomed teenage romance. Her son, John,* was in his mid-thirties, a psychiatric patient at a south London hospital and, apparently at the time that fellow patient Julia became pregnant, he was on a locked ward.
"Everybody at the hospital knew what was going on but I didn't," says Louise. "They didn't seem to care and they weren't worried about what had happened."
She had known Julia and John were friends, both with a diagnosis of schizophrenia, and she was happy that her son, who had spent most of his adult life in institutions, had some company.
She never imagined their relationship would develop as it did while he was in the hospital's care. Just a couple of months after Julia gave birth she committed suicide, which set in motion a chain of events that led Louise to a breakdown.
"I thought 'there is no way I can do this'," she recalls when she was asked to break the news to John.
"In the end I told him she had died but I didn't say she had killed herself. I'm not sure he took it in. He went pale, we had a whisky and it was never mentioned again."
Her grandchild is now 12. She was adopted by a family friend and Louise sees her regularly. There is a 50 per cent chance that she will develop schizophrenia.
Louise insists her story is not unusual. A report released by the National Patient Safety Agency (NPSA) in July revealed that there had been 122 allegations involving issues of sexual safety recorded by trusts, including claims to The NHS Litigation Authority for three unwanted pregnancies. It is evidence that sexual safety issues need to be addressed.
A survey by Community Care in July showed that, in the past three years, mental health trusts in England had recorded 224 allegations of sexual assault by patients against other patients.
Mental health tsar Louis Appleby told Community Care: "We do not know how many incidents are occurring. But we are getting a message about a safety problem that we have to tackle."
Addressing the issue will be complex. Cases of consensual sex, as Louise's story illustrates, are a moral maze for mental health trusts. Expecting trusts to devise policies that police consensual relationships effectively is not achievable, says Claire Johnston, director of nursing at Camden and Islington Mental Health and Social Care Trust.
"It would be a human rights issue," she argues. "It is difficult to control the welter of human emotions and we would be arguing for a ban on sex."
Louise acknowledges that people with mental health problems are entitled to a sex life but she believes the people caring for her son could have done more to manage it. "Why couldn't they have put Julia on the pill?" she asks. "It is ridiculous to give condoms to someone in the state she was in as a form of contraception."
The issue of consensual relationships may be fraught with complex arguments but allegations of sexual assault present greater problems for trusts.
Johnston hopes that most assaults would be reported to the primary nurse. Serious attacks are rare and would be dealt with by the police but remarks or the passing of an amorous note could make someone feel more vulnerable so the trust operates a policy of zero tolerance, she says.
Sometimes it is a case of someone harassing another patient because they are unwell and are unaware of the impact of their behaviour, which may be resolved by talking to them. If they persist they, or their victim, can be moved elsewhere.
But how do staff decide whether an allegation is credible if delusions or hearing voices are a part of the complainant's illness?
And how do they decide whether the allegation is malicious?
"We try to defuse the situation with minimisation strategies," says Johnston. "Every person who makes an allegation is taken equally seriously. We are not deterred by their diagnosis."
But Mind policy director Sophie Corlett says: "Lots of trusts are overcautious about believing people to an extent that is dangerous. It would be better to err on the side of believing people.
"Staff appear to be tolerant of generally inappropriate behaviour such as indecent exposure and nothing is done, partly because of understaffing and a lack of managers."
Jenny's complaint (see They told me nothing could be done) about a male who assaulted her is an example of the blase attitude Corlett describes. She was told to avoid the person who had assaulted her. Given that he was confined in the same building this was neither realistic nor reasonable advice.
Her experience resulted from a placement in what was essentially a mixed-sex environment with separate male and female areas for sleeping and bathing, which many trusts operate.
Appleby denies that such accommodation is falsely defined as single-sex. Undoubtedly though, the number of assaults would be reduced if patients were given the option of segregation.
As a result of the NPSA report, Appleby is reviewing the 19 most serious assaults to find out how the trusts dealt with them and will report to health minister Rosie Winterton by the autumn. "We may find that it's time to question whether the guidance on accommodation needs to be strengthened," he says.
* Not their real names
'They told me nothing could be done'
A week after Jenny* was admitted to a hospital on a three-month section a male patient started to harass her. It began with him talking to her, even though she made it clear she did not want to talk to anyone, and then he started following her.
"I mentioned it to staff but they told me to stay in the women-only wing all day. But then they told me they did not want me to do that because I couldn't take part in activities.
"One evening, late on, I went into the kitchen and he followed me. He trapped me against the wall and was saying sexual stuff, what he wanted to do to me, and touching me. Then he heard someone in the corridor and I was able to escape because he was distracted. I got back to my room, which was on the ground floor, and he had gone outside and was by my window. I didn't leave my room to tell anyone because I was really scared.
"I told a health care assistant the next day. She hung around me to make sure I was ok and told someone higher up. But nobody spoke to him.
"He continued to follow me and I was too scared a lot of the time to leave the women's wing so I couldn't do group activities. A ward manager said there was nothing that could be done because he was ill. I wanted them to speak to him but he was high half the time. But I could have been moved.
"I am appalled about the way my complaint was dealt with. I thought about complaining when I left but then I decided against. If they weren't prepared to do anything when I was in the hospital, why would they once I'd left?"
*Not her real name
100 women raped or assaulted on mixed sex NHS wards
Last updated at 08:18am on 11th July 2006
According to the report, there have been three unwanted pregnancies in a single year in NHS mental health units
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Vulnerable women patients have suffered more than 100 rapes, sexual assaults and incidents of sexual harassment in NHS hospitals in just two years, it has been revealed.
The shocking tally emerged in a confidential study blocked from publication by the Department of Health for the past eight months, a delay which health campaigners claim has prevented steps being taken to stem the attacks.
It underlines the government's repeated failure to fulfil its pledge on scrapping mixed sex wards in hospitals - a scandal the Daily Mail has repeatedly campaigned against on grounds of patient dignity, as well as safety.
According to the report, there have been more than ten rapes over the period and three unwanted pregnancies in a single year in NHS mental health units.
The new information, leaked by a Whitehall source, was compiled by the National Learning and Reporting System - a monitoring programme set up by the National Patient Safety Agency (NPSA) in 2003.
Most of the reported incidents occurred in the 12 months to October 2005 as the 84 mental health trusts were among the last bodies to sign up to the system that is supposed to cover all healthcare organisations.
The report included both patient-on-patient and staff-on-patient incidents ranging from men exposing themselves to women, through to physical assaults and rape.
Paul Farmer, chief executive of the mental health charity Mind, described the findings as 'extremely disturbing'.
He said: 'It is absolutely unacceptable that this data has been sitting unpublished for so long.
'If incidents like these occurred on cancer wards there would be an outcry, and immediate action. But mental health patients will be the most emotionally vulnerable, and should have the highest levels of protection.
'Rapes and sexual assaults on mental health wards are the results of faults at every level, and it is impossible to defend this systematic failing.
'Yet again, mental health is being neglected. The unpublished figures represent enormous levels of trauma and suffering, and they deserve attention - and action.'
He added that with many safety breaches in the NHS going unreported, the actual picture could be much worse.
'We are talking about the care of some of the most vulnerable patients. I think people will rightly be appalled by these findings,' he said.
In 1996, Tony Blair - then in opposition - first promised that mixed-sex wards for all NHS patients would be phased out, and the government set a deadline of 2002 for this.
Yet ten years on, after many missed targets, the practice persists - even after the government had declared that wards where screens had been placed between male and female beds could be classed as single sex.
Neither do the targets include 'assessment areas' where patients are held on trolleys in Accident and Emergency departments before being admitted or sent home after treatment.
In 2004, a convicted rapist indecently assaulted an elderly woman in the next bed in one such holding area in a south London hospital.
Health charities point out that the recent spate of huge deficits faced by some NHS trusts are having a severe effect on caring for the mentally ill, with staffing and bed cuts compounding the problems of providing single-sex wards.
Conservative peer Baroness Knight of Collingtree, who has raised concerns in Parliament about mixed sex wards in hospitals dozens of times, said she was disappointed that the Government had failed to act.
She said: 'I cannot believe how many years I have been complaining in both Houses of Parliament about the appalling business of mixing women and men in hospital wards, especially those suffering from mental problems.
'The dangers this system brings are indeed serious, as this latest report reveals.
'I fear we must start all over again trying to persuade the Government that the system is wrong, cruel and dangerous.
'It is over a year since Lord Warner gave me and the House the impression that he would deal with the matter. Quite clearly he has not done so.'
Tim Loughton MP, shadow health minister, said: 'The risks faced by mental health patients are exacerbated by the Government's failure to ensure that wards are single sex only. The problem is only set to get worse as this year's NHS deficits have forced mental health trusts, who are already struggling to meet demand, to make devastating cuts to their services. '
Sandra Gidley MP, Liberal Democrat health spokesperson, said: 'The Government have been sitting on this report since November and refuse to give a date of publication. Urgent steps must be taken to ensure that nobody is being treated on mixed sex wards, which is particularly important when it is the most vulnerable in society who are being looked after.'
Lynne Jones, Labour MP and co-chair of the All Party Parliamentary Group on Mental Health, said: 'In wards that should be the safest of all, the problems are worst. We put trust in the NHS to look after vulnerable people, sometimes against their own will, yet many of them are being put into a dangerous situation when they go into hospital. Our trust and theirs is too often betrayed.'
A Department of Health spokesman said in a statement: 'Patient safety is paramount across every area of the NHS and we would expect all Trusts to thoroughly investigate any allegations of sexual assault and to involve the police where necessary.
'A report by the NPSA into patient safety in mental health services is in the process of being finalised and will be published as soon as this is complete. However, some of the information in the report remains unclear and work is already underway to clarify this and to ensure that the report reflects the most complete picture.'
Extent of 'sexual abuse on mental health wards' revealed
Publisher: Ian Morgan
Published: 18/07/2006 - 10:57:51 AM
The extent of sexual abuse, including rape, on mental health wards has been unveiled in a shock new report today.
Following pressure from Mental health charity Mind, the Department of Health has released research conducted by its safety watchdog, the National Patient Safety Agency.
It reveals at least 122 reported sexual incidents including 19 rapes, while stating that a significant number of under-reporting.
The data has been taken from mental healthcare settings in England from November 2003 to September 2005.
Of the nineteen reported rapes, the alleged perpetrator in the majority of cases - 11 - was a staff member.
The report confirms that the NHS Litigation Authority received three claims for compensation following unwanted pregnancies.
It does not reveal how many of the 20 reported cases of 'consensual' sex involved staff members.
The response of mental health trusts to these incidents is reported as 'varied', suggesting that not all trusts had appropriate procedures in place.
It is also not clear in how many incidents the police were involved - something that should be routine for allegations of sexual abuse.
The report also doesn't reveal how many of the reported incidents occurred in mixed-sex settings.
The Government pledged to abolish mixed-sex wards and has for some time claimed that 99% of all mental health wards are single-sex.
But the criteria they use are insufficient, and as the report concedes, guidance is broken.
This report data was available from the end of last year.
Paul Farmer, chief executive of Mind, said: "This is a truly shocking report which requires urgent action. People who are extremely vulnerable should be treated with the best care and attention - not subjected to abuse. We urgently need an audit of the implementation of single-sex wards. Service users are consistently telling Mind that Government claims are not the reality.
"It is even more shocking that staff are the perpetrators of sexual abuse. Professional guidelines clearly prohibit any kind of sexual contact with patients - we need to eradicate this appalling state of affairs. We must also have a systematic way of collecting data on an annual basis to show us what the true picture is. Mind will be writing to the Minister to request immediate action."
Concerns stoked over scale of sexual abuse in single-sex mental health wards
Posted: 27 July 2006 | Subscribe Online
A patient safety watchdog has revealed a worryingly high incidence of sexual assault in mental health wards in England and Wales. However, as Sally Gillen reports, figures uncovered by Community Care show the scale of the problem is likely to be much bigger
The revelation last week that there have been 122 sexual incidents on mental health wards in England and Wales from November 2003 to September 2005, including 11 alleged rapes by staff, was shocking.
Figures contained in the first mental health services report by watchdog the National Patient Safety Agency gave an insight into levels of abuse in in-patient settings.
More shocking still was an investigation by Community Care that uncovered more than 300 allegations of sexual assault made by patients on wards in England alone from 2003 to 2006, indicating that the NPSA may just have scratched the surface of the problem (Official figures on mental health sexual assault claims do not add up).
The NPSA report admits that the true figure is likely to be higher because allegations are under-reported. It also makes the point that a high number of allegations in particular trusts could be due to higher levels of reporting rather than more incidents.
Assaults are committed by patients and staff, according to the NPSA report and Community Care's research. Our figures show that 224 allegations were by patients against patients.
Arguably, the government has failed to limit this figure by the way in which it has allowed single-sex wards to be defined.
Despite its readiness to trumpet the fact that 99 per cent of wards are single sex, on closer inspection it is using a questionable definition of what constitutes such an environment.
Mental health trusts are required only to provide single-sex sleeping and bathing areas in wards to satisfy the government's requirements. Day areas can remain mixed.
Many in the sector believe the government requirements are not stringent enough to safeguard patients. They argue that much more could be done to separate male and female patients, thus reducing the number of alleged assaults.
Even with separate areas for sleeping and bathing, it is not uncommon for men to be given beds on a women's ward if male provision is over capacity, and women have often reported that bathrooms are not secure, says Sophie Corlett (pictured left), policy director at charity Mind.
Health minister Rosie Winterton defended the government's requirements when she was questioned during a parliamentary debate on the NPSA report on its day of publication, arguing that having areas that could be used by men and women made a ward a "normal setting".
Mental Health Foundation head of policy Moira Fraser agrees that this is a valid reason, especially when people may be detained for many months. However, she adds that it should be optional as, while there may be people who want to be on a mixed ward, others do not. Mental health charities claim that many female in-patients in psychiatric wards have been victims of some sort of abuse in their lives, and being forced into a closed environment with men may hamper their recovery and prove even more damaging if they are assaulted again.
Among the key messages and recommendations of the NPSA report is that mental health units should be reconfigured to provide single-sex wards only. It also says that wards must not be pressurised into admitting patients of the opposite sex into single-sex areas when there is high demand for beds. Neither of these points was addressed by Winterton.
Mental health tsar Louis Appleby has now asked all mental health trusts to review their procedures on patient safety. Some mental health organisations, such as Mind, which highlighted the dangers in its Wardwatch campaign in 2004, may wonder why this has taken so long.
It could be seen as another example of the lower priority given to adult protection compared with child protection.
"If this had happened on a children's ward there would have been a national outcry," says Corlett. "It appears that people have not taken on board the fact that these sorts of things are happening in in-patient settings.
"Somebody senior needs to be saying this is an absolutely disgraceful state of affairs. This is not the same as mistakes over medication or falls. This is not about accidents happening."
The disparity between Community Care's statistics and those gathered by the NPSA inevitably raises questions about the rigour of the system. Margaret Edwards, head of strategy at charity Sane, says: "We do have concerns about the robustness of the system for collecting information (see The Reporting System, below), especially as the delay in publishing the NPSA report was attributed to the need to validate the data received." She believes there should be an annual audit of incidents of sexual abuse on mental health wards.
The NPSA does not inspect services but campaigners argue that its findings should be used to regulate them.
Corlett says: "I can see a world in which the NPSA has a place because no-blame learning is useful. But it would be good if we could see what comes out feeding into what the Healthcare Commission does in terms of inspection."
Certainly the way in which allegations are dealt with is crucial to tackling abuse, both by patients and staff, and many patients often complain that they are not believed when they report assaults.
In April, the NPSA launched an online service for patients and the public to lodge complaints. But three months after its launch it has dealt with just 37 complaints and it does not know how many relate to sexual assaults on mental health wards.
Our research indicates that, over time, the potential number of people using the complaints system may prove more shocking than the findings unveiled by the government last week.
No allegations made
Trusts that told Community Care they had dealt with no recorded allegations of abuse:
Doncaster and South Humber Healthcare NHS Trust
Pennine Care NHS Trust
Somerset Partnership NHS and Social Care Trust
Selby and York Primary Care Trust
Hertfordshire Partnership NHS Trust
Craven, Harrogate and Rural District Primary Care Trust
Worcestershire Mental Health Partnership NHS Trust
North Warwickshire Primary Care Trust
Trusts that had recorded no allegations made by patients against staff:
Cambridge City and South Cambridgeshire Primary Care Trusts
Morecambe Bay Primary Care Trust
Shropshire County Primary Care Trust
Bedfordshire and Luton Mental Health and Social Care Trust
Suffolk Mental Health Partnership Trust
South Essex Partnership NHS Foundation Trust
West London Mental Health NHS Trust
Trusts that had recorded no allegations made by patients against patients:
North Cumbria NHS Trust
Nottinghamshire Healthcare NHS Trust
Hampshire Partnership NHS Trust
Surrey and Borders Partnership NHS Trust
Dudley, Beacon and Castle Primary Care Trust
A breakdown of the 122 incidents recorded in the NPSA report:
19 allegations of rape; 20 consensual sex; 13 exposure; 18 sexual advances; 26 touching; and 26 other incidents.
Community Care asked mental health trusts in England:
Forty-four of England's 70 mental health trusts with psychiatric wards responded.
The reporting system
Most of the information in the NPSA report comes from incidents reported to the National Reporting and Learning System. This is an anonymous system run by the NPSA to record incidents soon after they occur. The data are passed to the Patient Safety Observatory, a body set up by the NPSA and partners, which uses it to identify national trends and patterns. Trusts/local health boards and NHS bodies investigate individual cases.