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Warning over self-harm by mental health patients

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Polly Curtis, health correspondent
May 14, 2007

Levels of suicide and self-harming are soaring in mental health wards where there are few activities, locked wards and constant surveillance, according to a major study.

Patients are self-harming and even attempting suicide because of the "prison-like" conditions they are kept in according to the evaluation of over acute psychiatric wards.

The idea that patients already suffering acute mental problems are being bored into self-harming and even suicide prompted calls for an urgent overhaul of the way wards are managed.

"It [hospital] can feel like a prison and unsurprisingly if people are very distressed at the time that's when they are most at risk of self harming. We know from our study that most acute wards are dealing with 100% bed occupancy and that puts huge pressure on everyone," said Alan Simpson, of City University.

The report led by Professor Len Bowers at City University is based on detailed surveys from 136 of the country's 550 mental health wards, including analyses of 46,000 individual reports produce by staff on wards.

The academics were trying to find ways to reduce incidences of self-harm on mental health wards and found that the wards with the lowest self-harming and suicide rates were those which provided regular daily activities, had the best qualified staff and in which people at risk of self-harming were checked regularly but not constantly policed.

Wards with few activities - social, therapeutic or educational - had the worst rates of self-harm. "Those services without a programme of patient activities should take urgent steps to provide one," it concludes.

They found that the cost of dealing with self-harm in wards is over £90m a year. Four out of 10 wards had no occupational therapist and 87% have no dedicated clinical psychologist.

They also found some of the worst rates of self-harm were in wards which operated a "locked door" policy, which is increasingly common around the country. In London 50% of wards are now routinely locked. The Department of Health has now asked the academics to further investigate.

In interviews most patients reported feeling safe and well cared for in the wards, but a third said they had felt intimidated by other patients. Half had witnessed violence or verbal abuse on the wards and a third had witnessed or experienced a theft on the ward.

Hospital managers were also told to introduce new policies to tackle bullying and drug abuse in mental health wards.

Use of drugs and alcohol on wards was "widespread" the researchers conclude.

The reports from wards highlighted particular problems where there were large numbers of people being admitted and discharged in short periods of time. "The current policy drift towards smaller bed numbers and greater patient throughput seems likely to lead to greater levels of self-harm on wards, and may need to be reconsidered," it says.

A spokeswoman for mental health charity Mind said: "Hospitals are sometimes hindering people's recovery rather than helping them to recover. There's boredom and frustration with nothing to do; with nothing to do they will think more and more about their problems and the isolation they face. It can make people deteriorate.

"The government guidelines state mental health patients should have access to meaningful activity. That's' not happening. People have access to television and smoking and little else. What we call for is all patients should have access to fresh air, exercise and meaningful recreation. Art projects or whatever activity can help increase confidence and get people doing something positive."

A spokeswoman for the Department of Health said: "We welcome this report which provides an increased understanding of what measures can help reduce self harm on mental health wards. The vast majority of mental health patients receive safe and effective care and this research provides evidence that the current work to train staff to achieve more therapeutic care for patients, will have a positive effect. It also supports the recent announcement of £30 million of funding to enhance safety on mental health wards, particularly for women users."

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