SCIE Practice guide 09: Dignity in care

Dignity in Care within mental health - Acute inpatient care

Introduction

A recent consultation, The Sainsbury Centre for Mental Health Service User and Carer Centred Services Research, showed that the top priority for mental health service users was the conditions on acute inpatient wards.

“Star Wards - Another Bright idea” (Bright, 2006) states:

 “We know a lot about patients’ experience of acute wards, since most of the reports on the state of these wards are at least partly based on patients’ and carers’ views.  Concerns regularly raised include women hating being on the residual mixed sexed wards; safety issues; relationship with staff and boredom”

The 'Human Rights Insights Study’ (Ipsos MORI 2005/6 conducted for the Department of Constitutional Affairs; 4,000 adults interviewed) found that people in mental health units were far less likely to report that staff treated them with dignity and respect than those in primary and secondary care. 58% of the public stated that they were treated with dignity by hospital doctors compared to only 35% of those commenting on mental health unit doctors. Similar differences were reported for nurses and receptionists. 

Recent evidence (Patient and Public Involvement (PPI) Forum Care Watch Report, March 2007) shows significantly less satisfaction with dignity and privacy in mental health trusts than acute trusts. Of patients in acute Trusts, 98%said that they were treated with dignity and respect during their stay in hospital compared with 84%for mental health Trusts and 97% in Primary Care settings. Of patients in acute Trusts, 95%felt that their privacy was protected during their time in hospital compared with 82%for patients in mental health Trusts. 19%of patients requiring a gown in Acute Trusts were not given one which fitted them. In mental health Trusts this rose to 29%.

Other resources

2006/07 Healthcare Commission acute inpatient service review

• A multi-agency subgroup has worked in partnership with the Healthcare Commission (HC) to develop a common service user outcome focused assessment framework to underpin both the national project and the 2006/07 HC acute inpatient service review.  The review applies to all MH Trusts, PCT providers and Foundation Trusts in England. The assessment, launched on 6.6.07, has four criteria (underpinned by 56 indicators) to determine  whether:
• there is an effective care pathway that ensures admission to hospital is appropriate and that discharge from hospital is timely
• inpatient services provide individualised whole person care that promotes recovery and inclusion
• service users and carers are involved in care planning, in how the ward is run and in operational and strategic planning, evaluation and development
• the ward has systems, processes and facilities in place to ensure the safety of service users, staff and visitors

To download information on the HC service review and assessment framework  go to

Link: Healthcare Commission service review

'Onwards and Upwards: Sustaining service improvement in acute care’ - This is an electronic handbook (produced by CSIP-NIMHEin collaboration with the Healthcare Commission) to help local services to carry out the review. It includes information and hyperlinks to the key policies that provided the standards for acute care and suggests action points for improving services. It also provides pointers to good practice and information about different initiatives and approaches to sustaining improvements in acute mental health.

Link: Onwards and Upwards handbook (PDF file)

Virtual Ward website - A publicly accessible Virtual Ward web site is now available in order to display and distribute examples of positive practice, policies and training throughout the acute pathway, and help inform current service provision and service improvement within mental health care communities. Key categories include Admissions, Care Planning, Aftercare, Recovery and Empowerment, Environment, Standards and Partnerships.

Link: Virtual Ward website

“Positive Outlook” positive discharge practice toolkit - This practical toolkit was jointly developed (by the CSIP-NIMHE acute programme, CSIP Health and Social Change Agent Team and Older People’s programme) to help Trusts improve acute pathway working and discharge planning in order to reduce delayed discharges.

Link: Positive Outlook toolkit

Star Wards -improving the therapeutic environment in inpatient settings - There is excellent, rarely publicised, practice across the country on acute mental health wards, with patients accessing high quality therapeutic, creative and recreational opportunities. Star Wards works with mental health trusts to enhance acute inpatients' daily experiences and treatment outcomes. Members of the Star Wards' network try to implement whichever of the 75 practical ideas are relevant to them. The network is supported by the charity 'Bright’ whose role it is to provide wards with information and resources. Members also generously share their own experiences of great practice and of the challenges they face. It is free to join the network.

Link: Star Wards initiative

James Wiltshire Trust’s Community Engagement Project - extending rights to advocacy
Culturally and linguistically appropriate advocacy and befriending schemes are particularly important for black and minority ethnic (BME) service users. In Southampton and Hampshire, the James Wiltshire Trust’s Community Engagement Project runs a befriending scheme for BME patients in psychiatric in-patient care units. The scheme draws on the skills of service users, ex-service users, carers and mental health care volunteers who work to relieve the isolation felt by BME inpatients, and then to help them develop local connections and reintegrate with society. These 'befrienders’ play a crucial role in helping patients rebuild their lives, pointing them in the direction of part-time work, hobbies or exercise and sport.

More practical advice on culturally appropriate care is available on the DH website.

Link: Positive Steps: Supporting race equality in mental healthcare

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