Open up mental health wards to lay visitors, says new report

The closed, impermeable nature of mental health wards leads to poor social relations between staff and patients, according to a report published today. This in turn has a corrosive effect on patients' health and healing.

The Hear I Am report is published by Social Action for Health (SAfH), a community development charity that works with mental health service users. The report is based on observations made by SAfH staff and trained lay observers on a men's acute psychiatric ward in East London over a period of 12 months. A high percentage of men on the ward were African Caribbean.

During twice-weekly visits the project team built relationships with the men on the ward and observed ward life. They also introduced some patients to Multi Media Profiling (MMP) as a way to represent themselves at Care Programme Approach (CPA) meetings.

"A highly complex picture emerged that led to real depth of learning for the project team," says Elizabeth Bayliss, Executive Director of SAfH. "For the most part ward life was almost arelational, that is dialogue was not the norm. Ordinary rules of social life did not seem to apply. Thus ordinary greetings such as "Hello" or "How are you" were not used. The purpose of ward staff did not seem to be to care but to control.

"The wards were separate, segregated airless places that weren't doing anything other than suspending people," she adds. "Patients weren't in any therapeutic relationships. They were just hanging around."

The report concludes: "Keeping people on the wards in a state of suspension, by virtue of the way ward life is conducted, aggravates and enervates both patients and staff, rather than creating the sort of stabilising and empowering situation that promotes care and recovery."

Says Elizabeth Bayliss: "We want to find a way to open the wards up so that they can be more permeable and people can come and go and talk about ordinary things, whether it's the football or the weather. Patients lack that in a very profound sense. We want to recommend as strongly as we can that the wards need to open up."

Key recommendations made by the Hear I Am report include:

• Regular sessions on wards about health, hygiene and nutrition run by trained members of the lay community.
• Self-management courses run by accredited lay tutors so that patients can learn how better to manage chronic mental health problems themselves.
• Rotas of trained, supported local volunteers to accompany patients who want to take leave from the wards.
• More training for ward staff on relational skills.

In response, Paul Sherman, Associate Director of People Participation for East London NHS Foundation Trust says: "This thought-provoking report by Social Action for Health brings a fresh perspective to how life on an acute psychiatric admission ward is viewed by service users. Our challenge is to ensure that we have assimilated as much of the report as possible into the day to day running of our wards."

The report is accompanied by a multimedia DVD profiling the Hear I Am project.

Click here to download the report

See Elizabeth's guest post Dialogue was not the norm on the Mind blog.