A project to improve the safety of mental health service users by creating a safer environment on acute psychiatric wards was announced today by the National Patient Safety Agency (NPSA).

This is the first project in an extensive programme of work developed by the NPSA to ensure that services for people with mental ill-health in England and Wales are provided in the safest way possible.

Unsafe wards pose risks to both patients and staff and the NPSA is making a major contribution to work being carried out by a range of organisations involved in promoting safer mental health services. The Agency will work with frontline staff, service users and other key stakeholders in the mental health field to develop safety measures to be piloted.

To date 40 NHS Trusts in England and Wales have signed up to work with NPSA on this project.

NPSA Joint Chief Executive Sue Osborn said:

?Previous work has already identified the features and factors that optimise ward safety. The focus of our work will be to determine what prevents these features from being put in place and maintained. We will also concentrate on identifying and understanding systems that exist on acute psychiatric wards and how these can be managed to improve safety. ?

?The factors that make a ward safe are often the same as those which make a ward therapeutic. If we find solutions to the problems of ward safety we will also improve the quality of the whole experience of in-patient psychiatric care for both patients and staff.?

Factors that contribute to an unsafe ward environment, which will be considered as part of the project, are:

-- Lack of social and therapeutic activity for service users

-- High turnover of staff

-- Poor physical environment

-- Bed pressures

-- Lack of staff leadership

The issue was identified as a priority for action when a breakdown of data from the pilot phase of the NPSA?s National Reporting and Learning System (NRLS) showed a high number of mental health patient safety incidents related to in-patient wards.

Consultant Psychiatrist Professor Paul Lelliott, NPSA?s Clinical Specialty Advisor for mental health and Chair of its Mental Health External Reference Group said:

?The NPSA is able to give a unique focus to improving the experience of many service users of acute inpatient care. By focusing on the causes rather than the symptoms, the project will, in partnership with both service users and front line practitioners, be able to address many of the issues that have led to unsafe environments for both groups.

?By collaborating with other national projects that will have an impact on the future of acute psychiatric inpatient care the NPSA is able to ensure that patient safety is at the heart of this important work.?

The NPSA mental health programme is also working on or involved in a number of other patient safety issues. These include:

-- Developing safe practice in relation to the management of violence and aggression. A small but significant number of mental health service users have died following restraint either in a police cell or psychiatric hospital. The National Institute for Mental Health England (NIMHE) has published draft guidance for consultation. The NPSA is supporting this work through the joint appointment of a project manager to oversee the implementation of the guidance and the development of an accredited national training programme for the safe management of violence and aggression.

-- The safe application of cardio pulmonary resuscitation (CPR) and safe medication practice. This work has arisen from the findings of the inquiry into the death of David Bennett, the mental health service user who died in 1999 after being restrained in the Norvic Clinic in Norwich. Amongst other issues highlighted by the report the need to have well trained staff in relation to CPR and appropriate equipment readily available was recommended.

-- The prevention of suicide in older people. Older people may be vulnerable to the onset of clinical depression for the first time. Failure to recognise this within primary care and refer to specialist services may lead to avoidable death through suicide. The NPSA is examining the patient safety aspects of this issue. Endorsements for the NPSA?s Mental Health Programme of Work

Malcolm Rae (OBE), Joint Lead, Acute Care Programme, National Institute of Mental Health in England (NIMHE), says:

?The launch of the NPSA?s mental health programme is timely, topical and contributes to the development of a more enlightened mental health system which aims to be service user centred and more responsive to their needs.

?Of particular note is the focus on the creation of a safer environment on acute psychiatric wards as patient and staff safety on wards are of critical importance.

?The NPSA?s approach to the management of aggression, for example, is very sound, and it is encouraging that rather than looking at ways to handle disturbed behaviour the NPSA will be using a whole systems approach to identify the causes of problems. This solution-orientated approach with an emphasis on the environment, processes and leadership will prove beneficial in the prevention of disturbed behaviour occurring in the first place.

?One of the key challenges in this work will be to equip staff with sufficient knowledge, awareness and confidence to improve the safety of patients, staff and visitors to acute wards.

?I?m also very pleased that the NPSA is focussing on older people and physical health which are areas of mental health which have been neglected in the past. The focus on the safety of older people will assist in improved assessment at an earlier stage and safer interventions. With the move to a more holistic approach to healthcare the NPSA initiative on physical health has the potential to raise awareness of the strong relationship between physical and mental healthcare and to significantly improve the unmet physical healthcare and lifestyle needs of service users.?

Simon Lawton-Smith, Senior Policy Advisor, Mental Health, the King?s Fund, says:

?The NPSA?s work on creating a safer environment in acute psychiatric wards could hardly come at a better time. The King\'s Fund\'s Inquiry into mental health in London, published in November 2003, highlighted the poor ward environment that many patients experienced, even to the extent of feeling their lives were in danger.

?Both patients and staff should expect their experience on wards to be positive and therapeutic. We don\'t underestimate how difficult this can be. Many patients have complex needs; there are problems with staff shortages; and the fabric and design of many wards is poor. But we have high hopes that the NPSA project will point to real solutions to these problems.?

Terry Butler, Director of Social Services for Hampshire and Joint chair of the Association of Directors of Social Services Mental Health Committee, says:

?The ADSS is delighted that the NPSA?s holistic approach reflects the way in which health and social services are coming together to deliver services.

?In many areas across the country, mental health services are provided through fully integrated teams and increasingly the commissioning of services is also integrated. It is therefore vital that the NPSA?s approach addresses safety issues across acute, primary and community settings for patients, service users and carers.

?The solutions across the NPSA?s mental health programme will impact on staff in a social care setting. ?Transfer of care?, for example involves health and social care staff, and it is good that the NPSA has recognized the important role that social care plays in mental health care.

?We look forward to our continued involvement in the development of this programme.?

Dr Mike Shooter, President of the Royal College of Psychiatrists, says:

?The Royal College of Psychiatrists shares the NPSA\'s commitment to improving the safety of people with mental health problems. In particular, it welcomes and looks forward to working with the NPSA to create a safer environment on acute psychiatric wards.

?For too long psychiatric wards have been neglected as attention and resources have been focused exclusively on developments in community care. As a result, many people with the most severe forms of mental illness are cared for in old, shabby wards not suited to their needs. Also, these wards are often inadequately staffed. These factors, coupled with low morale and high turnover, make it difficult for staff to provide safe care.

?The College, through its Research Unit, has published guidelines about ward safety and co-ordinated a series of clinical audits over the past five years that have highlighted the problems. The time has now come to find answers to these problems.

?The College believes that some improvements can be achieved by changing the way in which these wards are managed. However, it is inevitable that the real improvements in safety will require financial investment to transform wards so that they meet the expectations of patients and staff.?

Chris Heginbotham, Chief Executive of the Mental Health Act Commission says:

?The Mental Health Act Commission (MHAC) supports fully the importance given by the National Patient Safety Agency (NPSA) to the development of safe, supportive and effective mental health services. People using mental health services are often very vulnerable and should be provided with services of a consistently high standard.

?The MHAC is concerned especially with people detained and treated under compulsorily. Many of these patients and service users are not able easily to demand improvements in care. Recent inquiries, such as that into the death of David Bennett, have highlighted many shortcomings in services that must be addressed, including the need to tackle discrimination and the fear that many patients have about the way they may be treated.

?The roles of the MHAC and NPSA are therefore vital in protecting the rights of patients and service users, and in ensuring that services are safe, relevant and appropriate. The MHAC welcomes the NPSA initiative and will continue to work with the NPSA and other agencies for continuous improvement in mental health services.?

Ian Hulatt Mental Health Adviser, Royal College of Nursing says: \"The RCN is happy to add its endorsement to this programme of work. We are keen to see work undertaken that identifies creative and innovative ways that may enhance the patient experience for service users and nurses alike. For too long this has been a neglected area within service development. ?Opportunities are now arising to address the environment within which individuals are cared for. We wish to see in-patient areas transformed into a positive experience for individuals with mental health difficulties, their carers and families The RCN believes this work will contribute to that process.\" Phillip Chick, Director of Mental Health Services, Welsh Assembly Government says:

?The NPSA has recently developed a work programme focused upon the needs of mental health patients. As Director of Mental Health Services for the Welsh Assembly Government and a member of the NPSA Mental Health External Reference Group I am wholly supportive of this initiative. The decision to begin with a focus on the creation of a safer environment on acute psychiatric wards with future work addressing the needs of older people and the physical health care of people with a mental health problem is welcomed.

The programme is in keeping with the Welsh Mental Health Strategy and National Service Framework.

The NPSA work in mental health is vital in addressing the need for safety among some of the most vulnerable users of NHS services. People admitted to mental health inpatient facilities are frequently experiencing a crisis due to severe mental distress. In order to provide them with the care and treatment they require, wards need to be safe places where the service user?s appropriate right to privacy and dignity is upheld. The roll out of the NPSA?s first initiative should assist in making a real difference to the quality and safety of mental health ward environments.

The Welsh Assembly Government is about to undertake a priority risk review including all mental health inpatient facilities for adults of working age and older people which will include the engagement of service users through patient panels. This work and the NPSA acute ward work will complement each other and should make a positive improvement to mental health facilities in Wales.?

Notes for Editors:

1. For further information please contact Alison Pitts-Bland on 020 7927 9520 or Olivia Lacey on 020 7927 9363 in the NPSA?s communications team.