Damning report exposes 'pitiful' hospital conditions ahead of Bill

Mentally ill patients are being physically assaulted, verbally abused and sexually harassed on hospital psychiatric wards, according to a damning new investigation.

Mentally ill patients are being physically assaulted, verbally abused and sexually harassed on hospital psychiatric wards, according to a damning new investigation.

A report published this week by the mental health charity Mind exposes the "pitiful" and "woeful" conditions that many vulnerable psychiatric patients are forced to endure.

The charity found that, in some cases, drugs were being bought and sold on wards and staff ignored claims from patients of sexual harassment. In one case, a suicidal patient was left in a room with a broken window and another complained that someone had urinated in their bedroom.

The report will put pressure on the Government to improve the quality of treatment ahead of a reworking of a controversial Mental Health Bill, due to be published on Wednesday. The original draft of the Bill was fiercely opposed by psychiatrists, mental health campaigners and patients who feared it would increase powers to lock up mentally ill people on psychiatric wards. The Independent on Sunday led a campaign against the original Bill.

Ministers are now thought to have watered down proposals to introduce compulsory treatment orders, but campaigners fear that the Bill is still weighted towards criminalising mentally ill people instead of caring for them.

Nearly 40,000 men and women are treated in hospital psychiatric wards every year. More than 400 current or recently treated patients took part in the Mind survey. More than half of the men and women surveyed said their care while in hospital had not helped their recovery. Nearly one-third said it had made their health worse.

Almost a quarter of those surveyed said they were currently or had been placed on mixed-sex wards, despite a pledge by Tony Blair when he was in Opposition in 1996 to end the practice.

Almost a quarter of patients also said they had been physically or verbally threatened while under psychiatric care by staff or other patients. Many complained that wards were dirty with burned and stained carpets, that access to fresh air was limited and that they had long waits - in some cases up to six weeks - for therapy sessions.

Richard Brook, the chief executive of Mind, said the charity had identified some "excellent" examples of good practice but said that far too many other patients were being treated in "unsafe, untherapeutic" surroundings. As part of the charity's new Ward Watch campaign, he is calling on the Government to increase security for patients in hospitals and to address the over-reliance on untrained agency staff.

"The Government needs to face up to the fact that vulnerable people are being let down by the mental health services that they come to rely on, when they need them most," he said.

The Department of Health denied the accusations and said that 99 per cent of NHS trusts were providing single-sex sleeping accommodation for patients with policies to protect patients' privacy.

"We do appreciate Mind's concerns and are meeting them [tomorrow] to discuss how we can further improve patients' safety, privacy and dignity," said a spokesman.

The mental health charity Sane, which runs a helpline for people suffering from mental illness, said its own research supported accounts of traumatic experiences on mental health wards. These included drug dealing, threats and sexual abuse as well as overcrowding, squalor, boredom and bleakness.

"Sane has its own evidence of the appalling state of acute wards, and we have been campaigning about this for years," said Marjorie Wallace, head of Sane.

"Far from being places of healing and safe, secure asylum, psychiatric wards have become places where many people fear to go."

The victim: 'I was physically and mentally damaged'

Monica Endersby, 52, from Kettering, Northamptonshire, has dissociative identity disorder (DID), also known as multiple personality disorder. She claims to have been physically abused during treatment at an NHS hospital seven months ago.

"After two weeks on a mental health ward I was not just physically hurt, but mentally damaged by what I'd been through," she said. "I felt worse than when I went in, and my husband had to discharge me.

"It was the most appalling discrimination I've ever come across in my life. I was on a mixed-sex ward, and was threatened both physically and mentally. At one stage, a male patient touched my hair and back and told me he was going to do every sexual deviation to me, and then kill me.

"While he was saying this, the nurse just left the room."

The other patients weren't the only problem Mrs Endersby faced. She also claims to have suffered a serious arm injury while being led back to her bed by a nurse.

"I was being dragged down the corridor by two nurses and they had me in the restraining hold," she said. "I was so frightened: it felt like one of them was actually breaking my arm - the pain was incredible. I ended up with an 8in black bruise, and a hand swollen to twice its size. It looked like it had been run over by a truck, and took six weeks of treatment to heal.

"These wards are soul-destroying. You have no dignity and no power. They are very frightening places to be."

The family: 'The place was so awful Daniel walked out in total desperation'

On a bitterly cold day in late February, 26-year-old Daniel Heard went missing from a mental health unit in Exeter. His frozen body was found five days later. Daniel's mother, Lynda Kelly, blames the hospital for her son's death, and has campaigned for redress.

"The blame lies with the system," said Mrs Kelly, 50, from Tiverton, Devon. "I could write a book about the appalling treatment Daniel received. I have so many horrible things to say about his ward: it was just awful in there. Daniel walked out in total desperation."

According to Mrs Kelly, Daniel's ward was "barren" and the patients received very little care or treatment, aside from being "pumped full of drugs".

"The patients were bored out of their minds," she said. "The hospital was unable to offer any proper emotional support, recreation or ongoing care. Communication with the family was awful and, most of the time, non-existent."

Daniel, who suffered from paranoid schizophrenia, was admitted to the Cedars Unit at Wonford House hospital under Section 3 of the Mental Health Act, and was supposed to be under 15-minute watch.

Despite this, he managed to walk out of the unit, wearing just jeans and a T-shirt on one of the coldest days of the year.

"They said they had him on 15-minute watch, but when he went missing, nobody regarded it as an emergency," Mrs Kelly said. "It was snowing that week, and he left the ward with bare arms."

Dr Paul Cawthron, medical director for the Devon Partnership NHS Trust, said: "The trust takes very seriously any untoward incident and the importance of learning from such a tragic event. Trust policies and procedures are regularly reviewed and an internal inquiry into this event has been carried out and will be shared with the family."

For Mrs Kelly, it will be too little too late.

"The only reason people are listening to me now is that my son is dead," she said. "Nobody listened to me when he was alive."

The hospital: 'The beds on one ward are old and dirty and the bathroom leaks'

The mental health unit at St David's hospital in Carmarthen, south Wales, was heavily criticised over the standard of its facilities in a recent government report.

St David's is one of a number of mental health hospitals up and down the country that the Government has found to be below par. A report into the running of the facility, published in March, was damning. The Commission for Health Improvement (CHI), the Government body that carries out NHS inspections, said it had "serious concerns" about conditions there. The report said: "The beds on one of the wards there are old and dirty and the bathroom leaks."

The hospital, a former Victorian asylum, still houses a number of mental health patients. It is due to close in November with patients to be moved out to four smaller local units.

The CHI concluded: "At present the mental health service of Pembrokeshire and Derwen NHS Trust does not command the trust of the community.

"It urgently needs to demonstrate that it can provide good care when it is needed and particularly in an emergency. The trust provides a service in a challenging environment, but it needs to respond to incidents with appropriate thoroughness, and address the staffing problems more innovatively and with more imagination." The chief executive of the NHS Trust, Frank O'Sullivan, admitted that St David's mental health unit was "run down in certain areas", but pointed out that one of the major problems was the financial resources made available to the trust.

"A lot has happened since March," Mr O'Sullivan said. "The bottom line is that there were some significant criticisms of our service, and we have responded to that with a detailed action plan, which covers three years. Some things will be done immediately, but others have major resource implications. The key issue is obviously getting the funding for this."

According to the Mind report, over half of inpatients said hospital surroundings had not helped their recovery. Almost a third found the hospitals so bad they considered them damaging to their mental well-being.

Case histories by Jonathan Thompson

The survivor: 'Even as a doctor I was shocked by what I saw'

Eve Anderson (not her real name) is a newly qualified doctor working in the NHS. In early 2003, Ms Anderson, who suffers from bipolar disorder, was herself admitted to a mental health ward for two weeks, and was shocked by what she saw.

"I didn't think it was a very healing environment," said the 23-year-old from London. "There was a serious shortage of beds. People would get settled, start to get a bit better, and would then be told they had half an hour to pack."

Ms Anderson, now fully recovered and working in a hospital herself, said the lack of beds led to patients, including those with psychotic illnesses, being "inappropriately placed".

"There was the potential for abuse a lot of the time," she said. "By and large, the staff were pretty threatening, too.

"The consultant acted very unethically and tried to wind patients up during his ward rounds. The nursing staff - with one or two exceptions - were mostly terrible. They were just awful to you all the time."

Ms Anderson said her experience has ultimately inspired her to train as a psychiatrist herself. "A lot of psychiatric nurses sit around reading magazines all day, and ignoring the patients," she said. "The impression I get is that a certain number of people working in mental health see it as an easy option."

The psychiatrist: 'Even the mentally robust probably couldn't cope with these places'

Professor Robin Murray, 60, is a London-based consultant psychiatrist working in the NHS and head of psychiatry at the Institute of Psychiatry.

"Inner-city psychiatric units in Britain are just a scandal," said Professor Murray. "A number of in-patient units are forlorn, stark and anti-therapeutic.

"Altogether it is a very bad situation, very distressing. We could do a lot more for patients, but we're stuck with these demoralising and decaying institutions."

A rise in the use of recreational drugs over recent years has added to the problem, Professor Murray said.

"There has been an increase in the frequency of psychosis, driven in part by an increase in drug use. There are a lot of very disturbed people in a smaller number of beds, and it is difficult to keep drug dealers off the wards."

Larger, more modern facilities and higher staffing levels are needed if the situation is to improve, he added.

"These units need to be pleasurable places where patients feel they would like to be admitted for a respite.

"Safety needs to be considered, too: when you have a concentration of very disturbed patients and a low staff ratio, it creates a situation where patients might be assaulted.

"It is such a sad situation. Even those of us who are mentally robust probably couldn't cope with being admitted to places like this."

What we are demanding

The Independent on Sunday is campaigning for better treatment for mentally ill people. We want significant changes to existing services. Mentally ill people have a right to be heard and we will give them a voice. We are calling for:

* Mentally ill people to have the right to the most appropriate treatment when needed. This includes people in high-security hospitals who are eligible for transfer. Such cases must be reviewed.

* Those able to make decisions about care should also have the right to refuse treatment, unless others are put at risk.

* People should not be detained unless they need treatment for their own benefit or have committed a crime.

* People should not be subject to forcible treatment once they have left hospital. Instead, we need improved, more flexible and accessible services, including the provision of mentors and sheltered accommodation, which are attractive enough to appeal to users.

Do you have personal experience of injustice in the mental health system? Or do you have a story to tell? If so, write to Mental Health, The Independent on Sunday Newsdesk, 191 Marsh Wall, London E14 9RS