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Patients Safety in Psychiatric Wards

Updated on July 27, 2014

When you are admitted to a general hospital for medical reasons, apart from having some mild anxiety about any upcoming treatment, you tend for the most part to feel you have some control. You can refuse treatment and you can walk out at any time even if that is against medical advice. When you have a mental health crisis, such may be the severity of your illness, that you don’t even remember the day you are admitted to a psychiatric ward or unit.

Many mental health inpatients will arrive on the ward feeling confused, fearful and possibly very much out of any control. A patient will feel even more powerless if he has been placed on a section, or as is more coldly termed, detained under The Mental Health Act of 1983. This forces you to be admitted and held in the psychiatric facility for as long as is deemed necessary.

Patients are at their most vulnerable when admitted to inpatient care.
Patients are at their most vulnerable when admitted to inpatient care. | Source

Whether you are a voluntary or an involuntary mental health patient, being admitted to a psychiatric ward can be a very scary experience, especially if this is your first time. Media stories and films about those with mental health problems tend to reveal only the negative and most of this can be somewhat shocking. We sometimes hear snippets of random violence, even murders, being committed by psychopaths or schizophrenics.

We have heard about electric shock treatment (electro convulsive therapy), strange tales of lobotomies, strong stupefying medications, straitjackets and padded cells. It is little wonder that the thought of becoming an inpatient is enough to make anyone recoil with dread. Psychiatry is steeped in horror stories and myths but what is the reality? Are you safe in a psychiatric ward?

Admission to a Psychiatric Ward

If you haven’t been an inpatient before, you can usually expect to be met by a nurse who will attend to your admission. She will want to inspect the contents of your bag and purse to check that there are no dangerous objects in there that you or any other patient could use with harmful intent. If you smoke your lighter or matches will be taken away as will any medications you have. You will be asked to hand over your belt if you are wearing one, and there is a chance that your mobile phone will need to be handed over too. Some nurses are more thorough than others and it isn’t unusual for something to get missed. The nurse is unlikely to go through your pockets or socks! All this will bring you to the stark reality of the perceived dangers that the professionals attach to patients being in a psychiatric ward.

You will undergo a risk assessment for self harm, intentions of suicide and potential violence by members of staff on admission. On a good ward you will be introduced to the other patients and shown around the ward so you know where everything is. Your room is likely to be a single room usually with a bed, a bedside cupboard, a wardrobe, a table and shower room with toilet. You will probably be observed routinely every so often wherever you are on the ward, until you are felt to be out of crisis.

Patient Safety and Ward Layout

Things have changed so much since the old asylums have now closed. In the acute wards of the old psychiatric hospitals, patients ate their meals on the wards in a designated eating area. Now we have dining rooms off the ward. The single rooms were more likely to be for seclusion purposes and long bedded wards were common. Now we have modern units and an increasing number are given the luxury of a single bedroom per patient. These rooms are lockable from the inside and staff members have a key to all rooms. So, you can lock yourself in your room to at least stop other patients walking in. Most of the bedrooms can not be seen from the nurse’s station. There is usually a quiet room for such things as reading and if you are not under observation you could ‘hide’ in there! The ward door is usually locked.

Patient safety within the layout is actually down to how good members of staff are with attention and observation but of course ward design in the first place needs a mention.

Self harming still happens on psychiatric wards.
Self harming still happens on psychiatric wards. | Source

Self Harm and Suicide

Partly because of the layout of the ward, there are chances for self harm and even suicide to happen. Those deemed most at risk are ideally placed nearer to the nurse’s station and on such close observation it is more unlikely to happen. It must be taken into consideration though that once a patient is off close observation, because silent intention can be so strong, a patient may hoodwink the staff and attempt suicide. The same can be said for self harming. Patients who seriously intend to commit suicide or self harm will try their best to find a way to do so if the feelings are compelling enough. Hanging and self strangulation tend to be the most common ways to commit suicide on a mental health ward. Now that baths are being phased out of psychiatric wards, drowning is less common.

Stockpiling pills presents a problem for nursing staff.
Stockpiling pills presents a problem for nursing staff. | Source

Staff must be very wary of patients stockpiling their medications with the intent to overdose on them. You are not forced to open your mouth by staff to prove you have swallowed your medication unless there is suspicion or cause to do this. This has been an area of concern for many years.

Although I have said that all belongings are checked on arrival and any dangerous implements or drugs are removed, from time to time there will be errors. What of visiting times when you are likely to go off the ward into a visiting room? Of course you should be checked when you re-enter the ward but there is yet another chance for staff errors to occur. What if there was an emergency on the ward whilst you were out in the visiting room and on re-entering the ward staff were elsewhere attending to that emergency? No check at all in such an instance. Although unlikely, someone may bring something for you on their visit without realizing your intent with such an item. At the least, illicit drugs and alcohol could possibly be smuggled in which can be very dangerous when combined with psychiatric medications.

Feelings of  powerlessness and fear can increase after admission to a psychiatric ward.
Feelings of powerlessness and fear can increase after admission to a psychiatric ward. | Source

Patient Violence

Statistically there is little evidence to support claims that 'mental health patients' are violent and it is certainly not the norm. It is pure myth that mental health patients are generally more dangerous than anyone else in society. Acts of violence happen daily around the world and a huge majority of these acts are devoid of a mental health diagnosis. Bewilderment and fear are quite common however with mental illness and this often shows in the form of anger. Depressed people sometimes have an anger issue for example but then so do many other people who are not depressed! Such things as feeling misunderstood, not wanting to take medications, not having enough talk time with nurses, being stared at by other patients and feeling victimized within the system can make a patient angry. Feeling powerless to a mental health disorder is no laughing matter.

Again, nursing staff and psychiatrists are at the core of preventing patient violence on a psychiatric ward. Observation and risk assessment should be an ongoing matter. If you are a woman for instance, who has had a breakdown following a violent domestic situation with a partner, you will feel very vulnerable in a ward setting where there are males. This vulnerability should be recorded and taken into account. A patient may have a history of violence that started a long time before he or she was diagnosed with a mental health problem but being mentally ill does not naturally equate with being violent or dangerous.

Patient Restraint

Restraint is supposed to be used both for the patient’s own protection and that of other patients and staff members. Nurses learn how to restrain patients effectively and there must be an adequate number of staff members during restraint. There has been evidence in the past, although very rare, of patients suffocating during restraint (remember this can happen with police restraint also). The head should ideally be protected by a staff member at all times during restraint. It has also been known for dislocation of an arm to occur during the struggle in being restrained. All patients should have adequate warning of the possibility of being restrained and given chance to comply. It is an odd fact that when a patient doesn’t struggle, this can be interpreted as that patient complying with restraint when actually they may be passively terrified and confused.

Absconding

Doors leading out of the ward are locked but as with other areas of concern, there is always room for error. The safety of patients should be of paramount importance when they are in a critically vulnerable state. Absconding or running away may mean the difference between life and death for some patients and a huge concern for relatives. Relatives need to know their loved ones are safe when admitted to a psychiatric ward. Good security and vigilance is vital.

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Physical Health Problems

Although psychiatrists were medical doctors first and psychiatrists only after further training, the physical needs of mental health patients sometimes gets overlooked to a degree. Mental health disorders often bring with them an array of physical complaints ( apart from the ones actually caused by psychiatric medications). All physical complaints should be taken seriously and checked out thoroughly to rule out serious medical issues arising on the ward. A very short medical history is taken on admission and is obviously recorded but it is ultimately down to the psychiatrists and nurses to make sure medical issues are consistently addressed.

In conclusion

It is a fact that severe mental health problems within an inpatient setting, pose varying levels of threat to the safety of both the patient and sometimes to the staff. That said, we all live our lives with some threat around us even if we don’t feel aware of it. Patients who are going through crisis often find it hard to verbalize how they feel and it is up to the staff to make sure all areas of communication are open to patients and so avert any eruptions or dangerous situations. Powerlessness and a feeling of having no control, no voice, can feel soul destroying. Having a mental illness can feel very isolating and a patient needs to know when in a psychiatric ward that they are safe. Safe to talk, safe to express emotion, safe to be with other patients, safe with the staff and most of all in the safest place to recover.

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    • billybuc profile image

      Bill Holland 5 years ago from Olympia, WA

      Very interesting and informative hub about a difficult subject; you did a great job of presenting the facts about a subject few know about.

    • krsharp05 profile image

      krsharp05 5 years ago from 18th and Vine

      meloncauli, What a terrific idea for a hub! I agree that the media has given psychiatric wards a bad name. I think your quote, "recoil with fear" is apropos in many ways because of the stigma that media has caused.

      Having worked with kiddos in a psychiatric boy's home, people used to ask me all the time about how "crazy" the kids were. I used to tell them, "not any crazier than you or I" because I always felt so protective of those sweet kiddos. We used the MANDT restraining system which was a good system but like you mentioned, there were times when a child would be restrained and come up bloody, or with vomit and urine or soaked in sweat because we had been on the floor for 45 minutes. I miss the days of the blue padded room...not really. I do however, miss the kids. Excellent hub. Interesting and Up. -K

    • meloncauli profile image
      Author

      meloncauli 5 years ago from UK

      billybuc - thanks for your comment. It's a sensitive issue because I would not want to inflame fear of being admitted to a psychiatric ward. It's good to know that negative safety issue incidences are the exception to the rule.

      Hi kr and thanks for your comment. Sounds like extremely interesting work and the type that I would liked to have done. Those with mental illness do need all the support and protection they can get!

    • spartucusjones profile image

      CJ Baker 5 years ago from Parts Unknown

      Your arguments where logically presented and I like how you where able to effectively handle what could be a delicate (but important) subject.

    • meloncauli profile image
      Author

      meloncauli 5 years ago from UK

      Thanks for the comment spartacus. I have seen restraint being used within the realms of adult mental health inpatients and it is not a nice sight to say the least. Should be absolutely last resort in my book.

    • catgypsy profile image

      catgypsy 5 years ago from the South

      Very important topic that you did an excellent job explaining. After my recent experience with a friend being put into a mental health facility, I was relieved to find the facility she went into very safe and secure. Great hub!

    • meloncauli profile image
      Author

      meloncauli 5 years ago from UK

      Thanks catgypsy. It's good to hear of positive experiences .

    • Simone Smith profile image

      Simone Haruko Smith 5 years ago from San Francisco

      What an incredibly thorough, helpful guide to psychiatric ward safety. It's great to have a better understanding of what checking into one and being in one would be like- what processes take place and what controls are present. I feel slightly less nervous about them now that I understand them better. Thank you so much, meloncauli!!

    • meloncauli profile image
      Author

      meloncauli 5 years ago from UK

      Thanks for your comment Simone. Glad it's made you feel less nervous!

    • lambservant profile image

      Lori Colbo 4 years ago from Pacific Northwest

      Wonderful topic and well written. I wrote a hub about what to expect during an inpatient stay on a psychiatric ward. I coverd the issue of safety based on both experience as the patient, and what I've learned from professionals in the field. The comments about the restraints were near hostile by people who had had a bad experience. I have not had to have restraints but have witnessed it in ER once or twice. Over all, many thought my depiction of a modern day psychiatric unit was out of touch, shall we say. However, one of my commenters was a psychiatric nurse and actually contacted me about using some of the information I wrote about in the literature they are formulating in their mental health hospital. She is a nurse and did her best to support me. People need to hear about what you have written and I am very thankful you did. Voted across the board (except funny of course).

    • meloncauli profile image
      Author

      meloncauli 4 years ago from UK

      Thanks for your comment lambservant!

      My thoughts about restraint are that when you give anyone the power to "manhandle" another in order to control that person, it will always be open to abuse. I have met psychiatric professionals over the years that seem to have a "power" issue and have shown to be over-controlling. I actually found the females to be the worst. Of course these are the exception to the rule and most nurses/doctors try to do a good job, often in difficult situations.

      I am going to head over to your hub now :)

      Thanks again

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