Mental health patients not reporting abuse as they fear revenge, experts suggest

Patients who are subjected to abuse on mental health wards do not formally complain as they “do not want to expose themselves to any risk of revenge” from staff, academics have suggested.

It comes after a small study involving 21 patients and two carers – thought to be the first of its kind – uncovered more than 750 separate incidents of violence and coercion by staff, few of which were reported.

The researchers suggest there should be social workers present on wards, with staff also required to wear body cameras to protect patients.

For the study, Chris Munt, a mental health act manager at the Hertfordshire Partnership University NHS Foundation Trust, and Dr Brian Littlechild, a professor of social work at the University of Hertfordshire, spent months “working on trust” with 21 service users and two carers before noting their experiences.

There were 754 claims of violence and coercion allegedly committed by staff.

This included claims of patients being physically restrained, verbally abused, being moved with force and being deliberately ignored.

Eight patients told researchers one or two staff were responsible for abuse against them, while 18 said acts were witnessed by other patients or staff.

Only four official complaints were made, according to researchers, with just one upheld.

Mr Munt told the PA news agency: “It is very difficult for patients that are pre-occupied with serious illness, that has a very detrimental impact on their confidence, their self esteem, to actually take that brave step of formally complaining.

“The pre-occupation for many patients is that they do not want to expose themselves to any risk of revenge.

“A number of people that I worked with said that if they had felt that if they were to complain about their treatment by a nurse or a healthcare assistant, if that would result in in a disciplinary action, they would have made the complaint, but they have no confidence in that.”

Of the group, eight patients had been pinned down by multiple staff 37 times over the course of several years, and there were more than 100 instances of severe verbal abuse.

Mr Munt said that patients “that were of a certain size or shape or orientation or gender” would be “actively humiliated on a regular basis, often with the same staff, using the same language in a very derogatory fashion”.

“So much so that it became an everyday thing, and it was often in front of other staff, other patients.”

He added that “lots of the behaviours that come up in the chapter have been in plain sight of other staff”.

Dr Littlechild added: “In the main people don’t want the reputation of their trust, or their social care agency, being that private or non-governmental organisation or local authority, that they will often work quite hard to keep things quiet.”

The research has been published as part of the book Coercion and Violence in Mental Health Settings: Causes, Consequences, Management.

The academics have a made a number of recommendations, including conducting unannounced drop-in inspections on mental health wards, trialling staff wearing body cameras, and an overhaul of the complaints procedure.

Mr Munt also suggested that having a social worker present on all mental health units would be “really helpful”.

He said: “Social work is part of the system, until you’re on a ward and then you have no social work.

“And I think that if you had a social worker just to be present, I think that they would act as a really strong moderator in terms of culture on those wards.”

An NHS spokesperson said: “It is unacceptable that mental health patients report feeling this way, and NHS England has co-produced national standards with a range of independent experts which sets out the culture of care expected across all mental health hospitals, including ensuring patients feel safe and are able to raise concerns.

“Services are receiving expert support from an Improvement Programme team to ensure the standards are met.”

A Department of Health and Social Care spokesperson added: “Patient safety is paramount and any staff committing acts of violence or abuse should be removed permanently and face the full force of the law.

“These findings are disturbing and we encourage any patients or families who suspect abuse to report it to the authorities.

“We know that mental health patients have not been getting the high-quality care and treatment they deserve, which is why we are modernising the Mental Health Act to ensure patients receive better, more compassionate treatment.”