[D66] 'Toxic culture' of abuse at mental health hospital revealed by BBC secret filming

[René Oudeweg]

bbc.com <https://www.bbc.com/news/uk-63045298>


  'Toxic culture' of abuse at mental health hospital revealed by BBC
  secret filming

By Panorama team and Joseph Lee
11-14 minutes
------------------------------------------------------------------------

*By Panorama team and Joseph Lee*
BBC News

Media caption,

BBC Panorama goes undercover to film humiliation, verbal abuse and
bullying at a psychiatric unit.

*Humiliated, abused and isolated for weeks - patients were put at risk
due to a "toxic culture" at one of the UK's biggest mental health
hospitals, BBC Panorama can reveal.*

An undercover reporter at the Edenfield Centre filmed staff using
restraint inappropriately and patients enduring long seclusions in
small, bare rooms.

Staff swore at patients and were seen slapping or pinching them on occasion.

Hospital bosses said they have taken immediate action to protect patients.

Greater Manchester Mental Health NHS Foundation Trust, which runs the
medium secure unit, said it was taking the allegations "very seriously".

A number of staff members have been suspended, and the trust said it was
working with Greater Manchester Police, the independent healthcare
regulator the Care Quality Commission, and NHS England "to ensure the
safety of these services".

Greater Manchester Police said it has opened a criminal investigation.

The BBC's undercover reporter, Alan Haslam, spent three months as a
support worker inside the Edenfield Centre in Prestwich, near Manchester.

With capacity for more than 150 patients, it is intended to care for
people held under the Mental Health Act who are at serious risk of
harming themselves or others, including some patients from the criminal
justice system.

Whistleblowers had made allegations about poor staff behaviour and
patient safety at the hospital.

Wearing a hidden camera, the reporter saw:

  * Staff swearing at patients, taunting and mocking them in vulnerable
    situations - such as when they were undressing - and joking about
    their self-harm
  * Patients being unnecessarily restrained - according to experts who
    reviewed the footage - as well as being slapped or pinched by staff
    on some occasions
  * Some female staff acting in a sexualised way towards male patients
  * 10 patients being held in small seclusion rooms - designed for
    short-term isolation to prevent immediate harm - for days, weeks or
    even months, with only brief breaks
  * Patient observations, a crucial safety measure, being regularly
    missed and records falsified

Dr Cleo Van Velsen, a consultant psychiatrist, said the BBC's footage
showed a "toxic culture" among staff of "corruption, perversion,
aggression, hostility, lack of boundaries", which was undermining
patient recovery.

Prof John Baker, an expert in mental health nursing at the University of
Leeds, said: "It doesn't feel safe. You're quite clearly seeing toxic
staff. There's an awful lot of hostility towards patients across all of
the wards, which is really concerning."

/*Warning: This story contains repeated use of highly offensive language*/

Claire - not her real name - has a history of self-harm and was filmed
being humiliated by a female support worker for needing help with going
to the toilet.

The staff member complained to her face about "having to look at your
arsehole where biohazard fucking waste comes out".

In a sign that boundaries between patients and staff had broken down, on
another occasion Claire sat on the lap of the same support worker, who
said: "If you fart I will actually kill you." The support worker then
pulled aside the patient's clothing and repeatedly slapped her bare skin.

A senior nurse was among those who watched, laughed and jeered as Claire
was slapped. Most of the time nurses are in charge of the wards.

One nurse was filmed refusing to check on a crying patient named Olivia,
who self-harms and has repeatedly tried to kill herself. The BBC is only
identifying patients where they and their families have given consent.

Staff members laughed and joked that Olivia was "only crying" and "if
she slit her throat you'd know it" because "she'd tell everybody about it".

When talking to patients about their bodies, staff used demeaning
language, often passing it off as a joke. But patients told the
undercover reporter they felt bullied and dehumanised.

Image caption,

Experts criticised the use of restraint on patients such as Harley, who
gave her consent to be identified

Olivia said staff had called her a "fat cunt", before claiming they had
been joking. The 22-year-old's mother said Olivia had in the past
stopped eating and drinking because she believed she was overweight.
"It's not funny, it's not a joke," Olivia said.

Another time, when Claire was due for a weekly injection, she hid her
head under a blanket. Support workers and the senior nurse with them did
not try to persuade her to comply, but instead were filmed dragging her
by the wrist from a chair and into a room down the corridor.

One of the support workers mocked Claire again as staff held her down on
a bed and exposed her body for the needle, saying "as if we'd choose to
see your arse" and calling her a "cheeky bitch" as she protested.

After giving the injection, the staff locked Claire in the room, telling
her they would keep her there for an hour as they laughed at her through
the glass in the door - before letting her out a few moments later.

Dr Van Velsen said the members of staff acted "like a gang, not a group
of health care professionals". "It's against any policy I've ever seen
about restraint in doing this," she said.

The code of practice for mental health workers says restraint and other
"restrictive interventions" should only be used to take control of
dangerous situations and stop anyone being hurt - not for punishment.

A BBC Panorama undercover investigation has found evidence that a secure
NHS psychiatric hospital is failing to protect some of its vulnerable
patients.

But the BBC filmed one patient being restrained after hospital managers
said she had been shouting and verbally abusive.

Harley, a 23-year-old autistic woman who was at Edenfield due to
self-harm, was sitting on the floor when at least eight members of staff
picked her up and dragged her away, screaming.

Harley was being restrained to take her back into seclusion, where she
had already spent more than two weeks.

At one point a nurse was filmed saying staff wanted her kept in
seclusion because they "need a break from her".

Reviewing footage of the incident, Dr Van Velsen said: "You cannot
deprive somebody of their liberties because staff are fed up of her."

Image caption,

Some patients were held in tiny, empty seclusion rooms for weeks at a time

Patients are only supposed to be confined to one room and isolated from
others for short periods when there is an "immediate necessity" because
they are likely to harm other people. It should not be used as a
punishment or threat, or because of staff shortages, guidelines say.

Staff told the BBC's undercover reporter that Alice (not her real name),
a patient who had attacked staff, had been in seclusion for more than a
year.

Guidelines for psychiatric hospitals say they can keep patients
segregated for long periods to protect others on the wards. But the
hospital must have the approval of a team of experts, consult the
patient's family where possible and give the patient additional space,
including access to an outside area.

Edenfield's seclusion rooms are small, with a bed, shower and toilet,
all of which can be observed by staff from an adjoining room. Some have
mould, peeling paint, a smell of sewage and windows that don't open.

During one 30-minute break from seclusion, Alice asked for her blanket
and teddy bears, comforts which she had been allowed before her
isolation began. A support worker refused, saying: "You're lucky you've
not got a straw fucking bed in there. I'd give you a straw bed like cows
have to sleep on."

On another occasion, staff were filmed trying to give Alice her
anti-psychotic medication Clozapine twice, because of an apparent
breakdown in communication.

Asked what would happen if she had too much of the drug, a nurse said:
"She'd probably just die."

While the majority of patients filmed being mistreated by staff were
women who had been sectioned and had self-harmed, some patients held in
Edenfield have been convicted of violent crimes.

Experts said staff showed a worrying lack of boundaries even with these
patients.

One patient, a man serving a life sentence for murder, was filmed
writhing on the floor and on a bed as a female support worker grappled
with him and tickled him.

Afterwards, she said: "You get away with murder here, don't we? Can you
imagine if I got caught by bosses?"

Image caption,

The secure unit is intended to care for people at risk of harming
themselves and others

A different female support worker was filmed dancing up against another
male patient.

"As well as making herself vulnerable she's also increasing the
vulnerability of the patients," Dr Van Velsen said. "The one thing you
should not do with patients is have a kind of sexualised relationship
with them."

Vulnerable female patients were also seen being mistreated by male
staff. A male support worker taunted a woman with a history of self-harm
as she undressed, saying he would turn his back because "I don't want to
be mentally scarred again".

The support worker was also filmed pinching her twice, the second time
while bending her arm backwards.

"It's an assault," said Dr Van Velsen when she viewed the footage.

Among the staff's most important duties are patient observations, or
"obs". These are checks to ensure patients are safe, made every 15
minutes - or more frequently for patients at higher risk.

Records of the observations affect decisions about care and can show
that patients were being properly looked after, in the event that they
hurt themselves or anyone else.

Observations were frequently missed or carried out poorly. A nurse was
filmed telling a support worker to falsify the records. "Here, sign some
of these things, say you've done them," he said.

He also asked the reporter to join in the falsification. "Want to
pretend you were doing obs?" he asked.

Image caption,

The BBC's Alan Haslam spent three months working as a healthcare support
worker at Edenfield

Hospital employees complained of understaffing and burnout. Sometimes
support workers were left on their own, with no nurse on the ward.

There was a shortage of nurses for adult secure wards on 58 occasions
during one five-week period, according to records from the trust which
runs Edenfield, seen by Panorama.

Prof Baker said there should never be a shift without a registered nurse
on the ward, but added that recruitment problems in mental health care
were "no excuse for the abuse we've been seeing in the footage".


    Information and support

If you are experiencing issues with mental health or self-harm, details
of help and support are available here.
<https://www.bbc.co.uk/programmes/articles/1NGvFrTqWChr03LrYlw2Hkk/information-and-support-mental-health-self-harm>

Seven members of staff were seen sleeping on shift by the BBC's
undercover reporter. One nurse went to sleep outside in the sun for
about an hour while on duty, in full view of other staff and patients.

The BBC has reported the findings of its undercover investigation to
hospital management and the Care Quality Commission.

Greater Manchester Mental Health Foundation Trust said senior doctors
have undertaken clinical reviews of the patients affected and it had
also commissioned an independent clinical review of services at the
Edenfield Centre.

"We owe it to our patients, their families and carers, the public and
our staff that these allegations are fully investigated to ensure we
provide the best care, every day, for all the communities we serve," the
trust said.

The Care Quality Commission, which had previously rated the Edenfield
centre as "good", says that rating is "currently suspended" and it is
"reviewing the information" provided by Panorama.


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