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News archive - November 2013

An unhealthy obsession with risk?

An unhealthy obsession with risk?

An ‘obsession’ with anti-ligature fixtures and fittings could be stifling innovation within the mental health sector, according to experts.

During the panel debate at this year’s mhf, speakers raised concerns that attempts by healthcare organisations to reduce the risk of patients hanging themselves was negatively affecting the overall design of units.

And they claimed that unless a more balance approach was taken, hospitals and mental health units would look ‘institutional’ and ‘like prisons’, instead of being homely environments that contribute to improving patients’ health and wellbeing.

Jeff Bartle, head of the built environment at St Andrew’s Healthcare, said: “There has been a push by clinical teams to make buildings work for them and that means more emphasis on addressing risk. It is a very difficult job as you want to prevent any problems and then the Care Quality Commission (CQC) regulators come in and say it is too austere and is not providing a healing environment for the patient.”

Steve Jameson, property services director at Lancashire Care NHS Foundation Trust, added: “What we want as a trust is to get away from the view that mental health units are prisons, but efficiencies within the NHS mean there are not the same number of clinical staff as there was a few years ago, so in some ways we are expecting the buildings to help us.”

This is a worrying trend for Joe Forster, a mental health nurse and chairman of the Design in Mental Health Network. He said: “We talk about evidence-based design and part of this is how risky is a particular feature or service. We are hung up on it.

“The statistics show that suicides among inpatients are going down and suicides by hanging are going down. Are we expecting to get down to zero in these services at this time, as I am not sure that is realistic?

“My concern is that is we make everything anti-ligature then staff expect the environment to do their job for them. When a patient is having a bad day, instead of letting them go to their room secure in the knowledge they cannot hurt themselves, clinical staff should be finding out why. I am concerned that if we make buildings so protective and secure then the real treatment gets forgotten.

“We have got to make sure the environment is safe, but it has got to work alongside staff, not as a replacement.

“Is it really about the risk to the patient and their life, or it is sometimes about the risk to the organisation and its reputation should anything happen?

“We seem to be able to cope with the thought of people going into general hospitals and dying of a physical disease, but we can’t have that attitude in mental health without becoming paranoid. We have got to sort that out.”

He added: “If a trust is worried about ligature risk, we should be asking ‘what is its history’? We need to see how it is performing against others. We should be interrogating, confronting and challenging them rather than just making everything ligature-free by default.”

The way buildings are operated after they have opened was also deemed vital to how successful they turn out to be in terms of striking the balance between safety and aesthetics.

“Staff and patients have got to have a nice environment that is well looked after and consequently they will look after it,” said Paul Yeomans, senior architect and director at Medical Architecture.

“I visited one building six years after it opened and it still looked great and that was testament to the staff because they took pride in it and so did the patients. I went to another that had only been open for two years and it wasn’t the same. The ward manager kept changing and it looked in a bit of a state.”

Bartle added: “Designers know they have to create robust products, but this brings its own problems because staff think that means they can let patients kick it and it can’t be damaged. They allow sometimes destructive behaviours to continue because they think the environment can take it. Then when it eventually breaks, which it will, they blame the manufacturer.

“When this attitude changes, we will be able to create much better products, but it starts with looking at the way we deliver care and not becoming obsessed with creating buildings that do that for us.”

Jameson admitted that in some cases NHS trusts were expecting more from their buildings than ever before.

He said: “The NHS is charged with making 20% efficiencies across its clinical networks. Because of this there is not the same number of clinical staff so some trusts are expecting the buildings to do some of this for them.”

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