Psychiatric wards

• Informal and formal patients
• What to expect on a ward
• Disturbed or violent behaviour
• Discharge planning
• Alternatives to psychiatric wards

Informal and formal patients

People who are experiencing severe symptoms of psychosis may spend time in hospital. If someone agrees to be admitted to a psychiatric ward or unit, they are called an ‘informal’ or voluntary patient. If someone is admitted to hospital against their wishes under the Mental Health Act (see Mental Health Act page), they are called a formal patient.

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What to expect on a ward

Guidance from the National Institute for Health and Clinical Excellence (NICE) lists what patients and their families can expect from inpatient wards or units.

This is set out in the NICE Guideline Violence: managing disturbed/violent behaviour

NICE says when someone is admitted to a ward they should be told the name of the member of staff who is co-ordinating their care. They should also be told why they have been admitted. If they have been detained under the Mental Health Act, they should be told why this has happened, what power has been used to detain them, what that means, and how long they will be detained. They should be told about their right to appeal against that decision, about their right to complain about the care they receive and how to get independent advice, particularly if they have been detained under the Mental Health Act.

When people are admitted to hospital, staff there should carry out an ‘assessment’ to work out the best package of treatment and care for an individual, then draw up a ‘care plan’ detailing what is proposed during the stay on the ward.

NICE says wards and psychiatric units should feel safe, should give people privacy, space, and offer separate toilet and washing facilities and separate sleeping accommodation for men and women.

Patients should be given the chance to exercise and take part in group activities and therapies, if they want to. This could include time spent with an occupational therapist or an art therapist, for example, as well as time spent with mental health professionals offering talking therapies.

However, of 7,500 people with experience of psychiatric wards surveyed for the Care Quality Commission, less than half – only 45 per cent – said they felt safe on the ward.

The results of the survey were published in September 2009. They also showed that 52 per cent of people had said they wanted talking therapies, but less than half got them; 27 per cent of people who had been sectioned felt their rights were not clearly explained; and only one third said they had felt properly involved in decisions about care and treatment.

The survey included people aged 16-64 who had been discharged from hospitals run by 64 mental health trusts after a stay of at least 48 hours.

Find out information about the results of the survey from the Care Quality Commission website.

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Disturbed or violent behaviour

When someone is admitted to hospital, staff will carry out a ‘risk assessment’ to work out how likely he or she is to become disturbed or violent.

If they think someone could become disturbed or violent, that patient should be offered the chance to say what they do and don’t want to happen in that situation. A record of what the patient has said should be included in their care plan.

The NICE Guideline Violence: managing disturbed/violent behaviour details what staff should do in a violent situation, what methods staff can use to calm people down and control a violent situation. This sometimes could involve ‘rapid tranquillisation’, the use of medication to sedate someone. Different medicines can be used for rapid tranquillisation of people with psychosis, including antipsychotic medication or lorazepam, a type of medicine called a benzodiazepine that makes people feel calmer.

After rapid tranquillisation, patients should be told why they were sedated, and families should be involved in reviewing what happened with staff on the ward, unless the individual who is unwell does not want family members to be involved.

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Discharge planning

Staff on the ward should start planning for discharge early on to make sure someone continues to receive the treatment and support they need when they leave hospital. This will probably involve transferring the responsibility of providing care to a community mental health team, or other sort of community-based team. If someone is discharged from the care of specialist mental health services, their GP then becomes their first point of contact if they become unwell again.  Discharge plans should be drawn up in collaboration with the individual and his or her family, unless the person who is unwell objects to the involvement of family members.

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Alternatives to psychiatric wards

People with experience of mental health problems, their families and mental health professionals have all expressed concerns about the effectiveness of psychiatric wards. Research has shown that people with mental health problems and their families feel the stigma associated with admission can be even greater than that associated with a diagnosis of mental ill health. Research has also shown that being admitted to a psychiatric hospital is an unpleasant experience for many people.

In recent years, there have been new residential services developed as alternatives to traditional psychiatric wards. Some of these are provided by the NHS and some are provided by the private and voluntary sector. One of the better known type of alternatives are crisis houses and these are mostly run by voluntary organsiations, offering safe places for people who need 24 hour care. In some places, there are women’s only crisis houses.

Research is currently going to find out how effective these alternative services are for people who are in crisis and would otherwise be admitted to a psychiatric ward.

Your relative’s GP or the mental health professionals offering support and care should be able to tell you whether there are any alternatives to psychiatric wards available in your area.