Minutes:
The SLaM (South London and Maudsley NHS Trust) update was provided by Ellie Bateman, (Clinical Service Director) and by Dr Martin Baggaley (Medical Director). They updated the Committee as follows:
Bethlem Royal Hospital provided a wide range of mental health services, which included a national mother and baby unit, eating disorders services, national psychosis unit, learning disabilities service and local inpatient services. This included people who were voluntary patients, or those being treated under civil sections of the Mental Health Act, who may never have had contact with the criminal justice system. It also provided inpatient assessment, treatment and rehabilitation for young people and adults with severe behavioural and psychiatric problems, including medium secure care.
The hospital had approximately 300 beds of which about a third had been provided for forensic patients in secure units. Some patients at Bethlem Royal Hospital who were detained under the Mental Health Act were not forensic patients. Public concern was usually focused on forensic inpatients who had escaped or absconded from the Bethlem Royal Hospital while detained in a medium secure unit. Forensic mental health services are specialist services for people who have a mental health problem who have been arrested, who are on remand or who have been to court and found guilty of a crime. ‘Forensic’ means ‘pertaining to the law’.
These services are an alternative to prison for people who have a mental health problem and offer specialist treatment and care. They are ‘secure’ units, which means that people who are referred there are not free to come and go. Most people are detained in secure forensic services under mental health legislation.
No crime:
In the past year there had been no instances of crime in the local area in relation to patients from Bethlem’s forensic services.
Escapes:
There was one escape from River House Adult Medium Secure Unit but none from Chaffinch Low Secure Unit.
Leave incidents:
There had been a number of incidents where patients on leave from the unit breached the terms of their leave - by staying out too long, or going further afield than agreed - or by absconding while off-site. All of these patients had been accounted for, including patients who breached the terms of their leave. Buddi tracking devices had been highly successful in locating them. In the past year there had been no crime associated with leave incidents.
Low incident rate:
There had been 57,835 episodes of both escorted and unescorted leave from May 2014 to January 2016 from River House MSU and Chaffinch LSU.
River House 2008 – 2016:
There had been one escape from the River House Unit since it opened in February 2008.
For all restricted patients approval of leave had to be given by the Ministry of Justice, and a clinical submission drafted. Although rare, when there were incidents, SLaM recognised and shared the public’s legitimate concerns when adult MSU patients absconded. There had been two incidents in the past seven years that led to public alerts.
Leave Breaches 2015 – 2016:
Definition of Key terms:
Escape – patient gets out of the ward without authorisation.
AWOL – patient detained under the Mental Health Act who fails to return whilst on leave without prior agreement or consent from the Clinical Team
Abscond- patient left the ward, hospital or an escort whilst on leave without prior agreement or consent from the Clinical Team
Failure to return – patient does not return from leave at agreed times by the Clinical Team.
Improvements to Security – GPS tracking and Police Liaison
In March 2010, Bethlem deployed the ‘Buddi’ system, a state of the art GPS tracking device for use with mental health patients, which locates and tracks anyone wearing one to within metres, logging their movements in real time. The devices are tamper proof and monitored 24/7. This device was specifically commissioned for SLaM in order to improve security around leave and also to enhance the confidence of the service users in case they got lost while on leave.
The Buddi system complemented SLaM’s other security arrangements, which included strong liaison and joint working relationships with Bromley Police. As a result of SLaM’s work with Bromley Police, a protocol was introduced for sharing alerts with them and with the Bromley Public Safety Committee. This included practical measures like ‘grab packs’ providing detailed information about every patient cared for within River House, including an up to date photograph. This could be provided to the police quickly in the event of a patient absconding.
Assurance and Investigation:
When a detained patient absconded, a notification is sent to the Ministry of Justice and to the Police, who make a judgement about whether to issue a public alert. All such incidents are monitored and investigated and if necessary escalated to Board level or external independent inquiry.
Patient risk assessments were updated in response to patient absconds. Wards multi professional teams also review patients’ risks daily. The following improvements have been made in response to the investigations undertaken into absconding incidents:
Members asked what sort of patients were being treated at Bethlem. The Committee heard that patients consisted of “forensic” patients, those with various mental disorders and also some voluntary patients. It was the case that approximately 10% of patients came to Bethlem after becoming mentally ill in prison. They were returned to prison when they had recovered adequately. Most patients however, were ill at the time of committing an offense, and came under the remit of the Mental Health Act.
The Service Director underlined the fact that as far as Bethlem was concerned, the rate of re-offending and readmission was low. This was due to first class treatment and support, combined with thorough risk assessment. It was noted that if a serious incident occurred, a briefing protocol was in place to cascade information to councillors and community groups.
The Chairman asked how patients were supported after release, and what activities would they get involved with inside the hospital to pass the time. Ms Bateman answered that a variety of activities were offered in the hospital, including basic living skills, budgeting, cooking, and sometimes leave to study college courses. After leaving Bethlem, individuals would not be left unsupported. Normally they would move into supported accommodation, where the level of support would gradually be reduced as the individual became more independent. A programme had been developed with Nat West Bank to support patients with online banking, and with the setting up of basic bank accounts.
Dr Baggaley stated that he was pleased that the Police officer role on site had been actioned, and that this was working well. He was of the view that this reduced the demands on local policing, and was fostering good relationships with the police.
Dr Baggaley informed the Committee that the Bethlem site had been visited by the CQC, and had been rated overall as “good”. With respect to learning disabilities, the site had been rated as “outstanding”. It was the case that the gallery and museum had been renovated, and a visit was recommended. Channel 4 was doing some new filming at the hospital, focusing on the medium secure unit. This would be screened in due course.
It was agreed that SLaM would provide updates at regular intervals.
RESOLVED that the SLaM update be noted.