Minutes:
Representing Bethlem Royal Hospital were Feizal Mohubally, Michael Holland, and Professor Thomas Fahy. They provided an update on incidents and issues at the Bethlem Royal Hospital.
The Committee were briefed that last year SLaM appointed world-leading healthcare experts, the Institute for Healthcare Improvement (IHI) and US healthcare provider Intermountain Healthcare, to deliver a three-year programme of work that would support staff to introduce improvements aimed at driving up the quality of patient care.Work had begun to create a new improvement culture across the Trust, with more integrated, standardised and stream-lined services where feedback would lead directly to continuous improvements to patient care.
The National Adult Outpatient Neurodevelopmental Clinic at Bethlem Royal Hospital had won the Award for Outstanding Health Services at the National Autistic Society's prestigious Autism Professionals Awards. The team was shortlisted by an independent panel of ten autism experts. The clinic provided diagnostic assessments for autism, ADHD and a range of other conditions and gave bespoke recommendations for post-diagnostic support. They had a specialist team including doctors, nurses, psychologists, neurodevelopmental specialists, managers and administrators and recently received an ‘Outstanding’ rating from the Care Quality Commission.
The Committee were informed that the inquest into the tragic death of Mr. Olaseni Lewis had commenced on the 6th February 2017. Mr Lewis died on 4 September 2010.
In Spring 2016 SLaM opened a Psychiatric Intensive Care Unit (PICU) at Bethlem Royal Hospital. This was a 10 bedded unit that provided care for men aged 18-65, who had severe and ongoing mental health problems. The service also facilitated short-stay intensive assessment and treatment for people with acute mental illness. The team was comprised of staff that included nurses, doctors, an occupational therapist, psychologist and a pharmacist.
A partnership had been formed with Oxleas and South West London and St George’s Trusts. The partnership was set up to share learning, expertise and innovation to help drive up quality across mental healthcare in south London. The partnership’s main focus was to examine how efficiencies could be maximised to improve patient care across the three organisations where appropriate.
In May 2014 a documentary series ‘Bedlam’ was awarded a BAFTA television award. Since then, SLaM had been working with Channel 4 and Rare Day (a production company) on a project looking at forensic mental health filmed at River House, Bethlem Royal Hospital. The aim was to give members of the public a better understanding of what forensic mental health really meant, seen through the eyes of the patients and the staff who care for them.
The first programme was broadcast on Channel 4 on 29 November 2016 and was received positively by staff and stakeholder audiences, helping to break down widely-held prejudices surrounding mental illness. It was noted that the documentary ‘Life on the Psych Ward’ was due to be shown on Channel 4 on 11th April.
The Committee were updated concerning leave incidents at the Forensic Units. Bethlem had approximately 300 beds of which about a third had been provided for forensic patients in secure units. 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. In the past year there had been no instances of patients from forensic services being found guilty of committing a crime whilst on leave in the local area.
In May 2016 a patient absconded
in Croydon whilst on escorted leave for medical treatment at
Croydon University Hospital. The individual was involved in an
incident and was subsequently charged with a number of offences
including attempted murder. Staff worked closely with the police
and alerted the Bromley Public Protection Committee at the time of
the incident, following the agreed protocol. A level 2 Trust-wide
investigation was near completion.
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 patients that had breached their terms of leave.
There had been one escape from within the River House Unit since it opened in February 2008. This happened in 2015.
Professor Fahy gave a PowerPoint presentation entitled ‘Forensic Psychiatry Services in the UK’.
(Forensic psychiatry is a sub-speciality of psychiatry and is related to Criminology). It encompasses the interface between law and psychiatry. A forensic psychiatrist provides services – such as determination of competency to stand trial – to a court of law to facilitate the adjudicative process and provide treatment like medications and psychotherapy to criminals.)
It was noted that data showed that between 1997 and 2007 there had been a steady increase in the numbers of the forensic population.
A pyramid diagram showed that the organisation of Forensic Services in the UK consisted or 4 layers:
· High Secure Hospital
· Medium Secure Hospital
· Low Security Rehabilitation Wards and General Psychiatric Wards
· Community Forensic Psychiatry and Psychiatric Hostels
The Committee heard that referrals from Forensic Services could come from three sources:
· Transfers from Prisons
· Admission Ordered by a Court
· Transfer from general psychiatric services or from the community
A case study was presented concerning a person who had spent 11 years in a high secure unit after committing a series of violent offences and being diagnosed with paranoid schizophrenia. He had made significant progress and was now rehabilitated with a stable family life.
A Member enquired why there had been an increase in the number of patients failing to return. Mr Mohubally answered that this was because the number of patients had increased and so had the number of patients taking leave. He pointed out that there were no related incidents associated with this.
A Member enquired who escorted patients when they were on leave, and it was confirmed that this would be the hospital nursing staff. Most patients were discharged at some point but could be recalled if it seemed that the level of risk was increasing.
The Chairman asked what help was provided to patients when they left Bethlem and lived in the community. Professor Fahy responded that patients would need help to manage their finances, and would also need help to integrate into either some form of education or work. Former patients found it very difficult to obtain paid work.
The Chairman queried why the number of incidents of mental health seemed to be increasing. Professor felt that part of the reason for this had been the use of former ‘legal highs.’ He particularly cited the use of ‘Spice’ which was often a cause of physical collapse and mental health issues.