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CQC warning on sexual incidents in mental health settings

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Nurses and other healthcare staff may be under-reporting sexual incidents on mental health wards, the healthcare watchdog for England has warned.

The Care Quality Commission said that sexual incidents were now “commonplace”, but that staff may not be treating them with sufficient seriousness.

“This report today shows that sexual incidents are also common-place on mental health wards”

Paul Lelliott

The regulator demanded that improvements were made to keep both patients and staff safe. The CQC said that planned new national guidance was badly needed to give a consistent response to sexual incidents on mental health wards.

This guidance is due to be drawn up by the Royal College of Nursing and Royal College of Psychiatrists, in partnership with NHS Improvement and NHS England.

The CQC said that people using mental health inpatient services did not always feel that staff keep them safe from unwanted sexual behaviour.

Clinical leaders did not always know what was good practice in promoting sexual safety, and that staff may be under-reporting sexual incidents, said the regulator.

“The actual number of such incidents may be higher than suggested by our findings”

CQC report

In a new report – titled Sexual Safety on Mental Health Wards – it said that staff and patients found it “difficult to speak up” when they saw unwanted sexual behaviour.

“We were told that staff may become ‘desensitised’ to the issue because sexual incidents happen regularly, particularly on acute wards,” the report stated.

“This may discourage staff from reporting incidents,” it said. “This lack of encouragement may be made worse when staff struggle to find the time to report incidents when wards are very busy.

“This means that the actual number of such incidents may be higher than suggested by our findings,” it added

It also said that there was “great variation” between trusts in the number of sexual incidents reported through the NRLS (NHS National Reporting and Learning System) over the three-month period covered by the report.

“It’s vital that everyone, both patients and staff, can feel safe in mental health settings”

Catherine Gamble

The report contains a case study in which “John” talks about how his wife had engaged in sexual activity with another patient on the ward but that nurses failed to take the matter seriously.

He said: “At the time of the incident, my wife lacked capacity and was on high levels of medication.

“I later found out that the two nurses on duty that night failed to inform the police, an action I felt was necessary as I believed my wife had been sexually assaulted as she had been coerced into performing a sexual act without her consent,” he said. “The experience was traumatic to me, and to my wife.”

The report followed a CQC review of patient safety incidents in which it analysed 60,000 reports made between April and June 2017. That analysis found 1,120 incidents of a sexual nature, with more than a third rated equivalent to sexual assault or sexual harassment.

The vast majority – 95% – of the incidents were carried out by patients but in 5% of the reports the alleged perpetrator was a member of staff. About two thirds of those affected were patients, according to the report.

Despite the system being there to report specifically on patients, in a third of incidents the person affected was a staff member, said the CQC.

“The experience was traumatic to me, and to my wife”

Case study

While 97% of the reports were classified as “no harm” or “low harm”, this figure may not be reliable due to a lack of staff understanding about the impact of unwanted sexual behaviour, it said.

While some trusts have taken the lead on this, others have found it difficult due to a lack of guidance and training on how to help staff to identity and support vulnerable patients, the CQC said.

An expert reference group will be established, led by the Royal College of Psychiatrists working with the RCN to develop the guidance.

This guidance will be co-produced with healthcare professionals and people with lived experience.

The CQC will work with other regulators and stakeholders to implement the recommendations, a spokeswoman said.

Dr Paul Lelliott, deputy chief inspector of hospitals at the CQC, said that last year’s State of Care in mental health services report had highlighted the high rates of violence towards patients and staff.

Care Quality Commission

Dr Paul Lelliott

Paul Lelliott

“This report today shows that sexual incidents are also common-place on mental health wards and can cause great distress to those affected, distress that may still be felt long after they leave hospital,” he said.

Patients and staff needed to feel confident that any concerns in relation to sexual safety would be effectively followed up, said Dr Lelliott.

“We are recommending new national guidance co-produced with people who use services, a strengthening of the reporting system so that it better reflects the impact of sexual incidents, and training to equip staff with the skills and knowledge to fully assess patient risk to help prevent incidents,” he said.

The CQC said the national guidance needed to be adaptable to different inpatient settings and set out what was acceptable behaviour and what kind of behaviour would be considered sexual harassment or abuse.

It would also need to detail how staff should respond to sexual incidents – including those that are triggered by disinhibition or some other feature of a person’s mental state.

In addition, it should recognise the potential physical and psychological harm caused by those affected by unwanted sexual behavior, and cover what support people who experienced unwanted sexual incidents could expect in terms of staff response.

Royal College of Nursing

‘Disappointing’ lack of progress in community mental health

Catherine Gamble

Catherine Gamble, RCN professional lead for mental health, said: “It is of great concern that the CQC’s report describes sexual incidents on mental health wards as ‘commonplace’.

“It’s vital that everyone, both patients and staff, can feel safe in mental health settings,” said Ms Gamble. She said it was right to identify lack of trained staff as a problem.

“In addition, as the CQC points out, many patients are being cared for in outdated, unsuitable buildings that are simply not appropriate for the 21st century,” she said.

Ms Gamble added that the RCN had today written to all directors of nursing to “draw this important report to their attention”.

She added: “We look forward to working in partnership with the Royal College of Psychiatrists, NHS Improvement and NHS England to produce joint guidance on sexual safety on mental health wards, and have asked directors of nursing today to take that work forward with us.” 

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