Mental health and the NHS estate: putting it right

With toilets falling apart, poor soundproofing, and uncomfortably hard flooring, mental health facilities can often feel more like prisons than actual hospitals.

In December 2018, the Independent Review of the Mental Health Act made a clear and unequivocal statement about the need for far-reaching improvements to the inpatient environments the NHS offers to people who are in hospital for mental health assessment and treatment.

It concluded that “people are often placed in some of the worst estate that the NHS has, just when they need the best,” and it called for major capital investment in renewing the mental health NHS estate to put this right.

The review noted that “the physical environment of wards… can create the kind of institutional atmosphere that psychiatry has been trying to move away from for the last half century because of its negative impact on patient experience. For example, rimless toilets, heavy wipe-clean armchairs, hard flooring, and bare walls that are easier to clean, but absorb little sound, make buildings oppressively noisy.

The review noted: “Poorly designed and maintained buildings obstruct recovery by making it difficult to engage in basic therapeutic activities (getting outdoors or social interaction with others) and contributing to a sense of containment and control.

Wards are experienced as cold and impersonal places that some say are more similar to a prison than a hospital – making a return to the community, with all its everyday stimuli and risks, more challenging.”

The review acknowledged that creating a safe, therapeutic, and effective environment is about much more than the physical fabric of an inpatient ward, or indeed any other place in which mental health care is provided. It exaplained: “Wards become people’s home, often for many months, and so should offer a positive community for the patient where they can build new relationships.”

“They should also support patients to keep connected to their communities and relationships outside of the hospital where that is appropriate. Ward culture should promote therapeutic benefit and minimise institutionalisation. Recruitment and retention of permanent staff at the right grades needs to be improved, and with ratios identified to ensure safety, a positive ward culture, and the development of meaningful therapeutic relationships.”

Full story: National Health Executive

Author: Philip Challinor
Posted on: 6th February 2019