Ward environments

Page last updated: 12 May 2022

Mental health inpatient wards are often noisy and bustling environments. This can be a challenge for all patients, who can feel trapped in a space that is not conducive to recovery. However, these types of environments can be particularly distressing for autistic people who may be at risk of sensory overload.

For example, on our review of a specialist eating disorder ward in January 2021, staff told us that there were a relatively high number of patients with diagnosed or suspected autism in the hospital. The lead nurse for autism had carried out work to help ward staff develop their skills in working with people with autism and had helped develop and refine care plans, but patients and staff told us that the environment was not friendly for autistic people or people with sensory challenges. The service had previously insulated walls and ceilings and fitted sound-reducing panels to walls, but was in consultation with a specialist sound engineer as the problems of noise persisted. They were also developing sensory rooms on wards in consultation with patients and a specialist company.

Steps that other services have taken to reduce noise levels include attaching rubber feet to moveable furniture on hard floor surfaces, and ensuring there are quiet spaces. We also heard that staff needing to stay on the wards during the pandemic had highlighted previously unidentified environmental challenges, such as noisy doors.

Dormitory wards in particular can be noisy environments that can be distressing to patients. Although likely to be a consequence of aging infrastructure, larger wards can add to problems with noise and disturbance, which can also create problems for patient involvement and engagement. For example, at one trust we heard that patients and visiting relatives who used hearing aids struggled with communication because of the level of background noise.

Even when dormitory wards are managed well, and in accordance with the guidance ‘Delivering same-sex accommodation’, we have heard that people do not always feel safe in these environments.

As stated previously, we do not think that dormitory accommodation should be acceptable in any mental health inpatient unit. The government has pledged over £400 million to make progress on replacing dormitories.

A number of larger wards were scaled back at the start of the pandemic, although this of course added to pressures over bed availability and the numbers of beds increased again as local infection rates declined.

The funding pledge to replace dormitory wards is welcome. However, there are many other improvements required in mental health inpatient environments that will similarly be dependent on adequate capital funding being available.

Sexual safety

The reconfiguration of wards at the start of the pandemic could create challenges for services in meeting the requirements for single-sex accommodation. Positively, the only breaches of guidelines we saw were when single-sex day spaces were temporarily unavailable. In many services these spaces were not in demand anyway.

While gender segregation alone cannot address all concerns around sexual safety, many services aim to group patient rooms so that women do not need to pass men’s rooms to get to their own rooms, and vice-versa. This is not a requirement of guidance on same sex accommodation, and is not always possible due to the infrastructure of the ward. However, where this can be arranged it can add to patients’ sense of sexual safety.

During the pandemic, some service reconfigurations meant that these types of arrangements could not be maintained. In these instances, we found that services had taken steps to maintain patients’ sense of safety, for example having staff allocated to specific areas where people were shielding.

For some services, the reconfigurations offered an opportunity to introduce single-sex wards that may continue post-pandemic.

We also heard about good practice in proactively addressing sexual safety:

WiFi connectivity issues

In last year’s report, we highlighted our concerns around the availability and quality of WiFi on mental health wards.

Over the last year, we have heard frequent complaints from patients, staff and even the Tribunal service about WiFi signal availability (see section on the First-tier Tribunal). In some hospitals, detained patients have had to use their own mobile phone accounts to speak with families, and even lawyers, at their own expense.

As a consequence, many of our remote reviews have requested that services address their WiFi coverage. In a number of cases, services have replied that they are installing signal boosters or other technological fixes.

Food and nutrition

The catering arrangements and quality of food available on mental health wards is an area for concern, with patients often telling us that the standards of meals provided is not good enough.

Over 2020/21, as part of the Adult Secure Clinical Reference Group, we have worked with NHS England and NHS Improvement to develop guidance on ‘Managing a healthy weight in adult secure services’. This guidance will be useful for all hospitals that detain patients, including those that are not specifically designed as secure hospitals, as it encourages services to work with patients on improving their diet and lifestyle. We have seen some good practice in services, for example:

In October 2020, the Independent Review of NHS Hospital Food published its report recommending measures to improve standards for patients’ food, including statutory standards. We welcome the inclusion of this in the Health and Social Care Bill, as improving the standard of meals provided to patients in hospital will help to support implementation of healthy weight strategies.

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