Fears of violence and aggression rule mental health facility ‘unsafe’

Wednesday 01 May 2019

Shards of smashed window glass being used as weapons and a lack of an adequate emergency staff alarm system are just two in a catalogue of failings identified in the island’s key mental health facility in the past year.

The findings emerged in three urgent improvement notices issued by the Health and Safety Inspectorate (HSI) in the first quarter of 2018 raising concerns about Orchard House, an residential care facility for adults.

Unearthed following a Freedom of Information request by Express, the notices reflected evidence of both patient and staff safety being put at serious risk - something the department was recently scolded over by a watchdog who used the notices as evidence of Health failing to manage “violence and aggression” in key facilities.

Issued in March 2018, the first improvement notice from the HSI to the States Employment Board (SEB) relates to staff at Orchard House having “not received adequate training in relation to the management of conflict, aggression and violence demonstrated by service users.” 

Pictured: Concerns have been raised about the safety of the service in three notices served on the facility in the last year.

The HSI demanded that the service should comply with the following requirements or face further reprimands. These included preparing “a mandatory training programme” for preventing and managing aggression and violence in the work place which includes guidance for staff on “de-escalation, disengagement, conflict management [and] physical skills training,” 

Another notice, issued just a month later in April of last year, deemed the service’s “staff-to-staff emergency alarm system” as “not fit for purpose,” as well as “poorly designed, unreliable and requiring employees to carry three separate portable devices.”

Pictured: The facility is key to the island's mental health provision.

This failing, the notice goes onto say, “exposes employees to the risk of personal injury during incidences when they may be assaulted or are faced with a threatening situation by a service user and are unable to summon timely assistance.”

A third notice issued to Orchard House on the same day as the one flagging up the ‘impractical’ alarm system, raises more general concerns about the ward environment not being “safe for patients, staff and visitors” especially considering the function it serves as an adult in-patient facility.

The evidence to support this claim cited by the Inspectorate included the following: 

• “the presence of internal glazing which, when damaged by a patient, broke into large shards which were used as weapons”;
• “the failure to replace protective padding to a concrete pillar in the ICU [Intensive Care Unit, ed.] for over a month”;
• “damage to kitchen units in the main lounge exposing sharp edges”;
• “the failure to replace a glazed door pain in bedroom two of the ICU suite, which had been broken by a patient for several weeks.”

The notices made several recommendations for improvement including preparing “a written risk assessment” to audit the physical safety of Orchard House, as well as installing anti-ligature fixures and fittings, and ensuring that decor, lighting and materials present in the residential care centre create a "positive therapeutic environment."

Statistics show that these improvement notices came in a year when self-harm and suicide attempts within island institutions hit a high.

Figures released earlier this year by the Health Minister showed that there were 34 acts of deliberate self-harm recorded in 2018, with one patient alone having 18, while there were 10 attempted suicides across the General Hospital, Clinique Pinel and Orchard House.

Approached by Express, a government spokesperson commented: "Orchard House has complied with all three improvement notices issued by the Health and Safety Inspectorate (HSI) in 2018. All relevant staff have received training in MAYBO conflict management, and undertake regular refresher training. 

"A new, updated personal alarm system has been installed and is working effectively. An action plan, accepted by the HSI, is in place. This has involved a health and safety environment risk assessment, and reviews of risks from ligature and glazing. Identified hazards have been addressed, or are being managed according to the plan. Orchard House is currently part of a wider assessment of Jersey’s mental health facilities."

Pictured: The Mental Health Scrutiny report laid bare cases where those in mental health "crisis" were locked up in prison cells rather than detained at a purpose-built facility.

The news comes amid increasing scrutiny of the island’s mental health service following a damning report recently published by a panel of politicians, who carried out a wide-ranging review of the service.

Led by Deputy Kevin Pamplin, they concluded that the island’s facilities were not fit for purpose and in urgent need of updating, finding that although staff are doing their best, islanders with mental health issues are still not receiving adequate support due to chronic underinvestment in the service.

Deputy Pamplin last week invited a group of States Members to inspect the facilities at Orchard House where he said they experienced “the raw, honest reality of this place.”

UPDATE: So as promised my request for the Chief, Health & Infrastructure Ministers to meet me & staff at Orchard House happened today. They had the raw, honest reality of this place. I will continue to work to help deliver change for #MentalHealth in #JerseyCI will follow up also pic.twitter.com/DkWDVKbS3x

— Deputy Kevin Pamplin (@KevinPamplin) April 26, 2019

Following that visit, the Health Minister Deputy Richard Renouf released his response to the report, explaining that a new facility was being considered, but adding that there was debate as to whether this should form part of the Future Hospital facility.

He also made a commitment to delivering improvements to ensure “mental health achieves the parity of esteem with physical health that has been lacking for so long.”

Meanwhile, yesterday’s States Assembly sitting also saw the Minister for Infrastructure, Deputy Kevin Lewis, detail the steps being taken to ensure the wider island environment did not give rise to ‘danger spots’ for suicide.

Pictured: The Health Minister has made commitments to improve support for mental health in the island, putting it on par with physical health.

Agreeing to a meeting with Deputy Pamplin on the matter, he explained that provisions had been put in place to minimise the possibility of suicide at local multi-storey car parks – including the placement of signs with phone numbers for supportive hotlines like the Samaritans.

Express' FOI request also revealed that Greenfields - the island's 'secure school', which is used as a remand facility for young people charged with offences in the Youth Court - was issued with formal notices for improvement over fears that "violence and aggression" towards staff were not being properly managed as recently as 2017.

Meanwhile, Aviemore - a care facility operated under the Special Needs Service, which neighbours Haut de la Garenne in St. Martin - was issued with three orders by the HSI relating to a substantial lack of written policy or procedure in protecting employees from "violent or aggressive incidents" from clients.