The trust that delivers mental health services in Portsmouth says risk assessments are carried out on all of their patients.
Yet last year, Solent NHS Trust recorded a total of 65 unauthorised absences or abscondments across the three units it runs in the city.
And the year before that – 2012 – it recorded a total of 69 incidents.
The trust says that while the figures may seem high, a lot of the incidents relate to patients who are late returning from allocated leave, so are therefore marked as absent.
Solent runs The Orchards, which has a secure ward called Maples and an ‘open door’ ward called Hawthorns.
These are run on the site of St James’ Hospital, in Locksway Road, Milton, Portsmouth, along with Oakdene which is a mental health rehabilitation unit.
Matthew Hall is Solent NHS Trust’s operations director for adult mental health.
He says: ‘If someone is five minutes late coming back from an authorised leave, then we have to mark it as an absence.
‘So the patient could be late because they missed their bus, they lost track of time, or simply because they wanted to be out longer.
‘When a patient comes into our care, a risk assessment is formed by a consultant psychiatrist, to see what risks would be involved if a patient is granted leave off our site.
‘It’s important to remember that the units are not prisons, and people can go out for a set amount of time, and to certain locations.’
Section 17 of the Mental Health Act allows detained patients to be granted leave from the premises for a certain time and may have other conditions imposed, such as where a person can go.
Solent says that as well as detained patients, informal or voluntary patients are also assessed in a similar way, to ensure a risk assessment is made to protect the patient and those around them.
Two years ago, Solent introduced a system known as the five Cs checklist, after the Care Quality Commission were impressed with the idea.
CQC inspector Yasin Rahim said: ‘For people detained under the Mental Health Act, periods of leave from a mental health ward are often an important element of a recovery programme, helping patients begin to reintegrate back into community life.
‘However it’s also an area of potential risk for patients, which is why when we visit mental health trusts the process by which nurses and clinical staff authorise leave is a key area that we look in to.
‘Ensuring there are clear and consistent risk assessments in place can greatly reduce the chances of patients going missing or causing themselves harm.’
At Solent, the five Cs checklist is carried out by nursing staff that need to assess a patient before granting leave – and it is done regardless of whether the person is detained or not.
The checks are:
· Circumstances of where someone is going;
· Clothing worn;
· Consideration of risk;
· Current mental state;
· Contingency plan.
Mr Rahim adds: ‘It is a simple approach, yet incredibly effective.
‘The added reminders around the staff areas, including a laminated credit card size copy of the five Cs handed out to all staff means it has now become standard practice in the hospital.
‘I am reassured that the welfare and safety of the people using the services at St James’ are not at risk and individual’s needs are being considered.’
Despite these measures, patients are still able to ignore the conditions of their leave.
And on very rare occasions these have led to fatal consequences.
Solent says in the past two years, three people have died on the grounds of St James’ Hospital.
One person died of natural causes, another was found hanged, and a third death is subject to an inquest.
In the same time frame eight people have died outside the hospital site who were still in the care of Solent.
Three of those patients had been inpatients on leave.
Mr Hall says: ‘Suicide is a phenomenon that’s difficult to predict. We carry out risk assessments, and for the most part they work.
‘We do not run a prison and patients are able to go out.’
The National Confidential Inquiry looks into trends and causes of suicide among mental patients.
It says people who are inpatients in mental health wards are always among those at greatest risk of suicide.
‘Although thorough risk assessments are carried out on all of our service users, it is not possible to accurately predict which people will make serious attempts on their life,’ adds Mr Hall.
‘There is international consensus on this fact.
‘Comprehensive analysis by NHS England shows over 2001 to 2011, there were an average number of suicides in Portsmouth and an average number of people who committed suicide were in contact with mental health services.
‘Nationally, 11 per cent of people in touch with mental health services who commit suicide are inpatients at the time of their death.
‘In Portsmouth this is slightly below that number – about 9.5 per cent.
‘Significantly fewer suicides in Portsmouth happen within three months of discharge, or within a week’s community contact, compared to the national average.
‘The data from 2011 to 2014 in Portsmouth does not alter the overall trend of the previous 10 years – as far as we can tell.
‘The only area where Portsmouth is above average with respect to suicide is more people who have a diagnosis of drug dependence as a primary risk factor – 35 per cent of suicides – than the national average of 31 per cent.
‘With respect to absconding – we review significant events and make changes, these include improvements to our perimeter fencing, changes to our key fob system, so that we can tell which member of staff has opened a door, and changes to our risk assessment systems to ensure it is noted.’
‘NOT A STRAIGHTFORWARD ISSUE’
ANOTHER trust that provides mental health services in Hampshire also came under criticism after two men in their care committed suicide.
The men, Craig Greer and Mark O’Shaughnessy, had both been cared for by services run by Southern Health NHS Foundation Trust.
As reported, Mr O’Shaughnessy, 28, of Williams Close, Gosport, hanged himself a day after he told health professionals he wanted to kill himself and hurt his mum.
Craig Greer, 33, of Woodcot Crescent, Havant, had told his GP he was having suicidal thoughts and admitted himself to Elmleigh Hospital in Havant on July 19. He was discharged three days later as he said he was feeling more positive and had follow-up phone consultations. But he did not respond to messages left on August 2 and 8.
Mr Greer was found dead in a tent in communal gardens outside his West Leigh flat on August 8. He had gassed himself.
Since the tragedies, the trust has made improvements including enhanced risk assessment training for mental health workers.
A spokesman says: ‘If you break your arm, you get an x-ray which shows exactly what the problem is and how you can recover.
‘If you have a severe mental health problem things can be less straightforward. So a big part of what mental health services do is help people safely recover a meaningful and independent life beyond their mental illness. Our teams of mental health professionals thoroughly assess any risks involved in this approach, and these are regularly reviewed for each and every person in our care.
‘Unfortunately we know that despite our best efforts, some people’s thoughts and behaviour can have tragic consequences. In such events, we always investigate the care we provided and whether there are any lessons we can learn to improve our services.’
The spokesman adds: ‘It’s important to remember mental health hospitals are not prisons, and most people in hospital are using our services voluntarily.
‘When people have been detained under the Mental Health Act, we work extremely hard to help them recover and return home safely as soon as possible.
‘As part of the recovery process, the Mental Health Act allows for patients who are sufficiently well to take periods of leave – for example to visit friends or family.’
MP CALLS FOR TRUST TO IMPROVE
THE patron of a mental health charity wants to ensure Solent NHS Trust keeps on top of its changes.
The trust has made improvements to fencing around its units and updated its key fob system, after the death of a patient.
Stephen Hipkins, 28, was found hanged in the grounds of St James’ Hospital, in Locksway Road, Milton, on January 27, last year.
An investigation found it could not determine how Mr Hipkins had managed to leave The Orchards unit undetected.
Since then a raft of measures have been introduced, and these have been endorsed by Mike Hancock, MP for Portsmouth South.
He is also the patron of charity Mind.
In a statement released by his office, Mr Hancock said: ‘This is obviously a very tragic case.
‘Solent NHS Trust told the inquest they have now corrected the lapses that contributed to Mr Hipkins’ death. Even if all the circumstances that combined to contribute to Mr Hipkins’ death could not have been foreseen, steps could have been taken to minimise the risks to him and other patients and this was, I believe, a failure on the trust’s part.
‘I hope they will also make sure they are continuing to monitor the arrangements for security and other matters and are doing risk assessments on a regular basis so things are not allowed to slip and give rise to such circumstances again – and I will be pressing them to do that.’