Serious breaches in established standards and practice in mental health ward

What happened

Mr M was admitted to a ward in the Trust's hospital for just over two weeks in late 2012 under section 2 of the Mental Health Act.

When Mr M refused to take oral medication, staff contacted the on–duty doctor by telephone. He authorised the forcible administration of medication via two injections. Mr M was held down by four male members of staff when he had these injections. Staff had not told him about the Trust's right to forcibly administer medication.

Five or six days after this, Mr M collapsed on the ward with low blood pressure. He was transferred to a cardiac unit, where he was diagnosed and treated for an abnormal heart rhythm.

Mr M told us that, from the first day of his admission to the ward, he was woken at night every hour by staff shining a very bright torch into his face. For two days after his return to the ward from the cardiac unit, he was additionally woken each hour for blood pressure tests until he persuaded a doctor to agree to these tests happening just twice each night. He says that he was also prevented from sleeping at night time because his room was cold and his only bedding was a sheet and a thin top cover, neither of which covered him properly. When he asked for a blanket, staff ignored his request. This continued for the remainder of his admission. Mr M felt that this was bad for his mental and physical health, particularly as he had a heart condition.

During Mr M's hospital admission, he was concerned that staff regularly escorted patients who were smokers to the garden for smoking breaks, to the detriment of non–smoking patients.

When he was no longer formally detained, Mr M was in the lounge area when a fire alarm went off. He says that, although this was known to be a false alarm, staff prevented him from leaving the lounge even though he explained that the noise of the alarm was hurting his ears and causing him distress.

What we found

We partly upheld this complaint. Mr M should have been given information about his rights, including the Trust's powers to force medication, both verbally and in writing as soon as possible, but this did not happen.

Staff carried out the forcible administration of medication without a satisfactory medical assessment and there was no recorded rationale for why it was therapeutically necessary. There was no evidence that staff gave Mr M information about the proposed treatment and possible alternatives.

The Trust failed to reduce the need for force by attempting alternative strategies and therefore the level of restraint used was probably excessive and unreasonable.

The night time regime of waking and the fact that Mr M was denied adequate bedding when he was recovering from a cardiac condition amounted to a serious failing in nursing care that would have been detrimental to Mr M's physical and mental health. Mr M was denied his rights to comfort and a lack of sleep due to cold.

Additionally we criticised the Trust for maintaining a ward routine that was, or appeared to be, dominated by the needs of smokers and for acting outside its authority when Mr M was prevented from leaving the lounge area during a false fire alarm when he was no longer detained under the Mental Health Act.

Putting it right

The Trust agreed to apologise to Mr M and explain how it would address the issues raised by our investigation. It also agreed to pay Mr M £2,000 to recognise the distress, anxiety, discomfort and frustration he experienced due to the Trust's failure to meet some of his basic care needs; its failure to provide him with the information to make an informed choice about his medication; its failure to reassure him that he was treated appropriately, fairly, and with dignity at a time when he was vulnerable; its failure to respect his wishes when he wanted to leave the Trust's premises and had a right to do so; and its failure to provide a complete and proportionate resolution to his complaint.