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1 – 10 of 290Margaret Flynn and Vic Citarella
This paper concerns the fall‐out from a TV programme which exposed the arbitrariness of cruelty at a private hospital that purported to provide assessment, treatment and…
Abstract
Purpose
This paper concerns the fall‐out from a TV programme which exposed the arbitrariness of cruelty at a private hospital that purported to provide assessment, treatment and rehabilitation to adults with learning disabilities, autism and mental health problems. The paper seeks to address the issues involved.
Design/methodology/approach
It describes the principal findings of a Serious Case Review which was commissioned after the TV broadcast, and outlines some of the activities designed to reduce the likelihood of such abuses recurring.
Findings
From policy, commissioning, regulation, management, service design and practice perspectives, events at Winterbourne View Hospital highlight a gulf between professionals, professionals and their organisations, and leadership shortcomings.
Originality/value
The English government responded promptly and encouragingly to the wretched circumstances of patients at Winterbourne View Hospital with a “Timetable of Actions”. The Serious Case Review which was commissioned after the TV broadcast contributed to the growing scepticism of “out of sight, out of mind” placements. It covered wide‐ranging territory.
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This paper aims to conceptualise the residential and psychiatric hospital as a space where criminality and social harms can emerge. Because of recent media scandals over the past…
Abstract
Purpose
This paper aims to conceptualise the residential and psychiatric hospital as a space where criminality and social harms can emerge. Because of recent media scandals over the past 10 years concerning privately-owned hospitals, this study examines the lived experiences of service users/survivors, family members and practitioners to examine historic and contemporary encounters of distress and violence in hospital settings.
Design/methodology/approach
The study consists of 16 biographical accounts exploring issues of dehumanising and harmful practices, such as practices of restraint and rituals of coercive violence. A biographical methodology has been used to analyse the life stories of service users/survivors (n = 9), family members (n = 3) and professional health-care employees (n = 4). Service users/survivors in this study have experienced over 40 years of short-term and long-term periods of hospitalisation.
Findings
The study discovered that institutional forms of violence had changed after the deinstitutionalisation of care. Practitioners recalled comprehensive experiences of violence within historic mental hospitals, although violence that may be considered criminal appeared to disappear from hospitals after the Mental Health Act (1983). These reports of criminal violence and coercive abuse appeared to be replaced with dehumanising and harmful procedures, such as practices of restraint.
Originality/value
The data findings offer a unique interpretation, both historical and contemporary, of dehumanising psychiatric rituals experienced by service users/survivors, which are relevant to criminology and MAD studies. The study concludes by challenging oppressive psychiatric “harms” to promote social justice for service users/survivors currently being “treated” within the contemporary psychiatric system. The study intends to conceptualise residential and psychiatric hospitals as a space where criminality and social harms can emerge. The three aims of the study examined risk factors concerning criminality and social harms, oppressive and harmful practices within hospitals and evidence that violence occurs within these institutionalised settings. The study discovered that institutional forms of violence had changed after the deinstitutionalisation of care. These reports of violence include dehumanising attitudes, practices of restraint and coercive abuse.
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Lucy Jade Jones and Ceri Woodrow
The purpose of this clinical audit was to review the adherence to the 2017 care and treatment review policy across two NHS assessment and treatment units. Care and treatment…
Abstract
Purpose
The purpose of this clinical audit was to review the adherence to the 2017 care and treatment review policy across two NHS assessment and treatment units. Care and treatment reviews should be offered to people with an intellectual disability and/or autism who are at risk of admission into a mental health hospital.
Design/methodology/approach
Admission and discharge data was collected across two assessment and treatment units between January 2019 and December 2022. Adherence to the care and treatment review policy was also reviewed as was length of inpatient stay. A retrospective evaluation was conducted. Triangulation of data was collected via the trusts’ electronic patient record system and NHS analytics team. Descriptive statistics, Mann–Whitney U test and a one-way ANOVA with post hoc tests were used in the analysis.
Findings
An increase in behaviours of challenge and deterioration of mental health were the main reasons for admission. Forty-nine percent (30) of those admitted to the assessment and treatment units accessed a care and treatment review. Care and treatment reviews were more frequently provided for individuals experiencing longer inpatient stays.
Originality/value
There is limited evidence relating to outcomes and impact of care and treatment reviews. Further research is required to explore effectiveness of care and treatment reviews to understand benefits and appropriately prioritise resource.
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This article seeks to consider the lessons from one of the worst failures in adult protection in the UK in recent times: the abuse of a number of patients with learning…
Abstract
Purpose
This article seeks to consider the lessons from one of the worst failures in adult protection in the UK in recent times: the abuse of a number of patients with learning disabilities or autism and challenging behaviour over a number of years at Winterbourne View private hospital in the outskirts of Bristol. The abuse persisted, irrespective of a number of attempts to alert a broad range of regulatory authorities and health professionals about the situation.
Design/methodology/approach
The article provides a detailed analysis of the lessons for professionals responsible for adult protection by one of the journalists most responsible for exposing the abuse at Winterbourne View private hospital. Drawing on information the BBC uncovered during the making of its two films about the subject, the author shares details of relevance to professionals responsible for adult protection and considers the implications of the catastrophic failure to protect vulnerable people.
Findings
This article shows how the lessons from the abuse at Winterbourne View have permeated only to some areas and professionals, not necessarily to where those lessons are most needed. The author suggests that further efforts are required to prevent another, similar scandal happening elsewhere in the UK.
Originality/value
The paper is a unique piece, sharing experiences from a journalist involved with exposing a scandal directly with professionals responsible for adult protection.
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The purpose of this paper is to examine the discourse of the leadership of professional and public policy responses to the scandals of the care and treatment at the private…
Abstract
Purpose
The purpose of this paper is to examine the discourse of the leadership of professional and public policy responses to the scandals of the care and treatment at the private Winterbourne View and NHS Calderstones Hospitals which demonstrates the lost learning from earlier attempts to provide humane care for the enduring numbers of people contained in similar settings.
Design/methodology/approach
An analysis of the use of general management and managerialism through commissioning, rather than a focus on pro-active self-leadership within professional practice or through collaborative, collegiate or distributed leadership has arguably been responsible for the lack of progress.
Findings
The emphasis on direction and action by government ministers, quangos, and managers across the NHS and local government has ignored and stifled the potential for initiative and self-leadership by professionals. This is notable for social work, aggravated by the absence of an engaged professional body for social workers.
Originality/value
This case study addresses the limitations of leadership approaches which focus on policy direction, general management, managerialist and commissioning approaches to the reform and delivery, contrasted with the potential of professionals self-leadership by practitioners.
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Yim Lun Wong, Rinzi Bhutia, Khalodoun Tayar and Ashok Roy
The purpose of this paper is to examine the trend of admissions and inpatient characteristics in a NHS intellectual disability hospital from 1975 to 2013, in particular looking at…
Abstract
Purpose
The purpose of this paper is to examine the trend of admissions and inpatient characteristics in a NHS intellectual disability hospital from 1975 to 2013, in particular looking at the effect following the Winterbourne View scandal.
Design/methodology/approach
A retrospective review of all admissions over a three-year period (January 2011-January 2013) was completed. This information was compared with admissions to the same hospital in three-year period over the last four decades (1975-1977, 1985-1987, 1995-1997, and 2003-2006). Number of admissions, gender, age, source of admission, length of stay, reasons for admission, type of admission, and diagnosis of psychiatric illnesses were included.
Findings
There were 87 admissions (including 29 from out of area) in the study period of 2011-2013. The number of admissions had varied over the years but male admissions were consistently higher than female. A majority of people stayed over six months. For the first time in five decades, there were more formal inpatients than informal ones. The diagnosis of Autism Spectrum Disorder (ASD) and of Attention Deficit Hyperactivity Disorder had increased.
Originality/value
This study has examined admission trends over five decades. It has highlighted that the Mental Health Act legislation is being used more frequently and that co-morbid mental disorders, such as ASD are commonly associated with those admitted to hospital. A well planned-out community health care system, as well as adequate social provision are keys to maintain people with intellectual disability in the community. Furthermore, a better understanding of the symptomology of challenging behaviours, and appropriate use of mental health legislation are crucial in providing a high-quality service that has clear treatment goals and values. Some of these issues have contributed to the failure of the recent initiative to reduce the size of the inpatient intellectual disability following Winterbourne View scandal.
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Elizabeth Marlow and Nina Walker
The purpose of this paper is to look at whether a move to a supported living model of care from traditional residential group homes could improve the quality of life for those…
Abstract
Purpose
The purpose of this paper is to look at whether a move to a supported living model of care from traditional residential group homes could improve the quality of life for those with a severe intellectual disability and other challenging needs.
Design/methodology/approach
Six men with severe intellectual disabilities moved from two residential homes into new-build individual flats. Their quality of life was measured using a battery of assessments looking at; environment, relationships, community participation, interactions, mood interest and pleasure, activities, physical health and challenging behaviour. These measures were taken before the move, immediately after and six months after the move. The views of staff and family carers were also assessed at each stage.
Findings
The move had a positive effect on the tenants in that it caused an improvement in their mood and a decrease in their challenging behaviours. Further improvements could be made in the tenant’s quality of life by introducing more activities. The initial concerns of family members about the move decreased over time. However staff found the changes to their working practices stressful.
Research limitations/implications
The study was a small scale one because of the small number of tenants. The tenants were unable to express their own views because of their limited communication abilities so a combination of direct observation and indirect measures were used.
Practical implications
In the light of the Winterbourne view report by Stephen Bubb this study looks at the impact on quality of life of a move to supported living for a group of people with complex and challenging needs who might otherwise be placed in an out of borough placement similar to Winterbourne view.
Social implications
The study also looks at the impact of such a move on the family members of the individuals and on the staff who had to change their working practices to adapt to both a new working environment and model of care.
Originality/value
This study also looks at the impact of a model of supported living for people with severe intellectual disabilities and complex needs rather than those with mild intellectual disabilities. This is particularly important in the post Winterbourne view climate when the authors need to look carefully at positive alternative models of care for these individuals.
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The purpose of this paper is to explore the importance and nature of relationships of trust in care settings. The paper addresses the central question of what is it about these…
Abstract
Purpose
The purpose of this paper is to explore the importance and nature of relationships of trust in care settings. The paper addresses the central question of what is it about these kinds of relationships that is associated with harm and abuse?
Design/methodology/approach
The paper takes a discursive approach, based, implicitly, on an ecological framework of analysis.
Findings
The conclusion is that the relationships between staff and service users in residential care settings are characterised by non-mutual dependency, isolation and unequal decision-making powers. Therefore such relationships deserve special focus and attention in order to safeguard and protect the people concerned.
Practical implications
The paper implies that practitioners and policy makers should find ways to ensure that they listen more closely to people living in residential settings. Practitioners should ask more about the quality of relationships that people enjoy with the staff that support them.
Originality/value
The paper suggests that in order to safeguard people more effectively, practitioners and policy makers should reconsider the central focus of their energies and revisit issues such as isolation, in the lives of disabled and older people living in residential care.
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The Policy Watch series reflects on recent and forthcoming developments in mental health policy across the UK. The purpose of this paper is to review recent developments in mental…
Abstract
Purpose
The Policy Watch series reflects on recent and forthcoming developments in mental health policy across the UK. The purpose of this paper is to review recent developments in mental health policy, specifically the implications and learning for mental health services of recent scandals such as Mid Staffordshire and Winterbourne View and the various responses to them.
Design/methodology/approach
This paper reviews and summarises recent developments in national mental health policy in England and their implications for mental health service provision.
Findings
The paper outlines how learning from recent scandals such as Mid Staffordshire and Winterbourne View can be applied in mental health services.
Originality/value
The paper updates and discusses recent policy developments in the NHS and their implications for mental health services.
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Gyles Glover, Ian Brown and Chris Hatton
Two censuses, from 2010 and 2013, respectively, shed light on the trend in use of in-patient psychiatric care for people with learning disability or autism following the BBC…
Abstract
Purpose
Two censuses, from 2010 and 2013, respectively, shed light on the trend in use of in-patient psychiatric care for people with learning disability or autism following the BBC documentary exposing abuse of patients at Winterbourne View. The purpose of this paper is to consider the implications of the detailed trends for future care for this group.
Design/methodology/approach
Published data from a recent (September 2013) census are compared with the re-analysis of a census undertaken by the Care Quality Commission in March 2010.
Findings
An overall 35 per cent reduction in numbers of in-patients is made up of larger falls in groups generally easier to discharge (older, female, in general as opposed to secure units). There is also substantial variation around the country.
Research limitations/implications
There are some uncertainties about the comparability of the two censuses and the question of how complete enumeration was of people with learning disabilities in general mental illness beds.
Originality/value
The paper raise the question of whether the beds that are reducing fastest may be those most likely to be of value to a high quality and sustainable service in the long term.
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