Analysis

Collaborative aims to improve sexual safety on mental health wards

A collaboration, with input from nurses, is looking at how to improve sexual safety on mental health wards and is drawing up new standards

A collaboration, with input from mental health nurses, has been commissioned to improve sexual safety on mental health wards and is drawing up new standards

  • Sexual Safety Collaborative set up after Care Quality Commission (CQC) investigation
  • CQC found 457 cases of sexual assault or harassment in three-month period
  • Mental health nurses urged to be proactive in discussing the issue
Illustration depicts a group of people talking about their experiences. A programme to improve sexual safety on mental health wards is developing standards on staff training and support.
Picture: iStock

Mental health nurses need to become more open to discussing sexual safety with colleagues and patients, according to a leading nurse academic adviser on a nationwide initiative launched this week.

The Sexual Safety Collaborative (SSC) is aimed at improving sexual safety on mental health wards in England and has involved input from mental health nurses and experts by experience.

The collaborative was established in response to a Care Quality Commission (CQC) report, published in September 2018, exploring the issue.

Three main aims

The Sexual Safety Collaborative project’s main aims have been to:

  • Produce a set of standards around sexual safety in mental health and learning disability inpatient pathways and a strategy to measure and support quality improvement
  • Run a national quality improvement collaborative to support inpatient mental health teams in every mental health trust in England in improving sexual safety on their wards
  • Produce a library of resources to develop best practice and support the work of mental health trusts in improving sexual safety

This CQC research reviewed nearly 60,000 reports of incidents that took place on mental health wards between April and June 2017.

'High time sexual safety was brought to the fore in the NHS'

The analysis revealed 1,120 sexual incidents involving patients, staff, visitors and others. More than one third of the incidents, 457, could be categorised as sexual assault or sexual harassment of patients or staff.

Following this, the SSC was commissioned to draw up new standards and improve sexual safety on mental health wards by NHS Improvement. It is facilitated by the National Collaborating Centre for Mental Health (NCCMH), which runs several national quality improvement programmes around mental health patient safety.

University of Leeds mental health professor Elizabeth Hughes is a member of the RCN mental health forum and carries out research into issues related to sex and mental health. She sits on the SSC expert reference group.

Professor Hughes says it is high time the topic of sexual safety was brought to the fore in the NHS and for mental health staff to be more proactive in discussing the issue.

‘We have had missed opportunities to talk to people about what is okay and what is not okay in terms of sex,’ she explains. ‘How do we help them to stay safe? Sexual safety and sexual health is a whole area of holistic care we have avoided.

‘We have had missed opportunities to talk to people about what is okay and what is not okay in terms of sex’

Elizabeth Hughes, University of Leeds professor in mental health and member of the Sexual Safety Collaborative expert reference group 

‘Mental health nurses are used to having difficult and sensitive conversations as well as sitting and allowing people to open up about very personal stuff, so why not this?

‘We have the skills to do this work perfectly,’ she adds, urging staff to have such conversations and warning against making assumptions based on marital status, age, gender or anything else.

95%

of sexual incidents are perpetrated by patients, 5% by staff

‘Don’t be afraid to ask. Often people just don’t know how to tell you, and asking the question gives them permission.’

'I know how it feels to be subjected to sexual trauma'

SSC expert reference group co-chair Amy Mary Rose Herring is an expert by experience and says co-production has been important to the development of the project.

Ms Herring says she has experienced post-traumatic stress disorder and depression stemming from experiences of sexual trauma.

‘Sexual safety is a huge passion of mine. I know how it feels to be subjected to sexual trauma, which is why I wanted to be part of this work.

 ‘These standards are designed to ensure sexual safety is taken seriously and handled with skill’

Vanessa Ford, co-chair of Sexual Safety Collaborative expert reference group   

‘Seeing and having experts by experience in the room to share their experiences and give input has been powerful.’

Picture of Vanessa Ford, acting chief executive of South West London and St George’s Mental Health NHS Trust. She is co-chair of the Sexual Safety Collaborative, a programme to improve sexual safety on mental health wards.
Vanessa Ford

The standards have yet to be published but are in development and relate to seven domains, including improving culture, staff training and support, multi-agency working, and incident recording and data analysis.

Fellow expert reference group co-chair, South West London and St George’s Mental Health NHS Trust acting chief executive Vanessa Ford, says: ‘These standards are designed to ensure sexual safety is taken seriously and handled with skill.’

Ms Ford, who is also national CQC adviser on mental health nursing, adds: ‘The standards will be clear and easy to understand for everyone – the people we serve, as well as our staff – so everyone is appropriately supported. Ultimately, this work is about improving the safety and experience of our patients and staff.’

‘An issue that has been hidden in plain sight’

NCCMH director Tom Ayers, who leads the SSC, says sexual safety is an issue that is ‘hidden in plain sight’ on mental health wards.

‘People have known about it, but it has never been talked about on a national level before the CQC did its report last year and set out the scale of the issue.’

The collaborative is ambitious and involves 58 wards or units from 43 organisations around the country, which equates to about four out of five mental health trusts in England, says Mr Ayers. It will run until April 2021.

‘There was big interest in doing this,’ Mr Ayers says. ‘It’s captured the hearts and minds of executives. It is a priority.’

Each of the 58 wards or units is allocated a coach, employed by the NCCMH to visit and support teams delivering care.

‘We will be trying to change the culture on wards to one that is sexually safe. It is not about persecuting people or bringing in sets of rules’

Tom Ayers, leader of Sexual Safety Collaborative

Success will be measured fortnightly by asking staff and patients the same two questions:

  1. In the past two weeks, have you felt safe from sexual harm on the ward?
  2. If you did not feel safe from sexual harm at any point, would you feel able to speak to someone about it?

Two thirds

of those affected in sexual incidents were patients, about one third were staff, a few were visitors

Staff on participating wards will also meet every couple of months to share ideas and best practice, and take part in what Mr Ayers refers to as ‘a community of improvement’.

‘We will be trying to change the culture on wards to one that is sexually safe. It is not about persecuting people or bringing in sets of rules.’

Referring to the standards, Professor Hughes says they will fill a void: ‘Nothing existed before, so having a set of standards will act as a driver and help give people permission to legitimise these discussions.’

She says three quarters of the sexual incidents in the CQC report related to inappropriate behaviour, such as people being naked on a ward or exposing themselves, due to people being acutely unwell as opposed to allegations of sexual offences.

About one quarter of reported incidents, 273, were recorded as ‘sexual assault’. There were 29 allegations of rape, one in 40 of the incidents.

‘Sexual offences are extremely rare,’ she cautions. ‘We don’t want people to be scared to go into hospital. We have a responsibility to ensure people feel safe in our care. The standards and the improvement initiative will help guide local initiatives on this important topic.’

Case study: service user coercion

After John’s wife developed postpartum psychosis following the birth of their second child, she was admitted to hospital.

He later discovered what had happened to her there, described in the Care Quality Commission report on sexual safety on mental health wards.

‘At a later date there was a tribunal to review my wife’s detention, and I was shocked to hear from a solicitor that she had performed oral sex on a male patient.

'She had not been kept safe in hospital’

'I was very distressed that my wife, who the tribunal said was “likely to put herself at risk by sexual inhibition”, had not been kept safe in hospital.’

At the time of the incident, John’s wife lacked capacity and was on high levels of medication.

‘I later found out that the two nurses on duty that night failed to inform the police, an action I felt was necessary as I believed my wife had been sexually assaulted as she had been coerced into performing a sexual act without her consent.

‘The experience was traumatic to me, and to my wife.’


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