By Niamh Molloy, Image by Marcelo Leal on unsplash
Content warning: The following article contains mention of self-harm, body shaming and degrading and violent behaviour towards vulnerable patients which some readers may find distressing
Throughout September and October, Instagram is full of posts addressing ‘Suicide Prevention Awareness Month’ or ‘World Mental Health Awareness Day’. While it is positive that resources are being shared and conversations are spawning, it isn’t enough. Throughout history, society has failed those struggling with their mental health by using them for ‘entertainment’ or locking them up and throwing away the key. Unfortunately, this still happens in the 21st century Britain. After multiple allegations from whistle-blowers about the behaviour of staff and concerns about patient safety at the Edenfield Centre, the BBC investigated in a Panorama episode titled ‘Undercover Hospital: Patients at Risk’. The findings were truly horrific.
Alan Haslam, the undercover reporter, received months of training from healthcare workers to ensure he was able to provide basic-level care to patients, but NHS Greater Manchester Mental Health didn’t know this. They gave him one day of online training before thrusting him onto the eleven wards of the Edenfield Centre, a medium security psychiatric hospital that holds 200 patients deemed to be at serious risk of harming themselves or others. Alan worked 12 hours shifts as a healthcare support worker and received minimum wage pay of £9.51 an hour, less than some supermarkets pay staff. He was left shaking and distraught, claiming “Nothing has ever upset me more.”
The Edenfield Centre claims to provide “individualised care and treatment” where “Service users have access to a wide range of activities to support their recovery” but the documentary painted a very different picture. Alan claimed that for most patients it is “an excruciatingly mundane existence, where all there is to do is sit and watch music videos and vape”. Psychiatric facilities like Edenfield are supposed to provide education and life-skills, encourage exercise and opportunities to take up new hobbies to aid recovery and help their patients truly ‘live’ rather than just survive, but the reality is often much more distressing and traumatic with constant noise, a lack of freedom and privacy, interrupted sleep and no control over meals and medication.
Patients have their own rooms at Edenfield, but are sometimes locked in a more secure area known as ‘seclusion’. Seclusion is only supposed to be used to isolate patients when they are viewed as being an immediate risk to themselves or others, and for the shortest time necessary. It is in line with British and human rights law, only when “used proportionately, in accordance with the law, and only ever as a last resort”. Over the last four years, the number of seclusions recorded by hospitals in England has almost doubled, from 8,000 to just over 14,000. Staff at the Edenfield Centre have been part of this problem and have put patients in unnecessarily stressful and unpleasant situations. These seclusion rooms are cramped, dark and “smell like sewage.” How can we put highly vulnerable, often very ill patients in such a horrific environment and expect them to get better? During Alan’s time undercover, he saw ten patients in seclusion, many for weeks on end. One patient named Alice had been kept in isolation for over a year. She was allowed two teddy bears and very little else. “She has only seen other people through a little pane of glass” and hasn’t been allowed to leave the tiny room in over 12 months. We don’t even do this to our most dangerous and violent prisoners so how can we claim to ‘care’ for patients or be providing treatment by treating them like this?
The behaviour of staff at Edenfield was truly horrifying to watch; they regularly went for naps while on shift, tickled and sexualised patients, falsified records for observations and degraded and dehumanised those they were supposed to be looking after. When Alan asked for advice on how to manage a patient repeatedly hitting her head off a wall, the other support worker responded with “She does that all the time- each to their own” before laughing and walking away. Another patient would have been given a double-dose of her antipsychotic medication- enough to kill her- if she hadn’t insisted that she had already received it. Many patients require assistance when going to the bathroom and are often body-shamed and humiliated for needing this care. One support worker told a patient that he would turn around when she undressed because he didn’t “want to be mentally scarred again. Nightmare me, nightmares.” It is common for patients at Edenfield to have histories of self-harm and struggles with body image so to shame, degrade and bully them is horrifying especially when the perpetrators are employed to care for them. Not only was the language and manner used when interacting with patients completely disgusting, it was a breach of Article 3 of the Human Rights Act – freedom from torture and inhuman or degrading treatment. How can patients be expected to recover in a facility where their basic human rights are violated?
Although the whole programme was quite disturbing to watch, the most distressing part was the practice of restraining patients. Under the Mental Health Units (Use of Force) Act (2018), staff can use reasonable force if patients refuse to co-operate or put themselves or others at risk, but Edenfield and other psychiatric facilities use excessive force that increases distress and risk of injury. Between 2016 and 2017, nearly 2,000 members of staff and over 500 patients were injured in England during restraints- which were happening on average once every 10 minutes. Staff at Edenfield used force without having conversations with patients first and as one patient said “Staff provoke a patient, and then my reaction is used against me but they’re provoking us.”. Patients’ limbs and heads were aggressively manoeuvred and manipulated and they were reduced to a series of body parts instead of being seen as people. Alan was left distraught by one patient’s restraint and said that “She cried like I have never heard a person cry and I never want to hear a person cry like that again.”. Under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 10 (Dignity and respect) patients are entitled to care, humanity and respect. This simply didn’t happen at Edenfield.
The scenes of the BBC documentary were chilling; patients were regularly treated as though they weren’t human. Managing the care of vulnerable patients at serious risk of harming themselves or others is a challenging task, but it does not excuse the behaviour of staff at Edenfield, and the human rights abuses that appeared to take place. The Mental Health Act (1983) is the legislation that allows people to be held and treated against their will if they are deemed to be a risk to society or themselves, but it does not give the right to assault or ridicule patients. Staff at Edenfield routinely ignored the Mental Health Act, the Equality Act (2010) and the Human Rights Act (1998), and basic values of human compassion and respect. Neglect, unnecessary force and restraint and degrading and disrespectful language and actions were clearly routine behaviour at the Edenfield Centre and severe breaches of care expectations and the law were normalised. Human rights are for exactly that, for humans. People do not lose their humanity when sectioned, so why do staff at Edenfield, and in countless psychiatric facilities across the country, treat them in such inhumane ways that go against all codes of conduct and mental health and human rights laws?
In amongst the abuse, moments of compassion and tenderness between staff and patients were captured that remind us, underneath it all, they are still human. Working in mental health services is an extremely demanding job, both physically and emotionally, and these hospitals are extremely underfunded and understaffed- almost 1 in 5 mental health nursing posts are currently vacant. While this may help us to understand some poor behaviour, it certainly doesn’t justify the degrading and abusive behaviour of staff shown in the documentary. NHS England were horrified by the findings and have suspended and fired numerous members of staff and Greater Manchester Police have opened a criminal investigation into staff members at Edenfield. While this is progress, it shouldn’t take hidden cameras and undercover reporters to ensure abuse is exposed and make sure that patients are treated with dignity and respect. As Alan said about one patient, “How’s she going to trust anybody, you know, if the people that are supposed to be looking after her in hospital treat her like that?” What BBC Panorama exposed wasn’t care, wasn’t treatment, wasn’t legal. These are some of the NHS’ most vulnerable patients and this is how they have been treated. They lack a voice, they aren’t listened to, they aren’t believed, and they aren’t safe. We cannot allow this to continue.
If you are struggling with your mental health or with self-harm, information and resources can be found with the link below:
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