Count Me In Mental Health and Ethnicity Census 2013 Report by Business Delivery Units

Count Me In Mental Health and Ethnicity Census 2013 Report by Business Delivery Units Report commissioned by: Dawn Stephenson, Director of Corporate Development June 2013 Report produced by: Suzy Daly Clinical Audit Facilitator

CONTENTS EXECUTIVE SUMMARY... 1 1. INTRODUCTION... 5 1.1 Aim... 5 1.2 Objectives... 5 1.3 Methodology... 5 1.4 Sample size... 5 1.5 Staff Involved... 6 2. INPATIENT RESULTS BY BUSINESS DELIVERY UNIT... 7 2.1 Gender... 7 2.2 Age Range... 8 2.3 Length of Admission... 10 2.4 Ethnic Category... 10 2.5 Legal Status... 12 2.6 Care Programme Approach... 14 2.7 Diagnosis... 14 2.8 Disability... 15 2.9 Sexual Orientation... 15 2.10 Marital status... 16 2.11 Preferred Language... 16 2.12 Religion and Faith... 17 2.13 Recorded Incidents... 17 2.14 Source of Referral... 20 3. CONCLUSIONS AND RECOMMENDATIONS... 22 3.1 Conclusions... 22 3.2 Recommendations... 22 APPENDICES: APPENDIX 1: Audit Tool... 23 APPENDIX 2:... 25 APPENDIX 3: Action Plan... 27 Page i

FIGURES: Figure 1: 2013 - Age range of respondents (n=439)... 9 Figure 2: Number of patients with recorded incidents... 19 Figure 3: Percentage of patients with recorded incidents by ethnicity 2013... 19 TABLES: Table 1: Business Delivery Unit... 7 Table 2: Gender... 7 Table 3: Ethnic category... 10 Table 4: Legal status on admission... 12 Table 5: Legal status on census day... 13 Table 6: Diagnosis... 14 Table 7: Disability... 15 Table 8: Sexual orientation... 15 Table 9: Marital status... 16 Table 10: Language... 16 Table 11: Religion... 17 Table 12: Recorded incidents by number of patients... 18 Table 13: Referral route... 20 Acknowledgements Grateful thanks to Andrew Devonport, John Marley, Victoria Hitchman and Liam Redican for their assistance in the production of this report. This report has been peer reviewed by Gillian Marley Please note: Percentages throughout this report may add up to +/- 100% due to rounding up/down. The term Patient or inpatient is used throughout the report and covers service users, clients, service participants and service representatives. This terminology has been used to match the language nationally used in the census. Page ii

EXECUTIVE SUMMARY provides a variety of services to a diverse population across the geographical localities and is committed to achieving the objectives set in the Mission, Vision and Goals. These objectives include: Improve the health and wellbeing of our service users and influence the wellbeing of the local people we serve Manage risk and deliver safe, high quality services Improve the service user experience, engaging individuals in the design and delivery of services Ensure that the Trust remains viable and sustainable into the future Improve the efficiency and productivity of our services in line with the best evidence based practice In March 2010, the Trust participated in the National Mental Health and Ethnicity Census ( Count Me In ). This survey is regarded as a key element of a national programme to improve services for patients from black and minority ethnic communities. The census was led by the Care Quality Commission and started in 2005 with the final census in 2010; its objective was to support the Department of Health's five-year action plan for improving mental health services for black and minority ethnic communities. Although the National survey is no longer compulsory for trusts, South West Yorkshire Partnership NHS Foundation Trust made the decision to commission the survey to take place in February 2013. The aims of the survey are to: Obtain robust baseline numbers of black and ethnic minority inpatients using mental health services on a given date Provide a comparison of results with previous years Investigate the extent to which providers of mental health care have implemented culturally sensitive, appropriate and responsive services The project includes all mental health inpatients (including patients on leave) at midnight on the 28 th February 2013 and includes: adult services, older people s services, learning disability and medium and low secure services. This report presents a summary of the results across all the participating mental health services in the Business Delivery Units of Calderdale, Kirklees, Wakefield, Barnsley and Forensics. The census was completed for a total of 440 inpatients, 289 (66%) male patients and 151 (34%) female patients on 34 wards. Page 1

% of inpatients % of inpatients Ethnic census 2013 - SD The following are some of the main overall results from the census: In 2013 75 male inpatients, (26% of the total male patients) and 21 female inpatients (14% of the total female inpatients) were from an ethnic background (all none white British excluding not stated/patient refused ). 100% 80% 60% 40% 20% 0% White British Ethnic background Not stated 83% 78% 78% 78% 77% 16% 20% 20% 20% 22% 1% 2% 2% 2% 2008 2009 2010 2012 2013 1% The percentage of patients detained has increased on census day from 55% in 2008 to 58% in 2010, 59% in 2012 and 62% in 2013 - this increase may be attributed partially to some patients being admitted as informal patients but who were later detained. 72/96 (75%) of the patients from an ethnic background were admitted under a section of the mental health act. formal admission 2012 detained on census day 2012 formal admission 2013 detained on census day 2013 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 46% 81% 81% 75% 75% 59% 59% 53% 51% 53% 56% White British Ethnic background Trust total 62% The percentage of male patients admitted under a section of the mental health act is 11% higher than female patients and also those in hospital and on a section on census day, is 16% higher than female patients. 97% of patients were on CPA, an increase of 4% from 2012. Page 2

% of inpatients Ethnic census 2013 - SD The number of patients, who were secluded, required constraint, or who were involved in at least one incident of assault, accident or self-harm, have increased from the percentages of 2012, and the percentage of patients from an ethnic background continues to be high for some recorded incidents (restraint, seclusion, assault): White British 2012 Ethnic background 2012 Trust total 2012 White British 2013 Ethnic background 2013 Trust total 2013 25% 20% 15% 10% 5% 13% 12% 11% 11% 10% 10% 10% 8% 8% 7% 3% 2% 18% 18% 16% 16% 14% 13% 20% 20% 18% 17% 15% 14% 5% 9% 11% 10% 8% 6% 0% self-harm accident assault restraint seclusion The main conclusions are: In 2013 75 male inpatients, (26% of the total male patients) and 21 female inpatients (14% of the total female inpatients) were from an ethnic background (all none white British excluding not stated/patient refused ). The percentage of patients detained has increased on census day from 59% in 2012 to 62% in 2013 - this increase may be attributed partially to some patients being admitted as informal patients but who were later detained. 427 (97%) of the total inpatients were recorded as having a mental health problem 262 (97%) of total male and 157 (96%) of total female inpatients. 68/96 (71%) of the patients from an ethnic background were heterosexual, 1 person stated they were gay and 1 person stated they were bisexual and for 30 (31%) this was not known. The main recommendations are: Presentation of the report to the Equality and Inclusivity Trust Action Group and to the Business Delivery Units. Action plans to be produced by Business Delivery Units. Page 3

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1. INTRODUCTION is committed to undertake an annual audit and service evaluation programme. On the 28 February 2013, the Trust agreed to undertake the sixth Mental Health and Ethnicity Count Me In census although this was no longer a national requirement. The purpose of the survey is to identify areas for improvement for patients from black and minority ethnic communities. This report presents a summary of results for the Business Delivery Units (BDU) from the census. Several new were questions included on marital status, pregnancy and gender reassignment. 1.1 Aim To provide a snapshot of census information on all inpatients within the Trust on a particular date. 1.2 Objectives The main objectives of the audit are: To provide patient information on ethnicity, language, religion and sexuality to support future service provision. To make a comparison where possible with the results of previous census information in particular 2010. 1.3 Methodology The census sheet (see Appendix 1) was produced nationally with a guidance sheet and was used to record census information for each inpatient on the ward or on leave at midnight on the 28 February 2013. Some of the information was provided centrally from the Performance and Information team, some had to be completed by staff from their records and some by staff in conjunction with the patient or relative. In order to maintain confidentiality the census sheets were hand delivered and collected. 1.4 Sample size The census was to be completed for all inpatients including Adult Services, Older People s Services, Learning Disability Services and Medium and Low Secure Services. A total of 440 census sheets were completed for inpatients. Page 5

1.5 Staff Involved Dawn Stephenson Gillian Marley Suzy Daly Zahida Mallard Andrew Devonport Victoria Hitchman John Marley Ian Noble Director of Corporate Development Project Lead CGST Clinical Audit Facilitator Equality & Inclusion Development Manager Senior Systems Analyst CGST Information and Project Support Officer CGST Information and Project Support Officer CPA Coordinator Barnsley Page 6

2. INPATIENT RESULTS BY BUSINESS DELIVERY UNIT The benchmark was set in 2005 with the first Trust wide ethnic census of inpatients. There have been some changes in both the data required and the population therefore it is impossible to make a full comparison with the whole of the census information for the last 2 years of the National and local Census (2010 and 2012). The total inpatient population on the 28 February 2013 was 440; this is split by Business Delivery Unit (BDU) with Learning Disability Services being shown as part of the Wakefield BDU and Barnsley as a separate BDU. It must be noted that low secure services are included within the results for the Forensic BDU. Table 1: Business Delivery Unit Business Delivery Unit 2010 2012 2013 Forensic 118 133 134 Calderdale 50 48 49 Kirklees 102 101 101 Wakefield 131 114 116 Barnsley N/A 39 40 Total 401 435 440 2.1 Gender N/A not applicable 2013 440 inpatients 289 (66%) male, 151 (34%) female patients 2012 435 inpatients 271 (62%) male, 164 (38%) female patients 2010 401 inpatients 245 (61%) male, 156 (39%) female patients The age range and gender has remained constant over the last 5 years. Table 2: Gender Business Delivery Unit 2010 (n=401) 2012 (n=435) 2013 (n=440) Male Female Male Female Male Female Forensic 105 (89%) 13 (11%) 119 (90%) 14 (10%) 121 (90%) 13 (10%) Calderdale 21 (42%) 29 (58%) 17 (35%) 31 (65%) 27 (55%) 22 (45%) Kirklees 48 (47%) 54 (53%) 44 (44%) 57 (56%) 51 (51%) 49 (49%) Wakefield 71 (54%) 60 (46%) 65 (57%) 49 (43%) 67 (58%) 49 (42%) Barnsley 26 13 23 17 N/A N/A (67%) (33%) (57%) (43%) Trust wide 245 (61%) 156 (39%) 271 (62%) 164 (38%) 289 (66%) 151 (34%) Page 7

As part of the questions, some additional categories were included as follows: Female inpatients were asked if they are pregnant or have given birth within the last 12 months. This is the first year that this question has been included in the census. 6/151 (4%) stated they had given birth within the last 12 months (1 from Wakefield, 1 from Kirklees and 4 from Calderdale). Two were from an ethnic background. Inpatients were asked if they live and work in a gender other than that assigned at birth. This is the first year that this question has been included in the census. The majority 393/440 (89%) specified no and 47/440 (11%) stated not known. There were no positive responses. 2.2 Age Range The ages of the inpatients ranged from 19 to 97 years. One person s age was not specified in the Barnsley BDU. Figure 1 (overleaf) shows the age range by BDU for 2013. The age ranges for 2008, 2009, 2010 and 2012 are similar for the main group of inpatients aged between 25 and 54: 2013 269/439 aged between 25 and 54 61% 2012 248/435 aged between 25 and 54 57% 2010 227/401 aged between 25 and 54 57% 2009 214/385 aged between 25 and 54 56% 2008 213/410 aged between 25 and 54 52% Page 8

Number of respondents Ethnic census 2013 - SD Figure 1: 2013 - Age range of respondents (n=439) 105 100 95 90 85 80 75 70 65 Forensic Calderdale Kirklees Wakefield Barnsley Trust total 2013 Trust total 2012 Trust total 2010 Trust total 2009 Trust total 2008 60 55 50 45 40 35 30 25 20 15 10 5 0 16-24 25-34 35-44 45-54 55-64 65-74 75-84 85-94 95+ Age range *One patient in Barnsley did not specify their date of birth The results show the age split across the Trust as follows: 2013 (n=439) 35 aged between 16 and 24 8% 90 aged between 25 and 34 21% 103 aged between 35 and 44 24% 76 aged between 45 and 54 17% 53 aged between 55 and 64 12% 35 aged between 65 and 74 8% 35 aged between 75 and 84 8% 11 aged between 85 and 94 3% 1 aged 97 2% Page 9

The following results show the highest percentage of patients in a particular age range by BDU: 2013 Barnsley (n=39) 28% aged between 45 and 54 Calderdale (n=49) 18% aged between 35 and 44 Kirklees (n=101) 22% aged between 35 and 44 Wakefield (n=116) 17% aged between 35 and 44 Forensic (n=134) 34% aged between 25 and 34 Trust (n=439) 23% aged between 35 and 44 2.3 Length of Admission The length of admission for the inpatients ranged from 1 day for some patients who had been admitted on the 28 th to 11 years for one patient from Newton Lodge. 2.4 Ethnic Category The following table shows the categories for the question on ethnicity: Table 3: Ethnic category Ethnic Category Forensic (n=134) Calderdale (n=49) Kirklees (n=101) Wakefield (n=116) Barnsley (n=40) 2010 (n=401) 2012 (n=435) 2013 (n=440) White British 79 (59%) 41 (84%) 75 (74%) 106 (91%) 39 (98%) Caribbean black or black British Pakistani Asian or Asian British Indian Asian or Asian British Irish White & any other white background White & Black Caribbean, African & Asian Bangladeshi & other Asian African & other black background Other ethnic group * Not stated/patient refused 312 (78%) 341 (78%) 340 (77%) 11 (8%) - 9 (9%) - - 23 (6%) 20 (5%) 20 (5%) 16 (12%) 3 (6%) 7 (7%) 2 (2%) - 27 (7%) 29 (7%) 28 (6%) 4 (3%) - 3 (3%) 2 (2%) - 9 (2%) 5 (1%) 9 (2%) 4 (3%) 3 (6%) 1 - - 13 (3%) 15 (3%) 8 (2%) 10 (7%) - 1 2 (2%) - 4 (1%) 6 (1%) 13 (3%) 4 (3%) - 1 1-3 (1%) 2 (1%) 6 (1%) 3 (2%) - 1 - - 3 (1%) 7 (2%) 4 (1%) 1 1 3 (3%) 2 (2%) 1 1 2 (1%) 8 (2%) 2 (2%) 1-1 - 6 (2%) 8 (2%) 4 (1%) *Other ethnic groups/mixed backgrounds were: Chinese. In 2013 75 male inpatients, (26% of the total male patients) and 21 female inpatients (14% of the total female inpatients) were from an ethnic background (all none white British excluding not stated/patient refused ). In 2013-36% of the male inpatients aged between 25 and 34 were from an ethnic background compared to 24% of female inpatients in this age group. In 2012 61 male inpatients, (23% of the total male patients) and 25 female inpatients (15% of the total female inpatients) were from an ethnic background (all none white British excluding not stated/patient refused ). Page 10

In 2012-48% of the male inpatients aged between 16 and 34 were from an ethnic background compared to 20% of female inpatients in this age group. In 2010-58 male inpatients, (24% of the total male patients) and 25 female inpatients (16% of the total female inpatients) were from an ethnic background (all none white British excluding not stated/patient refused ). 30% of the male inpatients aged between 16 and 34 were from an ethnic background. In 2009, 57 male inpatients, (23% of the total male patients) and 21 female inpatients (16% of the total female inpatients) were from an ethnic background. 28% of the male inpatients aged between 18 and 34 were from an ethnic background. In 2008 17% of the male patients and 13% of the female patients were from an ethnic background. The way that the patients ethnicity was assessed is detailed below, the options were by the patient, by the staff, by the relative or not assessed. 13 patients from Forensic and 1 from Kirklees did not have their ethnicity assessed. Trust 2013 88% of inpatients assessed own ethnicity 2012 87% of inpatients assessed own ethnicity 2010 88% of inpatients assessed own ethnicity 2009 77% of inpatients assessed own ethnicity 2008 74% of inpatients assessed own ethnicity Forensic 2013 84% of inpatients assessed own ethnicity 2012 96% of inpatients assessed own ethnicity 2010 98% of inpatients assessed own ethnicity Calderdale 2013 84% of inpatients assessed own ethnicity 2012 100% of inpatients assessed own ethnicity 2010 100% of inpatients assessed own ethnicity Kirklees 2013 90% of inpatients assessed own ethnicity 2012 69% of inpatients assessed own ethnicity 2010 71% of inpatients assessed own ethnicity Wakefield 2013 89% of inpatients assessed own ethnicity 2012 86% of inpatient assessed own ethnicity 2010 89% of inpatient assessed own ethnicity Barnsley 2013 98% of inpatients assessed own ethnicity 2012 90% of inpatient assessed own ethnicity Page 11

2.5 Legal Status The legal status of the inpatients on admission and census day is shown for 2013 by BDU with a comparison of the totals for 2010 and 2012. Table 4: Legal status on admission Legal Status On admission Forensic (n=134) Calderdale (n=49) Kirklees (n=101) Wakefield (n=116) Barnsley (n=40) 2010 (n=401) 2012 (n=432) 2013 (n=440) Informal 6 (5%) 32 (65%) Section 2 5 (4%) 7 (14%) Section 3 34 (25%) 9 (18%) 63 (62%) 23 (23%) 13 (13%) 72 (62%) 20 (50%) 184 (46%) 201 (47%) 193 (44%) 30 (26%) 12 (30%) 65 (16%) 63 (15%) 77 (18%) 11 (10%) 7 (18%) 76 (19%) 72 (17%) 74 (17%) Section 4 - - 1 1-1 1 2 Section 5.2 - - - - - 1 - - Section 35 4 (3%) 1 - - - 6 (2%) 7 (2%) 5 (1%) Section 36 1 - - - - 2 1 1 Section 37/41 39 (29%) - - 1-19 (5%) 33 (8%) 40 (9%) Section 37 9 (7%) - - - - 10 (3%) 18 (4%) 9 (2%) Section 38 6 (5%) - - - - 5 7 (2%) 6 (1%) Section 47/49 Section 48/49 11 (8%) - - - - 15(4%) 9 (2%) 11 (3%) 17 (13%) - - - - 16 (4%) 10 (2%) 17 (4%) Section 47 2 (2%) - - - - 2 Section 48 - - - - - - 1 - Section 136 - - - - - - 1 - Section 17a - - - - 1-3 (1%) 1 Criminal courts act (S3) - - 1 1-1 5 (1%) 2 The percentage of patients admitted under a section of the mental health act has shown an increase of 3% from 53% in 2012 to 56% in 2013. The percentage of patients detained has increased on census day from 59% in 2012 to 62% in 2013 - this increase may be attributed partially to some patients being admitted as informal patients but who were later detained. Page 12

Table 5: Legal status on census day Legal Status On admission Forensic (n=134) Calderdale (n=49) Kirklees (n=101) Wakefield (n=116) Barnsley (n=40) 2010 (n=401) 2012 (n=432) 2013 (n=440) Informal - 24 (49%) 65 (64%) 60 (52%) 18 (45%) 184 (46%) 201 (47%) 167 (38%) Section 2-4 (8%) 12 (12%) 22 (19%) 6 (6%) 65 (16%) 63 (15%) 44 (10%) Section 3 35 (26%) 20 (41%) 23 (23%) 28 (24%) 15 (38%) 76 (19%) 72 (17%) Section 4 - - - - - 1 1 - Section 5.2 - - - - - 1 - - Section 35 1 - - - - 6 (2%) 7 (2%) 1 Section 36 - - - - - 2 1 - Section 37/41 Section 37 65 (49%) 13 (10%) 121 (28%) 1 - - - 19 (5%) 33 (8%) 66 (15%) - - 1-10 (3%) 18 (4%) 14 (3%) Section 38 1 - - - - 5 7 (2%) 1 Section 47/49 Section 48/49 9 (7%) - - - - 15(4%) 9 (2%) 9 (2%) 6 (5%) - - - - 16 (4%) 10 (2%) 6 (1%) Section 47 1 - - - - 1 Section 48 - - - - - - 1 - Section 136 - - - - - - 1 - Section 17a 2 (2%) - 1 - - - 3 (1%) 3 (1%) Criminal courts act (S3) In 2013: 1 - - 5 (4%) 1 1 5 (1%) 7 (2%) 247/440 (56%) of patients were admitted under a section of the Mental Health Act, 26/247 (11%) of patients then became informal prior to census day (a 1% increase from 2012), 221/247 (89%) remained under a section on census day. 193/440 (44%) of patients were admitted informally, 26/193 (13%) were then detained under a section prior to census day, whilst 167/193 (87%) remained informal on census day (an increase of 9% from 2012). In 2013: 173/289 (60%) of the male inpatients were admitted under a section of the mental health act and 74/151 (49%) of the female inpatients. 195/289 (68%) of the male inpatients were in hospital under a section of the mental health act on census day and 78/151 (52%) of the female inpatients. 72/96 (75%) of the patients from an ethnic background were admitted under a section of the mental health act. Page 13

2.6 Care Programme Approach In 2013 429/440 (97%) patients were on CPA of the 11 patients who were not on CPA - 3 were from Barnsley, 1 from Calderdale, 3 from Wakefield and 4 from Forensic. 2.7 Diagnosis The reason for being in hospital was recorded as mental health, learning disability or personality disorder. Some patients were recorded as having more than one diagnosis: 427 (97%) of the total inpatients were recorded as having a mental health problem 280 (97%) of total male and 147 (97%) of total female inpatients. 42 (10%) of the total inpatients were recorded as having a learning disability. 26 (6%) of the total inpatients were recorded as having a personality disorder. 51 (12%) of the total inpatients were recorded as having a combination of reasons for being in hospital 42 male and 9 female. 95/96 (99%) inpatients recorded as being from an ethnic background had a mental health diagnosis, 10 (10%) had a learning disability, 3 (3%) patients had a diagnosis of personality disorder, and 11 had a combination of diagnoses. Table 6: Diagnosis Diagnosis Forensic (n=134) Calderdale (n=49) Kirklees (n=101) Wakefield (n=116) Barnsley (n=40) 2010 (n=401) 2012 (n=435) 2013 (n=440) Mental Health Problem Learning Disability Personality Disorder 130 (97%) 49 (100%) 98 (97%) 114 (98%) 36 (90%) 394 (98%) 419 (96%) 427 (97%) 35 (26%) 1-6 (5%) - 22 (6%) 24 (6%) 42 (10%) 10 (8%) - 4 (4%) 11 (10%) 1 16 (4%) 15 (3%) 26 (6%) Combination 36 (27%) 1 2 12 (10%) - 31 (8%) 26 (6%) 51 (12%) *In 4 cases (3 Barnsley, 1 Kirklees), the diagnosis was not completed *It must be noted that some patients had more than one diagnosis Page 14

2.8 Disability It was noted on the census sheet if a patient had one or more disabilities. Table 7: Disability Disability Forensic (n=134) Calderdale (n=49) Kirklees (n=101) Wakefield (n=116) Barnsley (n=40) 2010 (n=401) 2012 (n=432) 2013 (n=440) Blind or sight impairment Deaf or hearing impairment Learning Disability Autistic spectrum disorder or Asperger s syndrome Wheelchair or mobility impairment 19 (14%) 6 (12%) 24 (24%) 26 (23%) 3 (8%) 85 (21%) 80 (19%) 78 (18%) 6 (5%) 4 (8%) 8 (8%) 18 (15%) 3 (8%) 44 (11%) 32 (7%) 39 (9%) 37 (28%) 3 (6%) 1 9 (8%) 2 (5%) 37 (9%) 51 (12%) 52 (12%) 13 (10%) 2 (4%) - 5 (4%) - 5 (1%) 9 (2%) 20 (5%) 5 (4%) 4 (8%) 17 (17%) 15 (13%) 4 (10%) 31 (8%) 30 (7%) 45 (10%) 3 patients were registered as blind (1 from Wakefield, 1 from Kirklees and 1 from Calderdale). 8 patients were registered as deaf (2 from Wakefield, 1 from Kirklees, 2 from Forensic and 3 from Calderdale), one was from an ethnic background. 13 patients with a learning disability were from an ethnic background and 6 patients with Autistic Spectrum Disorder or Asperger s Syndrome were from an ethnic background. 14 patients used a wheelchair (5 from Wakefield, 5 from Kirklees, 3 from Forensic and 1 from Calderdale); two were from an ethnic background. 2.9 Sexual Orientation Inpatients were asked about their sexual orientation. Table 8: Sexual orientation Sexual Orientation Forensic (n=134) Calderdale (n=49) Kirklees (n=101) Wakefield (n=116) Barnsley (n=40) 2010 (n=401) 2012 (n=432) 2013 (n=440) Heterosexual 79 (59%) 43 (88%) 92 (91%) 68 (59%) 32 (80%) Lesbian or gay 294 (73%) 283 (66%) 314 (71%) 2 (2%) - 1 1-1 4 (1%) 4 (1%) Bisexual 4 (3%) - - 1-5 (1%) 4 (1%) 5 (1%) Other - - - - - 1 3 (1%) - Not known 49 (37%) 6 (12%) 8 (8%) 46 (40%) 8 (20%) 100 (25%) 138 (32%) 117 (27%) Page 15

66/96 (69%) of the patients from an ethnic background were heterosexual, 1 person stated they were gay and 1 person stated they were bisexual and for 28 (29%) this was not known. 2.10 Marital status For the first time inpatients were asked about their marital status. A higher percentage of inpatients (65%) were single, and only 1 inpatient specified they were in a same sex/civil partnership. Table 9: Marital status Marital status Forensic (n=134) Calderdale (n=49) Kirklees (n=101) Wakefield (n=116) Barnsley (n=40) 2013 (n=440) Single 119 (89%) 24 (49%) 53 (53%) 60 (52%) 28 (70%) 284 (65%) Married 6 (5%) 13 (27%) 19 (19%) 24 (21%) 5 (13%) 67 (15%) Same sex/civil partnership - - - 1-1 Separated 2 (2%) 1 4 (4%) 1-8 (2%) Divorced 5 (4%) 6 (12%) 8 (8%) 16 (14%) 1 36 (8%) Widowed 1 2 (4%) 13 (13%) 10 (9%) - 26 (6%) Not disclosed 1 3 (6%) 4 (4%) 4 (3%) 6 (15%) 18 (4%) 2.11 Preferred Language The first or preferred language was recorded on the census as follows: Table 10: Language Language Forensic (n=134) Calderdale (n=49) Kirklees (n=101) Wakefield (n=116) Barnsley (n=40) 2010 (n=401) 2012 (n=435) 2013 (n=440) English 128 (96%) 48 (98%) 95 (94%) 113 (97%) 40 (100%) 392 (98%) 424 (98%) Gujarati - - 1 - - 1 1 1 Polish 1-1 - - 1 1 2 424 (96%) Punjabi 1-2 (2%) - - 3 1 3 (1%) Russian - - - - - - 1 - Urdu - 1 1 - - 3 3 (1%) 2 Any other language 4 (3%) - 1 3 (3%) - 1 4 (1%) 8 (2%) Other languages included Farsi, Hindi, Indian, Kurdish, Hungarian, Eretria and Pashtu. 8 patients required an interpreter (Wakefield, Forensic, Calderdale & Kirklees) and 3 (Forensic and Kirklees) sometimes required an interpreter. The percentage of patients with a first or preferred language of English has decreased from 98% in 2012 to 96% in 2013. Page 16

2.12 Religion and Faith Patients were asked about their religion and faith: Table 11: Religion Religion Forensic (n=134) Calderdale (n=49) Kirklees (n=101) Wakefield (n=116) Barnsley (n=40) 2010 (n=401) 2012 (n=435) 2013 (n=440) Christian 74 (55%) 22 (45%) 57 (56%) 66 (57%) 16 (40%) 232 (58%) 252 (56%) 235 (53%) Muslim 21 (16%) 2 (4%) 9 (9%) 2 (2%) - 34 (9%) 33 (8%) 34 (8%) Hindu 3 (2%) - - - 1 2 (1%) 1 4 (1%) Buddhist 1 - - - 1 1 1 2 Jewish - - - - - 1 - - Sikh 1 1 1 1-2 (1%) 1 4 (1%) None 21 (16%) 4 (8%) 17 (17%) 22 (19%) 6 (15%) 42 (11%) 41 (9%) 70 (16%) Other * 4 (3%) - 4 (4%) 3 (3%) 3 (8%) 15 (4%) 12 (3%) 14 (3%) Not stated 9 (7%) 20 (41%) 13 (13%) 22 (19%) 13 (33%) 72 (18%) 94 (22%) 77 (18%) * Other religion was not specified The percentage of patients with a Christian religion or faith continues to decrease from 68% in 2008 to 53% in 2013. 2.13 Recorded Incidents The census also requested the number of recorded incidents for each inpatient in a variety of categories as follows: 43 (10%) patients had at least one incident of self-harm recorded; this is a slight increase of 2% from the 2012 percentage. 45 (10%) patients had been involved in at least one accident; this is a decrease of 1% from 2012. 77 (18%) patients had been involved in at least one assault; this is a slight increase of 4% from 2012. Hands on restraint had occurred on at least one occasion with 86 (20%) patients, this is an increase of 5% from 2012. 44 (10%) patients had been secluded on at least one occasion; this is a slight increase of 4% from 2012. A full breakdown by BDU can be seen on the following page. Page 17

Recorded Incidents Self harm 1 incident Self harm 2-4 incidents Self-harm 5 9 incidents Self harm 10+ Accident 1 incident Accident 2 4 incidents Accident 5-9 incidents Accident 10+ Assault 1 incident Assault 2 4 incidents Assault 5-9 incidents Assault 10+ Hands on restraint 1 incident Restraint 2 4 incidents Restraint 5-9 incidents Restraint 10+ Seclusion 1 incident Seclusion 2 4 incidents Seclusion 5 9 incidents Seclusion 10+ Ethnic census 2013 - SD Table 12: Recorded incidents by number of patients Forensic (n=134) Calderdale (n=49) Kirklees (n=101) Wakefield (n=116) Barnsley (n=40) 2010 (n=401) 2012 (n=435) 6 (5%) 2 (4%) 4 (4%) 17 (15%) - 20 22 2013 (n=440) 29 (67%) 2013 Ethnic background (n=96) 5 (4%) 2 (4%) - 1-4 7 8 (19%) 2 (2%) - - - 1-4 4 1 - - 1-4 (3%) - 3 3 5 (12%) - 4 (3%) 2 (4%) 4 (4%) 12 (10%) 1 27 34-6 (12%) 5 (5%) 2 (2%) 1 10 8 23 (51%) 14 (31%) - - 2 (2%) 3 (3%) - 5 3 5 (11%) - - - 1 2 (2%) - - 1 3 (7%) - 15 (11%) 7 (14%) 5 (5%) 20 (17%) 1 42 41 12 (9%) 4 (8%) - 3 (3%) 1 9 7 48 (62%) 20 (26%) 1 2 (2%) - 9 (9%) 3 (3%) 1 1 1 2 (2%) - 6 6 5 (6%) 3 (3%) 1 2 (4%) - 1-5 7 4 (5%) - 20 (15%) 6 (12%) 4 (4%) 17 (15%) 7 (18%) 41 38 9 (7%) - - 3 (3%) 2 (5%) 14 10 54 (63%) 14 (16%) 9 (9%) 3 (3%) 4 (3%) 1 1 2 (2%) - 11 7 8 (9%) 2 (2%) 3 (2%) 2 (4%) - 5 (4%) - 7 11 9 (7%) 2 (4%) 3 (3%) 11 (10%) 4 (10%) 15 21 10 (12%) 29 (66%) 2 (2%) - - 1 1 6 3 4 (9%) 1 4 (3%) 1-1 - 3 1 6 (14%) 1 3 (3%) 3 (3%) 2 (2%) 2 (4%) - 1-2 1 5 (11%) 3 (3%) Page 18

% of inpatients Number of patients Ethnic census 2013 - SD The following chart gives a comparison for the last 5 years (2008 n=410, 2009 n=385, 2010 n=401, 2012 n=435, 2013 n=440): Figure 2: Number of patients with recorded incidents 100 90 2008 2009 2010 2012 2013 86 80 77 73 70 60 62 61 58 53 52 66 50 40 30 20 43 36 31 17 18 46 45 42 38 37 47 44 26 26 22 16 10 0 self-harm accident assault restraint seclusion The following chart shows the 2013 results split by the percentage of patients from an ethnic background, the percentage of white British and the percentage of inpatients in the Trust that had a recorded incident: Figure 3: Percentage of patients with recorded incidents by ethnicity 2013 25% White British Ethnic background Trust total 20% 18% 18% 20% 18% 20% 16% 15% 10% 12% 13% 10% 10% 11% 8% 10% 5% 3% 2% 0% self-harm accident assault restraint seclusion Page 19

2.14 Source of Referral The source of referral was recorded as shown below: Table 13: Referral route Source of Referral Forensic (n=134) Calderdale (n=49) Kirklees (n=101) Wakefield (n=116) Barnsley (n=40) 2010 (n=401) 2012 (n=435) 2013 (n=440) General Practitioner Local Authority/Social Services Accident & Emergency dept - - - 2 (2%) 1 4 (1%) 1 3 (1%) - - 1 2 (2%) - 3 (1%) 3 (1%) 3 (1%) - 2 (4%) 1 2 (2%) 3 (8%) 4 (1%) 4 (1%) 8 (2%) Police 1 2 (4%) 2 (2%) 2 (2%) 1 8 (2%) 10 (2%) 8 (2%) Other clinical specialty 7 (5%) 2 (4%) 4 (4%) 6 (5%) 2 (5%) 31 (8%) 22 (5%) 21 (5%) Carer - - 1 - - 5 (1%) - 1 Courts 15 (11%) - - - - 5 (1%) 14 (3%) 15 (3%) High security 2 (2%) - - - - 6 (2%) 3 (1%) 2 Medium security NHS Community Team Mental Health Community Team Learning Disabilities Prison Medium security independent Other inpatient service NHS Other inpatient service independent Unknown 5 (4%) - - - - 1 4 (1%) 5 (1%) 12 (9%) 34 (69%) 78 (77%) 80 (69%) 25 (63%) 178 (44%) 216 (50%) 229 (52%) 4 (3%) - - - - 1 5 (1%) 4 (1%) 22 (16%) - - 1-25 (6%) 24 (6%) 23 (5%) - - - - - 2 - - 31 (23%) 16 (12%) 19 (14%) 8 (16%) 10 (10%) 12 (10%) 7 (18%) 41 (10%) 61 (14%) 68 (16%) - - 2 (2%) - 22 (6%) 22 (5%) 18 (4%) 1 4 (4%) 7 (6%) 1 64 (16%) 41 (9%) 32 (7%) Self - - - - - - 4 (3%) - Employer - - - - - 1 1 - Page 20

In 2013 the 96 patients from an ethnic background were recorded as being referred from the following sources: 40 Community team mental health (inc 2 CTLD) 18 Other inpatient service NHS 9 Unknown 14 Prison 6 Courts 2 Other inpatient service independent 3 Other clinical speciality 1 Police 3 Local Authority/Social services, A & E and High Security Page 21

3. CONCLUSIONS AND RECOMMENDATIONS 3.1 Conclusions The main conclusions are: In 2013 75 male inpatients, (26% of the total male patients) and 21 female inpatients (14% of the total female inpatients) were from an ethnic background (all none white British excluding not stated/patient refused ). The percentage of patients detained has increased on census day from 59% in 2012 to 62% in 2013 - this increase may be attributed partially to some patients being admitted as informal patients but who were later detained. 427 (97%) of the total inpatients were recorded as having a mental health problem 262 (97%) of total male and 157 (96%) of total female inpatients. 68/96 (71%) of the patients from an ethnic background were heterosexual, 1 person stated they were gay and 1 person stated they were bisexual and for 30 (31%) this was not known. 3.2 Recommendations The main recommendations are: Presentation of the report to the Equality and Inclusivity Trust Action Group and to the Business Delivery Units. Action plans to be produced by Business Delivery Units. Page 22

APPENDIX 1: Audit Tool Page 23

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APPENDIX 2: The (CGST) is a multi-disciplinary consultancy and project management team with a wealth and diversity of expertise, established to promote and facilitate clinical governance and practice effectiveness throughout the Trust. The aim of the department is to facilitate the provision of high quality services in line with the principles of Clinical Governance and to support the Trust s mission, vision, values and goals. The works through partnerships with clinical and non-clinical staff, service users and carers, health and social care providers, universities and educational providers and voluntary agencies Service Practice Effectiveness Advice Surgeries Project Management Links with Trust groups Training and Development Risk Strategy Library Health Promotion Resource & Information Centre Clinical Governance Description of services/resources Promoting practice effectiveness through supporting staff to develop evidence based practice Providing advice, expertise and encouragement to staff wanting to undertake project work including service development, audit and service evaluation Delivery of localised and trust-wide commissioned projects within the clinical governance agenda, linking services or professions across any number of areas. Monitoring of project activity across the Trust and reporting of audit and evaluation priorities twice yearly to the CASE work stream of the Practice Effectiveness TAG Linking in and supporting the Trust Care groups and Trust Action Groups Supporting and developing the skills of staff through clinical governance training, advice surgeries and action learning. Supporting the involvement of service users and carers in audit and evaluation through training, learning and development. Support the organisation s risk strategy Loan service (books; Journals; CD.ROMS; etc ) access to Intranet, Internet, electronic databases, Inter-library loans; study facilities and electronic database training. Loan service (DVDs; videos, resource packs, anatomical charts and models, AV equipment, display boards; etc ); health promotion leaflets and posters. Support the monitoring of clinical governance through the annual report, action plan and the monitoring of the performance against the plan and through the membership of various trust groups. The team currently covers the full geographical area of the Trust. Location and contact details of all members of the team are as follows: Personnel Role Contact details Gillian Marley Liam Redican Marie Dawson Victoria Hitchman CGST Lead Project Manager Patient Experience Information Management & Project Support Officer Information Management & Project Support Officer CGST, Castleford, Normanton & District Hospital, Lumley Street, Castleford, WF10 5LT Tel: 01977 628065 Hazel Baxter CGST Lead CGST, SWYT, 4 th Floor, F Mill, Dean Clough, Halifax, HX3 5AX Suzy Daly Clinical Audit Facilitator Tel: 01422 281343 Michael Morley Sarah Thompson Library/Resource & Information Centre Manager Librarian Library/Resource & Information Centre, Learning & Development Centre, Fieldhead Hospital, Ouchthorpe Lane, Wakefield, WF1 3SP. Tel: 01924 328608 Page 25

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APPENDIX 3: Action Plan Recommendations and action plan for Ethnic census Recommendations Actions Expected Outcome Person(s) responsible Deadline(s) Signed: Signed: Signed: Signed: Is a re-audit required after this audit? Yes No If No please specify why not? If Yes please indicate time period until start of re-audit (e.g. 6 months or 1 year) Signed on behalf of Business Unit (Please print name below ) Date Contact number Page 27