Count Me In National Mental Health and Ethnicity Census 2010 Overall Report

Count Me In National Mental Health and Ethnicity Census 2010 Overall Report Report commissioned by: Dawn Stephenson, Director of Corporate Development initiated by Jon Chanpakkee, Lecturer initiated by Jon Chanpakkee Lecturer Practitioner Newton Lodge July 2010 Gillian Marley CGST Lead CASE: 528

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 Limitations... 6 1.6 Staff Involved... 6 2. OVERALL RESULTS AND COMPARISON WITH 2008 AND 2009... 7 2.1 Accommodation... 7 2.2 Gender... 8 2.3 Age Range... 8 2.4 Admission date... 9 2.5 Ethnic Category... 9 2.6 Legal Status... 10 2.7 Care Programme Approach... 12 2.8 Diagnosis... 12 2.9 Consent Status... 13 2.10 Disability... 13 2.11 Sexual Orientation... 14 2.12 Preferred Language... 14 2.13 Religion and Faith... 15 2.14 Recorded Incidents... 15 2.15 Source of Referral... 17 2.16 Deprivation of Liberty... 18 3. SUMMARY OF RESULTS... 19 4. CONCLUSIONS AND RECOMMENDATIONS... 20 4.1 Conclusions... 20 4.2 Recommendations... 20 APPENDICES: APPENDIX 1: AUDIT TOOL... 21 APPENDIX 2: CLINICAL GOVERNANCE SUPPORT TEAM... 21 APPENDIX 3: COMPARISON WITH NATIONAL CENSUS 2001... 24 Page i

FIGURES: FIGURE 1: Age range of respondents... 8 FIGURE 2: Recorded incidents... 16 TABLES: TABLE 1: Ethnic category... 9 TABLE 2: Legal status on admission and census day... 10 TABLE 3: Diagnosis... 12 TABLE 4: Consent status... 13 TABLE 5: Disability... 13 TABLE 6: Sexual orientation... 14 TABLE 7: Languages... 14 TABLE 8: Religion... 15 TABLE 9: Recorded incidents... 15 TABLE 10: Referral route... 17 Acknowledgements Grateful thanks to Stephen Pidgeon and Liam Redican for their assistance in the production of this report. 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 is committed to the provision of good quality care. The Trust provides a variety of services to a diverse population across the geographical localities and is committed to achieving the objectives set in the Vision, Values and Goals. These objectives include: Put in place clear and effective ways to manage and develop the organisation towards its goal Ensure these ways of working are supported by clear organisational policies, frameworks and standards Develop clear ways of measuring and understanding our performance so that we know whether we are making a difference Maintain and develop the Trust s culture so that it reflects our values and helps us provide services that are sensitive to the needs of a diverse population 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 is led by the Care Quality Commission and has received ethical approval from the NHS Research Ethics Committee and DH Review of Central returns. This annual national census started in 2005 with a predicted termination date of 2010; its objective is to support the Department of Health's fiveyear action plan for improving mental health services for black and minority ethnic communities. 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 Encourage all mental health providers to have accurate and comprehensive sustainable ethnic monitoring and ethnic record keeping procedures in place Investigate the extent to which providers of mental health care have implemented culturally sensitive, appropriate and responsive services The project includes all inpatients (including patients on leave and on community treatment orders) at midnight on the 31 st March 2010 and includes: adult services, older people s services and forensic and secure services. In 2005 learning disability services were excluded but these have been included for the past 5 years. This report presents a summary of the results across all the participating services in the Business Development Units of Calderdale, Kirklees, Wakefield and Forensics. The census was completed for a total of 401 inpatients, 245 male patients and 156 female patients and 42 patients on community treatment orders 26 male and 16 female. Page 1

The following are the main results from the census: 100% of sleeping accommodation is classed as single sex 95% of inpatients have access to single sex toilets and bathing facilities but 32% still have to share lounge/day room facilities with members of the opposite sex The percentage of white British has remained constant for the last two years % of inpatients 100% 80% 60% 40% 20% 0% 83% 78% 78% 16% 20% 20% 1% 2% 2% 2008 2009 2010 White British Ethnic background Not stated 20% (83/401) of inpatients were from an ethnic background this included all non white British and excluded the not stated category The percentage of patients assessing their own ethnicity has increased from 74% in 2008 to 77% in 2009 and 88% in 2010 The percentage of patients admitted under a section of the mental health act has remained constant at 54%, but has increased on census day from 55% to 57% and then 62% (2010). This increase is partially due to the inclusion of the 42 patients on community treatment orders, without these it would be 58% 4% of patients were admitted informally but were then detained under a section of the mental health act 61% of patients from an ethnic background were admitted under a section of the mental health act and 69% of patients from an ethnic background were detained under a section of the mental health act on census day % of inpatients 80% 60% 40% 20% 0% 69% 61% 52% 54% 55% 58% formal admission 2010 detained on census day 2010 White British Ethnic background Trust total 97% of patients were on CPA, an increase of 9% from 2009 44% of patients continue to be referred by a community mental health team, an increase of 7% in 2008 and 2009. The percentage of patients with an unknown referral source has decreased from 32% in 2008 to 20% in 2009 to 16% in 2010 The percentage of male patients admitted under a section of the mental health act and also those in hospital and on a section on census day, continues to be more than 20% higher than female patients and has increased from 2009 Page 2

The percentage of patients with a Christian religion/faith continues to decrease from 68% (2008) to 60% (2009) to 57% (2010). The percentage of not stated continues to increase The number of patients who were secluded, required constraint, who were involved in at least one incident of assault, accident or selfharm, all have increased from 2009 to 2010 % of inpatients 20% 15% 10% 5% 8% 8% 6% 11% 7% 10% 16% 15% 14% 19% 18% 17% White British Ethnic background Trust total 7% 6% 6% 0% self harm accident assault restraint seclusion The main conclusions are: There is a positive decrease by 16% of patients sharing a mixed toilet or bathroom and decrease by 6% of patients sharing a dayroom with the opposite sex which is directly due to the opening of new units at Fieldhead and the upgrading of some inpatient accommodation Following the changes to the CPA classification at the end of 2008, there was a decrease of patients on CPA in 2009, however this was a transitional stage in the implementation of the new guidance and 2010 has shown an increase to 97% for patients on CPA There is a higher percentage of patients from an ethnic background formally admitted and detained under a section of the mental health act compared to the percentage of White British patients, but this has decreased as a percentage of the whole detained population from 27% in 2009 to 24% in 2010 Apart from seclusion, the percentage of patients from an ethnic background recorded as having incidents of selfharm, assault, accident and restraint is lower than the percentage of white British The 2010 Trust results for ethnicity have been compared with the 2001 national census results and can be viewed in Appendix 3. The main recommendation is: Presentation and distribution of the results to the Business Delivery Units and the assistant directors for the formulation of action plans. Distribution to relevant Trust wide action Groups, Diversity TAG, Practise Effectiveness TAG and Clinical Governance and Clinical Safety Committee. Page 3

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1. INTRODUCTION is committed to undertake an annual audit programme. Included in this programme are national audits such as the Ethnic Census Count me in. On the 31 st March 2010, the Trust participated in the sixth National Mental Health and Ethnicity Census Count Me In. The purpose of the national survey is to improve services for patients from black and minority ethnic communities. This report presents a summary of results from the census and a comparison with the main results of the 2008 and 2009 census. A separate report is available which breaks down the results by Business Development Unit. 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, sexuality to support future service provision To make a comparison with the results of the 2008 and 2009 census To provide results that are comparable with other trusts and with national benchmarks 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 31 st March. 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 Forensic and Secure Services. A total of 443 census sheets were completed for the Trust. Page 5

1.5 Limitations Some of the issues encountered during the census period included: Changes to the audit tool and code sheet from the Care Quality Commission Problems with the instruction/code sheet and the lack of clarity of some questions on the audit sheet Lack of care in completion of audit tools Changes to the audit tool and inclusion of new questions Inclusion of patients not in hospital but on community treatment orders information not easily available for completion of the tools 1.6 Staff Involved Dawn Stephenson Gillian Marley Stephen Pidgeon Suzy Whitehead Liam Redican Director of corporate development Clinical governance support team Project lead Performance and information Project development analyst CGST Clinical audit facilitator CGST Information and project support officer Page 6

2. OVERALL RESULTS AND COMPARISON WITH 2008 AND 2009 The benchmark was set in 2005 with the first Trust wide ethnic census of inpatients. There were some changes in both the data required and the population included from 2005 to 2006 and changes again to some categories in 2007 and again in 2008 and once again in 2010, therefore it is impossible to make a comparison of the whole of the census information for the last 3 years. In 2005 information on asylum seekers was required and in 2006 a question on sexual orientation was included. In 2008 more questions around single sex accommodation were included and in 2010 questions on deprivation of liberty were included. In 2005 patients with a learning disability were not included, but have been included for the last 5 years. Due to space limitations comparisons have been made where possible for 2008, 2009 and 2010. It must be noted that information on patients on community treatment orders (CTO) was also requested, as these were not inpatients the same audit tool was not appropriate and therefore the full range of information is not available for all 443 patients. 2.1 Accommodation It was noted from the census sheets that 301 (75%) inpatients were not in single sex accommodation (wards / unit), 90 (22%) were in male only accommodation and 10 (3%) inpatients were in female only accommodation. This was a similar result to the previous years 77% in 2008, 73% in 2009 Questions were included regarding access to single sex toilet/bathing facilities, sleeping accommodation and a single sex day room: 2010 100% of the sleeping accommodation is single sex 2009 100% of the sleeping accommodation is single sex 2008 100% of the sleeping accommodation is single sex 2010 5% of the inpatients shared mixed toilet & bathing facilities 2009 21% of the inpatients shared mixed toilet and bathing facilities 2008 30% of the inpatients shared mixed toilet and bathing facilities 2010 32% of the inpatients shared a dayroom with the opposite sex 2009 38% of the inpatients shared a dayroom with the opposite sex 2008 45% of the inpatients shared a dayroom with the opposite sex 32% of the inpatients continue to have to share lounge/day room facilities with members of the opposite sex, but only 5% sharing toilet and bathing facilities. This question was not applicable to the 42 service users on community treatment orders. Page 7

2.2 Gender 2010 401 inpatients 245 (61%) male, 156 (39%) female patients 2010 (CTO) 42 patients 26 (62%) male, 16 (38%) female patients 2009 385 inpatients 250 (65%) male, 135 (35%) female patients 2008 410 inpatients 255 (62%) male, 155 (38%) female patients The age range and gender has remained constant over the last 3 years. 2.3 Age Range The ages of the inpatients ranged from 18 to 88 years and 24 to 77 for CTO patients. Figure 1 shows the age range by gender for 2010. The age ranges for 2008 and 2009 are similar for the main group of inpatients aged between 25 and 54: 2010 227/401 aged between 25 and 54 57% 2010 (CTO) 31/42 aged between 25 and 54 74% 2009 214/385 aged between 25 and 54 56% 2008 213/410 aged between 25 and 54 52% Figure 1 2010 Age range of respondents (n=443) Number of respondents 100 90 80 70 60 50 40 30 20 10 0 91 71 65 54 51 52 41 17 10 1 39 41 39 24 25 21 14 14 14 8 9 4 4 male inpatient female inpatient total inpatient total CTO 35 35 1817 14 10 4 2 16 24 25 34 35 44 45 54 55 64 65 74 75 84 85 94 Age Range Page 8

2.4 Length of Admission The length of admission for the inpatients ranged from 1 day for some patients who had been admitted on the 31 st to 16 years for one patient from Newton Lodge. 2.5 Ethnic Category The following table shows the categories for the question on ethnicity: Table 1 Ethnic Category Ethnic Category Inpatient (n=401) 2010 (n=443) CTO (n=42) 2009 (n=385) 2008 (n=410) White British 312 (78%) 29 (69%) 300 (78%) 342 (83%) Caribbean black or black British 23 (6%) 3 (7%) 21 (5%) 17 (4%) Pakistani Asian or Asian British 27 (7%) 5 (12%) 18 (5%) 12 (3%) Indian Asian or Asian British 9 (2%) 3 3 Irish White & any other white background 13 (3%) 3 (7%) 15 (4%) 16 (4%) White & Black Caribbean, African & Asian 4 1 (2%) 7 (2%) 4 Bangladeshi & other Asian 3 4 4 African & other black background 3 8 (2%) 3 Other ethnic group 1 2 4 Not stated/patient refused 6 (2%) 1 (2%) 7 (2%) 5 Other ethnic groups/mixed backgrounds were: British Moroccan, Goa, and Kashmiri. 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 nonwhite British excluding not stated/patient refused ). In 2010 8 male CTO patients, (31% of the total male patients) and 4 female CTO patients (25% of the total female patients) were from an ethnic background. 30% of the male inpatients aged between 16 and 34 were from an ethnic background this includes 1 CTO patient. 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. Page 9

2010 88% of inpatients assessed own ethnicity 2010 100% of CTO patients assessed own ethnicity when registered on RiO 2009 77% of inpatients assessed own ethnicity 2008 74% of inpatients assessed own ethnicity 2.6 Legal Status The legal status of the inpatients is shown for 2008, 2009 and 2010 for admission and census day. This question was only applicable to patients on CTO for census day and all 42 were on a section 17a. Table 2 Legal Status on Admission and Census Day Legal status On admission 2010 2009 (n=401) (n=385) 2008 (n=410) On census day 2010 2009 (n=443) (n=385) 2008 (n=410) Informal 184 (46%) 178 (46%) 187 (46%) 169 (38%) 165 (43%) 182 (45%) Section 2 65 (16%) 57 57 21 (5%) 20 35 Section 3 76 (19%) 80 87 123 (28%) 120 (31%) 117 (29%) Section 4 1 2 Section 5.2 1 1 5 1 1 1 Section 5.4 1 Section 35 6 (2%) 3 3 1 1 Section 36 2 2 1 Section 37/41 19 (5%) 24 29 46 (10%) 47 43 Section 37 10 (3%) 9 7 20 (5%) 12 9 Section 38 5 5 3 Section 44 1 Section 47/49 15 (4%) 16 19 12 (3%) 15 17 Section 48/49 16 (4%) 8 8 5 2 4 Criminal proceedings act Subject to guardianship section 7 Section 17a Supervised Community Treatment voluntary inpatient Section 17a Supervised Community Treatment outpatient 1 1 1 1 1 3 1 42 (9%) 1 Total 401 385 410 443 385 410 The percentage of patients admitted under a section of the mental health act has remained constant at 54%, but the percentage of patients detained has increased on census day from 55% to 57% and then 62% this increase (4%) is partially due to the inclusion of the 42 patients on community treatment orders, whilst another 4% were admitted as informal patients but were later detained. Page 10

In 2010: 217/401 (54%) of patients were admitted under a section of the Mental Health Act, 27/217 (12%) of patients then became informal prior to census day, 190/217 (88%) remained under a section on census day 184/401 (46%) of patients were admitted informally, 42/184 (23%) were then detained under a section prior to census day, whilst 142/184 (77%) remained informal on census day In 2010: 156/245 (64%) of the male inpatients were admitted under a section of the mental health act and 61/156 (39%) of the female inpatients 167/245 (68%) of the male inpatients were in hospital under a section of the mental health act on census day and 65/156 (42%) of the female inpatients 51/ 217 (24%) of the patients admitted under a section of the mental health act were from an ethnic background 69/274 (25%) of the total patients (inc CTO) under a section on census day were from an ethnic background 51/83 (61%) of the patients from an ethnic background were admitted under a section of the mental health act 69/95 (73%) of the patients (inc CTO) from an ethnic background were held under a section on census day The results for 2009 show that: 150/250 (60%) of the male inpatients were admitted under a section of the mental health act and 57/135 (42%) of the female inpatients 159/250 (64%) of the male inpatients were in hospital under a section of the mental health act on census day and 61/135 (45%) of the female inpatients 27% of the patients admitted under a section of the mental health act were from an ethnic background 27% of the total inpatients under a section on census day were from an ethnic background The results for 2008 show that: 62% of the male inpatients were admitted under a section of the mental health act and 43% of the female inpatients 64% of the male inpatients were in hospital under a section of the mental health act on census day and 41% of the female inpatients 20% of the patients admitted under a section of the mental health act were from an ethnic background 19% of the patients under a section on census day were from an ethnic background Page 11

2.7 Care Programme Approach In 2010 431/443 (97%) patients were on CPA 96% of patients from an ethnic background (including CTO) were on CPA, these figures included 41/42 patients on CTO who were on CPA the 12 patients who were not on CPA were from learning disability services In 2009 299/385 (78%) inpatients were on CPA 73% of inpatients from an ethnic background were on CPA In 2008 96% of inpatients were on CPA, 61% on enhanced and 35% on standard CPA 2.8 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: 394 (98%) of the total inpatients were recorded as having a mental health problem 243 (99%) of total male and 151 (97%) of total female inpatients 22 (6%) of the total inpatients were recorded as having a learning disability 16 (4%) of the total inpatients were recorded as having a personality disorder 19 (5%) of the total inpatients were recorded as having a diagnosis of mental health and learning disability 16 male and 3 female 1 female inpatient was recorded as having a learning disability and personality disorder diagnosis 11 (3%) of the total inpatients were recorded as having a mental health and personality disorder diagnosis 8 male and 3 female 81/83 inpatients recorded as being from an ethnic background had a mental health diagnosis, 9 had a learning disability of these 8 had a learning disability and a mental health diagnosis, 2 patients had a diagnosis of personality disorder, one of which had a mental illness and personality disorder diagnosis Table 3 Diagnosis comparison 2010 with 2009 and 2008 Diagnosis 2010 (n=401) 2009 (n=385) 2008 (n=410) Mental Health Problem 394 (98%) 371 (96%) 399 (97%) Learning Disability 22 (6%) 31 (8%) 36 (9%) Personality Disorder 16 (4%) 28 (7%) 6 Combination 31 (8%) 45 (12%) 30 (7%) (It must be noted that some patients had more than one diagnosis) This question and the following three questions were not completed for patients on CTO as the questions were only available to inpatients. Page 12

2.9 Consent Status The consent status of the inpatient on census day was assessed as follows: Table 4 Consent Status Consent Status 2010 (n=401) 2010 Patients from ethnic background (n=83) 2009 (n=385) 2009 Patients from ethnic background (n=78) 2008 (n=409) Informal capable 138 (34%) 16 (19%) 124 (32%) 15 (19%) 128 (31%) Informal incapable 29 (7%) 9 (11%) 30 (8%) 4 (5%) 54 (13%) Detained consenting Detained capable but refusing Detained incapable 153 (38%) 35 (42%) 149 (39%) 38 (49%) 143 (35%) 21 (5%) 9 (11%) 26 (7%) 4 (5%) 33 (8%) 54 (14%) 13 (16%) 37 (10%) 14 (18%) 46 (11%) Not known 6 (2%) 1 19 (5%) 3 (4%) 5 The percentage of patients capable and willing to consent to the census continues to increase from 66% in 2008 to 71% in 2009 to 72% in 2010 2.10 Disability It was noted on the census sheet if any inpatient had a disability. It must be noted that some patients had more than one disability. Table 5 Disability Disability Male (n=245) Female (n=156) Total (% of inpatients) 2010 (n=401) Number of Patients from an ethnic background (% of total 83) 2010 Total (% of inpatients) 2009 (n=385) Total (% of inpatients) 2008 (n=410) Blind or sight impairment Deaf or hearing impairment Learning Disability Autistic spectrum disorder or Aspergers syndrome Wheelchair or mobility impairment 46 (19%) 39 (25%) 85 (21%) 19 (23%) 72 (19%) 62 (15%) 24 (10%) 20 (13%) 44 (11%) 10 (12%) 25 (6%) 33 (8%) 29 (12%) 8 (5%) 37 (9%) 12 (14%) 36 (9%) 38 (9%) 5 (2%) 5 4 4 15 (6%) 16 (10%) 31 (8%) 7 (8%) 34 (9%) 100 (24%) 5 patients were registered as blind, 2 were from an ethnic background 5 patients were registered as deaf 10 patients used a wheelchair, 3 were from an ethnic background Page 13

2.11 Sexual Orientation Inpatients were asked about their sexual orientation. Table 6 Sexual orientation Sexual orientation 2010 (n=401) 2009 (n=385) 2008 (n=406) Heterosexual 294 (73%) 277 (72%) 298 (73%) Lesbian or gay 1 3 2 Bisexual 5 3 5 Other 1 Prefer not to say 50 (12%) Not known 100 (25%) 102 (26%) 51 (13%) 54/83 (65%) of the patients from an ethnic background were heterosexual, 1 person stated they were gay and 1 person stated they were bisexual and for 27 (32%) this was not known. 2.12 Preferred Language The first or preferred language was recorded on the census as follows and includes patients on CTO: Table 7 Languages Language 2010 (n=443) 2009 (n=385) 2008 (n=410) English 434 (98%) 374 (97%) 389 (95%) Bengali 1 1 Guajarati 1 1 Polish 1 1 2 Punjabi 3 3 1 Urdu 3 1 1 Hindi 1 Yue Chinese 1 German 1 Mandarin Chinese 1 Any other language * 5 12 2 patients required an interpreter and 3 sometimes required an interpreter. The percentage of patients with a first or preferred language of English has remained constant for the last 3 years at around 97% Page 14

2.13 Religion and Faith Patients were asked about their religion and faith, Table 8 below shows a comparison for 2008, 2009 and 2010 and includes patients on CTO: Table 8 Religion Religion 2010 (n=443) 2009 (n=385) 2008 (n=410) Christian 252 (57%) 231 (60%) 280 (68%) Muslim 37 (8%) 29 (6%) 21 (5%) Hindu 2 2 2 Buddhist 1 1 1 Jewish 1 2 3 Sikh 2 1 None 47 (11%) 55 (14%) 49 (12%) Rastafarian 1 Other * 16 (4%) 6 (2%) 11 (2%) Not stated 85 (19%) 58 (15%) 42 (10%) * Other religions include Jehovah s Witness, Mormon and Pagan. The percentage of patients with a Christian religion or faith continues to decrease from 68% in 2008 to 60% in 2009 and 57% in 2010. The percentage of not stated continues to increase. 2.14 Recorded Incidents The census also requested the number of recorded incidents for each inpatient in a variety of categories as follows: Table 9 Recorded Incidents (n = 401) Recorded Incidents Male Female Total Number of Patients from an ethnic background Self harm 1 incident 11 9 20 5 Self harm 2 4 incidents 2 2 4 Selfharm 5 9 incidents 1 3 4 Self harm 10+ 1 2 3 Accident 1 incident 11 16 27 3 Accident 2 4 incidents 7 3 10 1 Accident 5 9 incidents 3 2 5 2 Assault 1 incident 27 15 42 8 Assault 2 4 incidents 5 4 9 2 Assault 5 9 incidents 3 3 6 1 Assault 10+ 3 2 5 1 Page 15

Table 9 Recorded Incidents (n = 401) continued Recorded Incidents Male Female Total Hands on restraint 1 incident Restraint 2 4 incidents Restraint 5 9 incidents Number of Patients from an ethnic background 30 11 41 7 4 10 14 3 5 6 11 3 Restraint 10+ 4 3 7 1 Seclusion 1 incident Seclusion 2 4 incidents Seclusion 5 9 incidents 12 3 15 3 5 1 6 1 3 3 1 Seclusion 10+ 2 2 1 31 (8%) patients had at least one incident of selfharm recorded 42 (10%) patients had been involved in at least one accident 62 (15%) patients had been involved in at least one assault Hands on restraint had occurred on at least one occasion with 73 (18%) patients 26 (6%) patients had been secluded on at least one occasion The following chart gives a comparison for the last 3 years: Figure 2 Recorded Incidents 2008 (n=410), 2009 (n=385) and 2010 (n=401) 80 2008 2009 2010 73 70 60 62 53 52 58 Number of incidents 50 40 30 20 17 18 31 38 37 42 47 16 22 26 10 0 selfharm accident assault seclusion restraint Page 16

The number of patients who were secluded, required constraint, who were involved in at least one incident of assault, accident or selfharm, all have increased from 2009 to 2010. 2.15 Source of Referral The source of referral was recorded in 2008, 2009 and 2010 as shown below: Table 10 Referral Route Source of Referral 2010 (n=401) 2009 (n=385) 2008 (n=410) General Practitioner 4 2 7 (2%) Self 1 1 Local Authority/Social Services 3 6 (2%) 4 Accident & Emergency dept 4 2 4 Police 8 (2%) 15 (4%) 19 (5%) Other clinical specialty 31 (8%) 35 (9%) 30 (7%) Carer 5 9 (2%) 6 (2%) Courts 5 7 (2%) 1 High security 6 (2%) 3 2 Medium security NHS 1 2 1 Community Team Mental Health Community Team Learning Disabilities 178 (44%) 144 (37%) 123 (30%) 1 2 5 Prison 25 (6%) 13 (3%) 10 (2%) Medium security independent 2 1 Other inpatient service NHS 41 (10%) 44 (11%) 54 (13%) Other inpatient service independent 22 (6%) 22 (6%) 11 (3%) Unknown 64 (16%) 78 (20%) 131 (32%) Employer (not included in 2005 & 2006) 1 In 2010 the 83 patients from an ethnic background were recorded as being referred from the following sources: 33 Community team mental health 15 Unknown 9 Other inpatient service NHS 7 Other inpatient service independent 6 Prison 4 Other clinical speciality 2 Police 1 Accident & Emergency 1 Medium security independent 1 Local Authority/Social services Page 17

1 Courts 1 General Practitioner 1 High security 1 Community team learning disabilities 2.16 Deprivation of liberty In 2010, 2 new questions were added regarding deprivation of liberty is the patient subject to deprivation of liberty authorisation on 31 st March 2010 and if so, what was the start date of the deprivation of liberty authorisation. There were no inpatients within the trust who were subject to this authorisation on the 31 st March 2010. Page 18

3. SUMMARY OF RESULTS The main results of the audit are split into positive results and areas of concern: Positive 100% of sleeping accommodation is classed as single sex 95% of inpatients have access to single sex toilets and bathing facilities The age range and gender remains constant over the last 3 years The percentage of white British has remained constant for the last two years with a slight decrease from 83% in 2008 to 78% The percentage of patients assessing their own ethnicity has increased from 74% in 2008 to 77% in 2009 and 88% in 2010 The percentage of patients admitted under a section of the mental health act has remained constant at 54%, but has increased on census day from 55% to 57% and then 62% (2010). This increase is partially due to the inclusion of the 42 patients on community treatment orders, without these it would be 58% 4% of patients were admitted informally but were then detained under a section of the mental health act prior to census day 97% of patients were on CPA an increase of 9% from 2009 The percentage of patients capable and willing to consent to the census continues to increase from 66% in 2008 to 71% in 2009 to 72% in 2010 The percentage of patients with a first or preferred language of English has remained constant for the last 3 years at around 97% 44% of the patients continue to be referred by a community mental health team an increase of 7% in 2008 and 2009, and the percentage of patients with an unknown referral source has decreased from 32% in 2008 to 20% in 2009 to 16% in 2010 20% of the inpatients were from an ethnic background, 24% of the patients admitted under a section of the mental health act were from an ethnic background (a decrease of 3% from 2009) Areas of concern 32% of the inpatients have to share lounge/day room facilities with members of the opposite sex, although this has decreased from 45% in 2008, to 38% in 2009 The percentage of male patients admitted under a section of the mental health act and also those in hospital and on a section on census day continues to be more than 20% higher than female patients and has increased from 2009 There continues to be an increase in the number of patients who have a sight impairment or are blind, from 15% in 2008 to 19% in 2009 and 21% in 2010, but a decrease in the percentage of patients with a mobility problem or using a wheelchair from 24% in 2008 to 9% in 2009 and 8% in 2010 Page 19

In 2010, 54% of patients admitted were under a section of the mental health act. On census day this increased to 62% of the total inpatient population. The percentage of patients with a Christian religion or faith continues to decrease from 68% in 2008 to 60% in 2009 and 57% in 2010. The percentage of not stated continues to increase The number of patients who were secluded continues to increase from 52 (2008) to 58 (2009) to 73 (2010) and the number who required restraint also increases on annual basis from 16 (2008) to 22 (2009) to 26 (2010) The number of patients who were involved in at least one incident of assault, accident or selfharm has also all increased from 2009 to 2010 4. CONCLUSIONS AND RECOMMENDATIONS 4.1 Conclusions The main conclusions are: There is a positive decrease by 16% of patients sharing a mixed toilet or bathroom and decrease by 6% of patients sharing a dayroom with the opposite sex which is directly due to the opening of new units at Fieldhead and the upgrading of some inpatient accommodation Following the changes to the CPA classification at the end of 2008 there was a decrease of patients on CPA in 2009, however this was a transitional stage in the implementation of the new guidance and 2010 has shown an increase to 97% for patients on CPA There is a higher percentage of patients from an ethnic background formally admitted and detained under a section of the mental health act compared to the percentage of White British patients, but this has decreased as a percentage of the whole detained population from 27% in 2009 to 24% in 2010 Apart from seclusion, the percentage of patients from an ethnic background recorded as having incidents of selfharm, assault, accident and restraint is lower than the percentage of white British The 2010 Trust results for ethnicity have been compared with the 2001 national census results and can be viewed in Appendix 3. 4.2 Recommendations The main recommendation is: Presentation and distribution of the results to the Business Delivery Units and the assistant directors for the formulation of action plans The report to be presented to relevant Trust wide action Groups, Diversity TAG, Practise Effectiveness TAG and Clinical Governance and Clinical Safety Committee. Page 20

APPENDIX 1: AUDIT TOOL Page 21

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APPENDIX 2: CLINICAL GOVERNANCE SUPPORT TEAM The (CGST) is a multidisciplinary 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 nonclinical 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 trustwide 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, Interlibrary 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 CGST Lead for Adult and Forensic Care Groups CGST, Castleford, Normanton & District Hospital, Susan Alibone Clinical Development Facilitator Lumley Street, Castleford, WF10 5LT Tel: 01977 628011 Liam Redican Project Support Officer Hazel Baxter Suzy Whitehead Michael Morley Helen Rotherforth CGST Lead for Older Peoples and Learning Disability Care Groups Clinical Audit Facilitator Library/Resource & Information Centre Coordinator Library/Resource & Information Centre Librarian CGST, SWYT, 4 th Floor, F Mill, Dean Clough, Halifax, HX3 5AX Tel: 01422 281343 Fax: 01422 281568 Library/Resource & Information Centre, Education Centre, Fieldhead Hospital, Ouchthorpe Lane, Wakefield, WF1 3SP. Tel: 01924 328608 Page 23

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APPENDIX 3: COMPARISON WITH NATIONAL CENSUS 2001 Ethnic Census 2010 Ethnic Background Results Compared with Census 2001 Count me in 2010 The following table shows a comparison of the Trust results from the 2010 ethnic census with the results of the national census held in 2001. The results show that the trust has a lower percentage of white British than shown in each of the national census. It must be noted that the national census took place in 2001 and in the earlier reports for the trust the percentage was as high as 88% in 2007. Trustwide, Local and National Ethnic Background Statistics Ethnic Background White British White Irish White Other Mixed White and Black Caribbean Mixed White and Black African Mixed White and Asian Mixed Other Asian or Asian British: Indian Asian or Asian British: Pakistani Asian or Asian British: Bangladeshi Asian or Asian British: Other Black or Black British: Caribbean Black or Black British: African Black or Black British: Other Other ethnic group: Chinese Other ethnic group Not stated SWYT Ethnic Census 2010 (n=401) 312 (78%) 6 (2%) 7 (2%) 2 2 1 9 (2%) 27 (7%) 1 2 23 (6%) 2 1 6 (2%) Wakefield, Kirklees and Calderdale 2001 (n=896,144) 804,857 (89.8%) 6,802 (0.8%) 8,031 (0.9%) 4,049 (0.5%) 508 2,607 (0.3%) 1,243 17,623 (2%) 39,152 (4.4%) 709 2,002 (0.2%) 4,653 (0.5%) 811 656 1,391 (0.2%) 1,050 Yorkshire and The Humber 2001 (n=4,964,833) England 2001 (n=49,138,831) 91.7% 87% 0.7% 1.3% 1.2% 2.7% 0.4% 0.5% 0.1% 0.2% 0.3% 0.4% 0.2% 0.3% 1% 2.1% 3% 1.4% 0.3% 0.6% 0.3% 0.5% 0.4% 1.1% 0.2% 1% 0.1% 0.2% 0.3% 0.5% 0.2% 0.4% Page 25

The following table shows a comparison between the trust results for the Wakefield BDU (excluding forensic and learning disabilities) and the 2001 national census results. Wakefield Ethnic Background White British White Irish White Other Mixed White and Black Caribbean Mixed White and Black African SWYT Ethnic Census 2010 (n=117) 105 (90%) 2 (2%) 2 (2%) Mixed White and Asian Mixed Other Asian or Asian British: Indian Asian or Asian British: Pakistani Asian or Asian British: Bangladeshi Asian or Asian British: Other Black or Black British: Caribbean Black or Black British: African Black or Black British: Other Other ethnic group: Chinese 1 1 3 (3%) 1 1 Other ethnic group Not stated 1 Wakefield Census Results 2001 (n=315,172) 304,734 (96.7%) 1,262 (0.4%) 2,054 (0.7%) 509 (0.2%) 144 503 (0.2%) 291 980 (0.3%) 3,174 21 (0.01%) 256 191 207 39 (0.01%) 493 (0.2%) 314 Page 26

The following table shows a comparison between the trust results for the Kirklees BDU (excluding learning disabilities) and the 2001 national census results. Kirklees Ethnic Background White British White Irish White Other Mixed White and Black Caribbean Mixed White and Black African SWYT Ethnic Census 2010 (n=102) 78 (77%) 2 (2%) 1 Mixed White and Asian Mixed Other Asian or Asian British: Indian Asian or Asian British: Pakistani Asian or Asian British: Bangladeshi Asian or Asian British: Other Black or Black British: Caribbean Black or Black British: African Black or Black British: Other Other ethnic group: Chinese 2 (2%) 6 (6%) 1 1 7 (7%) 1 Other ethnic group Not stated 3 (3%) Kirklees Census Results 2001 (n=388,567) 325,348 (83.7%) 3,458 (0.9%) 3,853 2,927 (0.8%) 268 1,557 (0.4%) 662 (0.2%) 15,829 (4.1%) 26,536 (6.8%) 388 1,352 (0.3%) 4,203 (1.1%) 476 567 611 (0.2%) 532 Page 27

The following table shows a comparison between the trust results for the Calderdale BDU and the 2001 national census results. Calderdale Ethnic Background White British White Irish White Other Mixed White and Black Caribbean Mixed White and Black African SWYT Ethnic Census 2010 (n=50) 40 (80%) 1 (2%) 4 (8%) Mixed White and Asian Mixed Other Asian or Asian British: Indian Asian or Asian British: Pakistani Asian or Asian British: Bangladeshi Asian or Asian British: Other Black or Black British: Caribbean Black or Black British: African Black or Black British: Other Other ethnic group: Chinese 5 (10%) Other ethnic group Calderdale Census Results 2001 (n=192,405) 174,775 (90.8%) 2,082 (1.1%) 2,124 (1.1%) 613 (0.3%) 96 547 (0.3%) 290 (0.2%) 814 (0.4%) 9,442 (4.9%) 300 (0.2%) 394 (0.2%) 259 128 50 287 204 Page 28