Reports say “level of abuse” of patients with a serious mental illness in Welsh NHS is “underestimated”.

Healthcare Inspectorate Wales (HIW) and Care and Social Services Inspectorate Wales (CSSIW) have today published reports which have raised serious concerns about the care adults with a serious mental illness receive in the Welsh NHS.

The HIW report “Safeguarding and Protecting Vulnerable Adults in Wales: a review of the arrangements in place across the Welsh National Health Service” highlighted a number of problems relating to abuse, inappropriate medical treatment, mixed sex wards and the investigations of complaints made by patients with a serious mental illness.

The HIW report revealed:

• “Growing concerns that the level of safeguarding referrals made by mental health and learning disability services are low and hence the level of abuse underestimated. This coupled with concerns in relation to the correct application of the Mental Capacity Act… leads us to consider mental health and learning disability services to be areas where a particular focus is needed.”

• “There appears to be a lack of appreciation amongst some staff that assessment of ‘capacity’ is a decision that is time specific. Some examples include patients with mental health problems being assessed as having capacity and providing consent for treatment but when we spoke to them they seemed unclear about their treatment or lacked insight. We have also identified examples of nurses administering medication to patients where appropriate capacity certification or consent was not in place.”

• “We are particularly concerned about mental health services; both acute and elderly mental health. Mental health wards are often mixed gender and patients with wide-ranging mental health issues are being cared for together, making the management of the environment of care difficult. We are aware of several allegations of sexual abuse and intimidation being made by female patients in mental health settings and have found staff attitudes towards friendships and relationships between patients in mental health or learning disability settings to be variable.” In a separate section the report said: “Mixed sex wards, bathroom, shower and toilet facilities continue to exist…and seriously compromise the safety, privacy and dignity of patients and give rise to feelings of vulnerability.”

• “Often those with a mental health issue or learning disability are regarded as being ‘unreliable witnesses’ and so their concerns and allegations are not properly investigated. Also they are often afraid to raise their concerns in case they are punished for raising them.”

The report, which also drew attention to inadequate safety mechanisms and the lack of proper lighting in some wards, recommends that: “All NHS organisations should have training in place in relation to Mental Capacity and Deprivation of Liberty safeguards. Such training should not be restricted to only those working in mental health.” It also states that “NHS organisations should review their arrangements for the management of gender mix to ensure that they are appropriate and robust.”

Commenting on the report Peter Higson, Chief Executive of HIW, said: “The NHS has an important role to play both in identifying and reporting abuse and in ensuring that vulnerable adults are safeguarded when accessing healthcare. It is imperative that the NHS builds on the present arrangements so that staff are trained and confident in protecting adults who may be vulnerable.”

A second report by the Care and Social Services Inspectorate Wales said councils need to do more to provide a consistently effective service to protect vulnerable adults from abuse.

To access a PDF of HIW’s “Safeguarding and Protecting Vulnerable Adults in Wales: a review of the arrangements in place across the Welsh National Health Service” please visit:

To access a PDF of CSSIW’s “National Inspection of Adult Protection All Wales Overview” please visit: