Two in five mental health services are not safe, a report by the Care Quality Commission has found.
Some had wards with door handles and fittings from which patients could hang themselves and others had corridors with blind spots so staff could not monitor those who posed a risk, it said.
A number had mixed sex wards, despite having patients who displayed dangerous behaviour and others who had been victims of sexual abuse.
Research for the organisation’s first report into all 54 National Health Service trusts and 221 private operators who provide mental health services, took three years and concluded that the quality of care varied too much.
The commission’s biggest concern was over safety, for which 4 per cent of NHS trusts were graded inadequate and another 36 per cent were found to need improvement. There was a similar picture among independent services, with 5 per cent deemed inadequate and 34 per cent requiring improvement.
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The regulator said that mental health care, which faces rising demand as mental illness loses some of its stigma, was “at a crossroads” with much excellent provision but too much that was out of date. Inspectors were surprised to find 248 wards with 3,587 beds where patients were locked in — two thirds of them in privately run units — when a less restrictive environment where the focus was on rehabilitation would have been more appropriate.
In many cases locked hospitals were “long-stay wards that institutionalise patients”, the commission said. The average length of stay in a high-dependency ward was 341 days, with the longest 1,744 days. “More than 50 years after the movement to close asylums . . . we were concerned to find examples of outdated and sometimes institutionalised care,” its report said.
It found that physical restraint of psychiatric patients was used heavily in some units but rarely in others. Around 6,000 people a year were restrained by, for example, being forced face-down. Of these, 950 had been restrained at least five times.
The report said well-trained staff who interacted with patients and minimised the risk of disruptive behaviour used restraint far less and therefore avoided stress. But it found a wide range of practice, with some using restraint as a regular tool to manage behaviour and sometimes not recording incidents.
Paul Lelliott, CQC head of mental health, said: “Some services remain rooted in the past — providing care that is over-restrictive and that is not tailored to each person’s individual needs. This can leave people feeling helpless and powerless.
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“But the best services are looking to the future by working in partnership with the people whose care they deliver, empowering their staff and looking for opportunities to work with other parts of the health and care system.”
• The number of children seeking mental health services in Greater Manchester has risen by 10 per cent since the terrorist bomb at a pop concert in the city in May, according to psychiatrists. There have been smaller increases in other areas.