Wednesday, 15 May 2019

ITV The Priory: Teenage Mental Health Uncovered | Review

Disclaimer: Both this post and the programme contains talk of self harm and suicide. Please don't read or watch if you think you'll be affected by this. This is a very long post, I do apologise but it's Mental Health Awareness Week so I thought I'd try something a bit different this year.

On the 18th April 2019, The Priory: Teenage Mental Health Uncovered Documentary aired on ITV. This is an hour long documentary of what life is like within the Priory Ticehurst Child and Adolescent High Dependancy Psychiatric Unit after 14-year old Amy El-Keria died whilst an inpatient there, five years prior. The Priory group have recently been fined three hundred thousand pounds for its failings over Amy's death.




According to ITV, 'exposure goes undercover to reveal evidence of serious failures of care for teenage patients at a high dependency mental health unit.'

Initially, I was slightly skeptical about watching this documentary because I felt that the aim of this programme was to only show the negatives of the running of the ward and not the positives, but upon starting to watch, I was speechless at how horrendous the care given to the patients really was, and I have a lot to say about it.

It is no secret that Britain is in the middle of a teenage mental health crisis with 1 in 8 children in the UK experiencing a mental health condition, the Mental Health Services are underfunded and available inpatient beds are getting lower and lower but this is no excuse for a privately funded inpatient unit to promote unsafe and undignified care to their patients, knowing risk factors around the ward that could easily be used for a patient to harm themselves without doing anything to improve them, and continuing to work whilst being extremely unstaffed, putting the patients at even bigger risk. I am surprised that there hasn't been more deaths on this ward and I am even more shocked that the unit was allowed to continue running, despite what was seen on this programme. 

Gráinne Morrison was an undercover reporter who applied for a job as a Healthcare Assistant at the Priory Ticehurst House for three months where she secretly filmed the daily life on the ward. She was able to secure the job on the High Dependency Unit (HDU) with no previous experience or relevant qualifications however, she was told upon initially arriving at the ward that she will need specialised Breakaway and Restraint training before she is able to be placed on the unit, being told that some of her training will be completed within a fortnight. All she was initially taught was basic CPR and First Aid and there is even a clip on the programme of one worker stating that they "had no training" and how the patients "don't get near enough therapy," just medication and restraints. 

Five years prior, Amy El-Keria managed to kill herself whilst on the HDU. Amy's mother, Tania appeared on the programme, expressing her concerns of the running of the unit, and explaining the care that Amy received on the unit. Amy's mental health was complex, she suffered with a variety of disorders including ADHD, Tourettes Syndrome, OCD and Conduct Disorder, making it difficult for her to sit still. When Amy reached her teenage years, her Mental Health got drastically worse, she attempted suicide at home and her mum went straight to the Child and Adolescent Mental Health Service (CAMHS) to try and get support for her daughter but on the second suicide attempt, she decided that things weren't right and that Amy needed specialised treatment. Amy was given a place at the Priory's Ticehurst House and her mum felt a sense of relief, explaining how "she was in the right place now, she'll get the help that she needs and we'll get the right diagnosis."

Mark Beresford is a Mental Health Nurse who worked at Ticehurst House from 2004 to 2012, he explained how Amy had very complex needs and was a challenging person to work with. Before he left the Priory, Mark contacted management, expressing his concerns over the lack of staffing levels and the way the unit was running but never received any sort of response.

Amy's care was inadequate to meet her needs. When Amy's first restraint occurred, her mum wasn't even informed of the incident. Tania later found out from Amy that the incident started when she was given fifteen minutes on the phone and instead of the staff counting down her time or telling her to say goodbye, thee phone was just slammed down, with no prior warning. Amy told her mum how the staff pulled her t-shirt over her head to cover her mouth, exposing all of her top before sedating her and having to drag her along because she was strong. Amy's mum usually wasn't informed of incidents that took place, and it was very difficult to have communication with senior members of staff. Amy's mum received a phone call one day from the unit where she was told how "Amy was found with a ligature, they managed to regain a pulse." Her mum wasn't informed of the severity of Amy's incident and was just told to make the two hour journey to the hospital. Whilst driving to the hospital, Tania received another phone call from a doctor at the hospital who said that she needed to get to the hospital as quickly as possible. Amy died from strangulation and despite being categorised as 'high risk' over ten times since being on the ward, she was left alone in her room with items that she could harm herself with and ligature points.

Tony Murphy is the lawyer to the El-Keria family and he explained how the "failures were so basic", they could have removed the ligature items out of the room or even just spoken to her. In 2016, an inquest into Amy's death said how neglect contributed to her death and they found more than twenty issues including; Inadequate staffing and insufficient knowledge of care plans, Ligature risks not correctly identified and delays in contacting emergency services. The coroner warned that action should be taken to prevent further deaths. There had been hope that since this, there had been significant changes within the ward however, that simply did not seem the case within this documentary. 

Tony Murphy said how they had been told that ligature points had been removed and that there is now a better system in place for searching for items that may be used to self harm with and he had also been offered assurances that the quality of care had improved, which is yet to be seen and despite this, patients were still able to find ways to ligature.

Early on in her job, Gráinne was asked for help by a patient but had no training and was told nothing about the patients medical history. Four weeks into the job, she still hadn't received her restraint training even though she was initially told that she wouldn't be able to work on the ward without it. Gráinne expresses her own concerns, asking why it wasn't a priority and why she was suddenly allowed to work on the ward without it. She also discovered that on most of her shifts, patients were able to self harm even though the Priory group states that "treating this is one of their key areas of expertise." 

In a different clip, there was an extremely serious incident that occurred, and the senior staff members acted awfully. A patient called Amber was able to swallow a battery from a tv remote control. Amber receives 1:1 care, 24 hours a day and she still managed to not only get hold of the battery, but to swallow it. Amber wasn't taken to A&E for three days and Gráinne found evidence that a senior doctor at the local A&E department had concerns about staffing levels due to them not taking Amber to hospital immediately. The letter stated that "this should have been brought to the attention of the surgeons straight away and not delayed presentation". Within a later staff meeting, the ward manager spoke to staff about what to do when a patient swallows a battery. The ward manager also stated that "Batteries contain acid. If what is in the battery leaks into the body, they will die. Our policy for batteries is they go to A&E and they go straight away" and when asked what to say when the A&E staff question why the patient wasn't brought in immediately, she said to tell them that "the nurses and doctors on duty that day fucked up, sorry about that." Once thing that I can't get my head around is how was she left three whole days when usually the staff on shift change over every twelve hours, so there was around six different shifts before she was taken to A&E, yet nobody on shift questioned why she wasn't in hospital.

Clinical Psychiatrist, Andrew McDonald specialises in working with young people with challenging behaviour. When commenting on the battery incident, he explains how a form of negligence was involved and that no consequences were made. The incident happened again within two months, as well as with patients swallowing staples, screws and even a knitting needle.

Another patient called Ash who had been on the unit for over a month told Gráinne that she'd taken some tablets that another patient had smuggled into the unit. She explains that "I took so many pills and they still didn't kill me" to which Gráinne finds out that she took twenty sleeping tablets. Gráinne goes to the office to speak to the other staff about what had been done about the incident where she learns that Ash wasn't taken to A&E because the staff members had been told that "with the amount she had, she would be able to sleep it off. And then feel like she had a hangover." I am sorry - what? Those words came out of the mouth of a Mental Healthcare worker, if she has taken sleeping tablets, she needs to get medical attention, even if they do just tell her to sleep it off. It took over a day for Ash to be taken to A&E which just sounds ridiculous as the longer it is left, the more time there is for the tablets to dissolve into her system. Ash says how she was unconscious, they took her observations, couldn't wake her up and still did not take her to A&E.

When young people are admitted to the unit, they are often far away from their parents and home so parents have to put their trust into the staff to inform them of what it happening but in this instance, Ash's mum wasn't told until the night after that she'd taken a few tablets. She had no idea that her daughter had taken twenty tablets but she is a Mental Health Nurse herself and did question why she wasn't taken to hospital. She even explained how if they couldn't have taken her to A&E, they should have called a doctor in.

However, poor communication between staff and parents seems to have remained the same since Amy's case and her mum says how "You never found out about anything, not even the restraints" and it was only after looking through Amy's notes that were written by staff that she was able to piece together the failings in her care. The last page of Amy's notes shows how she was struggling and not getting the support. She had even threatened to hang herself earlier in the day that she died. Her mum was never informed, she never had any say and she feels that Amy may have thought that hr mum wasn't there for her when she just didn't know.

Since Amy's death, Tania has been trying to find out the truth about what happened to her daughter in the days and hours leading up to her death, "all they wanted to do was brush it under the carpet and put it down to a suicide" but her mum wasn't going to allow them to do that. It took five years for an apology and arranged settlement which makes the family concerned that the hospital isn't making changes.

After six weeks working at Ticehurst House, Gráinne still hadn't received her training, which is horrified considering that she has already had to deal with multiple incidences where she doesn't know how to react. We next meet a patient called Megan who often makes ligatures out of torn clothes. The priory says how everyone has a unique treatment plan tailored to their needs. In Megan's case, the decision was made by staff to not allow her clothing. Instead, she was left with nothing more than a safety blanket. After some time without clothing, staff decided that it was inappropriate for Megan to be in the dining room and with other patients naked so they decided that she could only be in her room where she just had to sit there. Consultant Clinical Psychologist Julia Faulconbridge explained how "it is utterly inappropriate for a teenage girl to have to spend a length of time without clothes" and later added that "she's not going to forget that." 

When Megan's parents realised what the hospital were doing to her, they decided to do what the hospital couldn't, or wouldn't do and they made her some clothes out of rip-stop material that they got from their local fabric store. According to Megan's parents, "there was no discussion of the safe suits, not about buying one in, not about we'll see what we can do" which is appalling. Surely, a HDU should have rip proof clothing stocked and how did they manage to get away with being so degrading towards one of their patients?

Megan's mum said how "at the beginning, you trust the hospital and the staff to do the right things but as time went on, more and more things became obvious that we felt weren't appropriate and communication was very difficult to have." Megan spent five months as an inpatient at the priory and is now treated at home, she explains that "when people think of psychiatric units, they don't think of how scary it can be for the patients, they think of how the staff were unsafe or how the patients are violent. Physically being naked gave me sores, made me itchy, made me red. It was very uncomfortable and emotionally, it made me very self conscious. It made me extremely unhappy and I felt so undignified."

After Megan had left Ticehurst House, Gráinne heard a senior member of staff discussing her case. In the documentary, you can hear the staff member say "Megan put in a safeguarding complaint against her saying that we didn't offer her any clothes. She was a month nursed naked in her bedroom. We didn't offer her a tear proof suit, even though we have them in stock. But they were told that they'd have to pay £70 if they were to have them. So God knows who told her that, because we haven't got any in stock. And apparently, the parents complained about us as well". Gráinne later hears the same member of staff and the ward manager having a conversation about Megan's parents which goes as follows:
"Mum and Dad are making a complaint"
"Ah mate, they all make complaints about different things"
"Because basically there's no place like home, they can't contain them but they think they can. All the parents are likely to be fucked up themselves."

I couldn't believe this conversation when I first heard it, so I watched it again and I do not understand how these people, who are a senior staff member and a ward manager, still have their jobs when they clearly have a very little understanding of mental health and little respect towards the patients. How about admitting that they messed up? That they left a vulnerable girl feeling undignified? 

On the Priory's website, it mentions how "they enable young people to get back on track and resume a for filling childhood" but this doesn't seem an accurate description of the care being provided. 

One clip shows a patient called Jessie asking for some PRN which is a medication used when an individual is in distress to help calm them down. The conversation goes as follows:
Jessie: "Can I have some PRN?"
Senior Nurse: "What for?"
Jessie: "Because I'm agitated"
Senior Nurse: "If I give you any PRN, you know you can't have it at night time... Do you know that?... I'll give it to you but you can't have it.."
Jessie: "Fuck"
Without the medication, Jessie begins to self harm by banging her head against the wall. She has a range of Mental Health Conditions as well as Autism. Gráinne has not been briefed about these conditions and therefore struggles to communicate effectively with Jessie and calm her down. She tries to protect Jessie's head by placing her hand against the wall, even resulting in getting blood on her hand. Jessie begins to bang her head harder. Gráinne decides to call fast response and radios for help to be told that nobody can respond.. for the second time within this documentary. 

It is another two minutes of head banging until a nurse arrives. This nurse tells Gráinne to stay right where she is and tries to talk to Jessie who repeatedly tells him to go away. He then stands there watching her, telling her how there are staff there for her to talk to. Jessie continues to head bang to the point where she falls to the ground to which the nurse responds with "she's breathing, she'll be fine". By the time that Jessie has been banging her head hard for thirteen minutes, Gráinne expresses her concerns to the nurse by asking "is that not dangerous or?", the nurse responds by saying that "she's using sideways of her head to bang. We've assessed it, there's no problem with that, yeah?" He didn't seem worried in the slightest and added, "head banging will not do anything to her."

This was later confirmed by Psychiatrist Andrew McDonald that this is not safe in the slightest and he wonders how it would be assessed as safe on the side of the head when if you bang slightly lower, there is a risk of blindness and we have senses of memory on both sides of the head as well as lots of other things that can cause brain injury. "We don't know about the long term effects of these things at all"

Understandably, this comment from the nurse agitates Jessie even more and she starts to bang the front of her head saying "now I'm using the front of my head hopefully that will be dangerous enough." Until seeing this clip, Jessie's parents were unaware of the extend of their daughters self harm at Ticehurst. Jessie's parents had previously told Ticehurst the risks of head banging as Jessie previously had to have a brain scan after head banging on a separate occasion at a different hospital. Jessie's mum said how "the doctors giving us the feedback of the scans said that they needed to make sure that this is not allowed to happen again under any circumstances." Her parents had to constantly remind staff when they saw evidence of head banging about the brain scan. It is very clear from the footage of Jessie that the nurses responsible either didn't know or had chosen to ignore the warning.

The nurse again says "We've assessed it, she's alright" to which Jessie replied "stop fucking saying I'm alright" and then the nurse leaves and Gráinne is left to cope as well as she can, without specific training, knowing her care plan or knowing what she'd specifically respond to. Eventually, after 40 minutes of head banging, Jessie is finally given some PRN but Gráinne doesn't witness her receiving any other medical treatment. Jessie is also no longer being treated at Ticehurst. 

After working for six week full-time, Gráinne finally receives her restraint training, during this training she is told of the importance of restraint techniques. One of the ladies giving the training explains how "hopefully you're able to de-escalate the situation before it goes into restraint because restraint is the last resort. You shouldn't be doing it, you should be trying to de-escalate." This is a complete contrast to what we've seen throughout the programme so far, and if they had given Gráinne her training sooner, she may have been able to remind other staff members that it is a last resort. 

Following this, another example of restraints not being used as they should is that Gráinne see's Ash banging her head on the wall, nobody had been out sitting with her and despite Gráinne asking for assistance, it was twenty minutes until two senior nurses arrive on the scene. They immediately tell her how they're going to move to the soft room and start to prepare for a restraint by calling for a five man response. Ash said herself how she didn't need to go to the soft room but three more male workers turn up and the situation quickly escalates with Ash getting very agitated. She screams how she doesn't want people touching her and their response was "well walk then", she also complained that her hand was being twisted and hurt to which the staff members again said "well walk then." They take Ash into a padded room where the restraint continues despite her telling them how much she hates small rooms.

Like many of the patients at Ticehurst, Ash is supposed to receive specialist treatment. When watching this clip, Andrew McDonald stated how this was a blatant over reaction and mentioned how there was nothing that suggested escalating this situation to the next level and that this will cause individuals to get frightened and scared. In this case, the restraint was not being used as a last resort, the staff members had barely even attempted to talk to her. Ash's mum said how she felt that how they behaved with her daughter was cruel and said that "if you're having to brutalise your patients by manhandling them, then you've failed." She added that it doesn't matter if it's done appropriately as an improved hold but you shouldn't have to go to a point where you need a five man response for a child head banging in distress and placing them into a small room that they don't like.

In a different clip, Gráinne is given a talk about the companies finances as part of her induction. We learn that across the country as a whole, the Priory group receives around 720 million pounds per year from both the NHS and local authorities. A senior manager brings up the subject of profit and states how they should have made £253,000 last month yet they only made £54,000 profit. He goes onto explain how "it's a real challenge. Thats not kind of your concern in that respect but it just shows the amount of effort it takes to make any profit." He later explains how their "average daily revenue per patient is about £500 per day, so we're not going to have a lot of profit out of that. Most of it is going onto making the site safe and staffing." I understand having to have conversations with members of staff about funding issues, budgets and where the money is going but to discuss with them that they're not making enough profit, that they aren't making enough money off of their vulnerable patients is disgusting. This is so wrong, psychiatric hospitals should not be used as a way to make money, it just makes you wonder if the staff members on the ward even care about the patients because it is clear that the individuals higher up don't.

Amy's mum said how she felt that all it was to the company was a bank and explained how "our vulnerable children, young adults are making money. It's all it is about, and my daughter was just the little coin in their cash pot."

Throughout her three months working at Ticehurst House, Gráinne found many occasions where it wasn't safe and there was a shortage of staff. On a shift towards the end of her time on the unit, this would be shown more seriously. Gráinne was asking to work with a high risk patient who needs close supervision. The patient seems to be asleep in the lounge but Gráinne hears Ash who is self harming by banging her head hard against a wall in the corridor outside. The ward seems short staffed and Ash is alone so Gráinne tries to help. There wasn't enough radios to go around all of the staff so Gráinne has to borrow one from a colleague. Gráinne checks on her patient who is still asleep in the lounge and calls for assistance to support Ash but there is no response. A minute later, she calls again but still, nobody answers. Her colleague goes to get help and Gráinne returns to check on Ash and although Ash is banging her head, Gráinne is conscious that she has left her 1:1 patient alone and returns to the lounge just over a minute later and by now the patient has woken up and has locked herself in the room. Gráinne again calls for assistance but there is still nobody to help. When Gráinne gets into the room she finds that the patient has found a way to make a ligature with the TV cable. Nine minutes after Gráinne's first call for help, a senior nurse arrives and removes the ligature. 

Watching this angered me as firstly, it is a HDU so why is there not enough staff members on shift? Surely there should be enough members of staff to go around all of the patients considering that this is a unit that probably has a lot of incidences. Secondly, why is there a TV cable that a patient can access? I have already heard numerous times on this documentary that they have recognised ligature points since the death of Amy. Thirdly, what is Gráinne meant to do? She's still fairly new to the job and to put her in a situation where she has no choice but to leave her 1:1 is disgusting. Short staffing should not be acceptable, we already heard earlier in the programme a ward manager saying how "we've got to work out if there's safe numbers to go on" and clearly, there wasn't safe numbers. There have been multiple occasions throughout this programme where an individuals life was in danger, but the senior staff act like they don't care. This is a thirteen bed unit, so why isn't there enough staff members to cover thirteen individuals? What is even more disgusting is that Gráinne wasn't told if the patient was taken to hospital for treatment nor was she asked formally about the incident by the manager or anybody else at the hospital. In this instance, I feel that Gráinne did the correct thing despite being on 1:1 with a patient but to not even be formally asked what went wrong baffles me completely. 

Immediately after Amy's death, the Priory said they'd assessed all known ligature points in all their hospitals. Yet Gráinne saw or heard of five different ligature incidents whilst working on the ward, on a High Dependency Unit may I add.

As well as Amy, there has been four other deaths reported of Children and young people receiving care of other Priory hospitals since 2012 but campaigners say the full extend of similar tragedies in Mental Health units isn't known. Debrah Coles, an execute director of the inquest states how it is very hard to find out how many children die in inpatient settings. The figures are shadowed in secrecy and they are not made publicly in the same way as other settings such as children's deaths in police custody. She says how this is something that parliament needs to address at the highest level.

When Gráinne filmed at Ticehurst, the unit was rated as 'good' by the Care Quality Commission (CQC) but after the Priory was told of the findings in March 2018, CQC carried out an urgent inspection. It confirmed the HDU was working in breach of regulations surrounding care and treatment of patients. But after a later inspection in November, the CQC rating of 'good' was given back to the unit. Ligature points had been address but it wasn't clear if work on these points had been completed.

Recently at Lewis Crown Court, the Priory Group pleaded guilty to a criminal charge over the death of Amy. They were fined three hundred thousand pounds by the judge. The company offered sincere and profound apologies to Amy's family. They said "we also intent to undertake a strategic review of our inpatient units and our CAMHS, to assess how best to respond to the individual needs of patients who are presenting with increasingly challenging conditions and self harm risks."

In response to the programme, the priory said how "we take patient safety extremely seriously and strongly refute any allegation that we put profit before safety. We continue to work closely with our commissioners on improvements to our Child and Adolescent Mental Health Services. We accept that there are instances shown in the programme where the care provider in 2017 has fallen below the high standards we expect and that our training and induction policies have not been followed. We sincerely apologise for this. We fully investigated these incidents as soon as they were disclosed to us and discussed them openly and candidly with our commissioners and our regulator. We took pro-active steps to address the concerns raised, including improving our risk management processes and providing additional training. Unfortunately, it has also been necessary to refer certain individuals to the Nursing and Midwifery Council. This programme is not representative of the CAMHS services provided at Ticehurst House. With the exception of the report from June 2018, all CQC reports in the last six years have found services at Ticehurst to be 'good' overall. The CQC's most recent review in November 2018 found that the standard of care being provided was 'good' in all areas.

Thank-you for reading, Tay x

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