Little is known about the work of forensic psychiatry services in the UK, so our motivation for taking part in the documentary is to give members of the public insight into the vital work we do to treat offenders with mental disorders. The programme shows how we carefully assess and treat them in safe, secure hospital conditions and, help them recover and reintegrate back into society. We hope the documentary will help challenge stigma surrounding mental disorder and give audiences a better understanding of what forensic mental health really means, seen through the eyes of the patients and the staff who care for them.
The decision not to blur the faces of the patients was not taken lightly however the Trust felt that in order to fully explore and highlight the effects of mental disorders the filmmakers had to reveal the real people behind the stories. The patients who tell their stories agreed with this approach. Without waiving anonymity the series could not have conveyed to the audience the raw emotions and challenges experienced by both patients and the clinicians during treatment right through to recovery. If for any reason any of the contributors declined to give their consent they were not included in the series.
Taking part in the documentary was a choice not a requirement for all those who featured in the programme. If a patient, relative, friend or member of staff said they did not want to be on camera, the producers did not film them. Some opted not to be in the film at all, others said if they appeared in a shot they were happy to be blurred out during the editing process.
This was very much a collaborative project, whilst recognising that Rare Day, Channel 4 and the Trust have different aims and responsibilities. Throughout the 12 months of filming the Trust communications team were involved in the correspondence, decision and discussion on filming with patients and staff. It meant a regular flow of emails which enabled us to monitor and therefore manage what was going on in each area.
The forensic senior management team met with the production company regularly providing them with a full induction into forensic services.
Before the producers even embarked on research for each film we ensured we were in close contact with all staff potentially involved. We accompanied producers to initial meetings, explained our reason for wanting to make the documentaries and gave them the opportunity to ask questions or opt out of filming.
While editorial control is with the Producers and ultimately Channel 4, SLaM had the right to view the programmes before transmission to point out any inaccuracies and anything that they believed to be unfair or inappropriate to air. The consultant psychiatrists responsible for the care of the patients featured also watched every episode to ensure that, on broadcast, the tone and content of the programmes would not be detrimental to the welfare of the patients.
In the access agreement signed by the Trust, producers and Channel 4 – producers agreed to ensure the programme is accurate and not misleading in the way it is edited. The agreement states that ‘the programme will provide a fair and accurate portrayal of life in the Hospital’ and the parties entered into the agreement on this basis.
All patients and clinicians who feature prominently in the programme have seen the finished programmes and are content.
The Trust Board were given the opportunity to view the programmes before they were broadcast.
The safety of our staff, vulnerable patients and the public is at the forefront of everything that we do and filming for ‘Life on the Psych Ward’ was no exception. We worked closely with Rare Day and Channel 4 to ensure that robust access agreements, consent and safeguarding protocols were put in place and adhered to throughout the production process. In addition Rare Day productions made best endeavours to contact the victims involved in an effort to keep them informed and minimise their distress.
The production team developed an extremely detailed consent protocol in close collaboration with SLaM and Channel 4 over many months.
Decisions about who to approach were always made in discussion with, and only with the support of the clinicians responsible for the patient’s care. The Rare Day production team always followed the basic principle that patients using mental health services are entitled to privacy and confidentiality and that only when a patient waives that could he or she feature in the finished programme.
If the consultant psychiatrists responsible for the care of the patient deemed a person fit to consent the producers were able to proceed. Consent is an on-going process, so each time the patient is filmed they are asked verbally for their consent. Some patients were able to give informed consent at the time of filming and were asked each time the crew arrived for filming if they were happy to continue. Written permission was required from patients before any material is broadcast. At no time will any footage be broadcast of identifiable patients who do not or cannot give informed, written consent.
Where there was doubt about a patient’s capacity to give informed consent, the final decision was made by the responsible clinician.
All patients and clinicians who feature prominently in the programme have seen the finished programmes and are content.
The patients’ welfare was, and continues to be paramount and clinical decisions made by SLaM always have precedence over any other considerations.
The Rare Day producers are in touch with all the patients in the series and have been since filming ended.
The right of victims to privacy, dignity and confidentiality is paramount. The Producers are bound by the OFCOM code, which has strict guidelines about the privacy and wellbeing of victims of crime.
The producers worked closely to guidelines agreed with the Ministry of Justice and all patients considered for filming were reviewed by the Trust’s Medical Director and the Rare Day Executive Producer to ensure it would be appropriate to attempt to contact the victim.
When a patient was identified as being suitable for filming, the production team used their best endeavours to contact the known victims of that patient, to explain to them the nature of the programme and how the patient will be featured in it and will pay due regard to any concerns they may have.
Whenever they could trace victims the producers made repeated attempts to advise them about the programme and also invited them to pass any comments or concerns to them. In some cases it was impossible to find victims because the crimes were so long ago or because they had made themselves difficult to trace.
We are confident that Rare Day made best endeavours to contact the victims in relation to the offences disclosed in the programme.
River House is a state of the art medium secure facility on the grounds of the Bethlem Royal Hospital in South London. Offenders receive specialist care in a medium secure environment supported by an expert team of staff from a range of disciplines, including psychiatry, psychology, nursing, occupational therapy and social work.
The cost of treatment at River House is £165k per year, a price set by our commissioner NHS England. Whilst this is more than it costs to imprison a person, we are a hospital and not a prison. We operate a therapeutic model and our vital work improves mental health, protecting the public and reducing re-offending.
An average stay in the Trust’s medium and low secure units is between two and a half to three years. During this time patients are carefully assessed by qualified clinicians and treated in secure hospital conditions with specialist services. A patient is only discharged when both the multi-professional clinical team and Ministry of Justice agree this is appropriate.
Patients come to us because they are deemed so unwell that they require treatment in hospital to get better and because they pose a danger to themselves and others.
Our two main priorities are to help restore a patient’s mental health and reduce their risk to the public. By treating an offender in a secure hospital environment we are able to provide them with specialist care, manage the risk, reduce further offending and support recovery throughout the person’s stay.
Yes if they are a sentenced prisoner that has become mentally unwell in prison. Patients come to us from prison for a period of time for treatment. Once their health is stabilised or they are recovered they will go back to prison for the remainder of their sentence. Patients that are diverted from prison by the court system do not return to prison and are discharged into the community.
No. By seeking to understand and treat serious offenders with mental illness in hospital we are not excusing the severity of their crime or trivialising its impact on any victims. However at times someone’s mental health can deteriorate so severely that they require specialist care and so the best place for them is hospital. It is also worth noting that when an offender is in the prison system they generally have an end date to their term, but in forensic psychiatry the patient will remain in our care until they are better and no longer pose a risk to the public or themselves. This of course can mean that they are never released from hospital
There are two types of leave that are granted to patients who have been effectively treated and their mental health is stable. The first is supervised leave, where a patient is accompanied by a member of staff, followed by short periods of unescorted leave and then eventually overnight leave to either their family home or to their residence.
Public safety is always our number one priority. All patients on unescorted leave must wear an electronic monitoring device, known as the ‘Buddi System’ so we can track their location and ensure that they are adhering fully to the conditions of their leave.
Bethlem Consultant Psychiatrist Dr Tim McInerny explains how doctors judge whether someone is well enough to be given leave in this BBC News Magazine feature.
Granting leave for patients cared for within our medium secure services is a necessary step in the rehabilitation process, so that we can judge their ability to look after themselves, connect them to rehabilitation services and family life in the community.
Public safety is our main priority, and patients will only be granted leave once an extremely detailed risk assessment has been completed and the doctors and nurses responsible for their care have assessed that they are responding well to treatment. If a patient is subject to a restriction order** we will also seek permission from the Ministry of Justice or Mental Health Review Tribunals in order to plan leave.
**Restriction order is another term for Section 41 of the Mental Health Act 1983 (MHA) (the law in England that controls what services can do when they are trying to assess or treat someone against their will). A Restriction Order means the Secretary of State decides when you can leave hospital.
You can find out more about leave in the short film
The programme name ‘Life on the Psych Ward’ was chosen by Channel 4 as a title that would catch the audience’s attention and to reflect the setting and location of the filming. As the broadcaster, the decision about the programme title was ultimately theirs.
We don’t want viewers to think that every psychiatric ward operates in the same way as what you will see in the programme: although named ‘Life on the Psych Ward’, the programme does not represent the workings of a general psychiatric ward or hospital, instead it offers a snapshot of what life is like on just one of our wards in our medium secure forensic unit, River House.
River House is a unit providing services for mentally ill offenders, which is why a level of security is needed. The facility is based at the Bethlem Royal Hospital in London, which is home to a number of our specialist services for people from across the UK who have been diagnosed with a mental disorder.
People living with mental health problems are more likely to become the victims rather than the perpetrators of crime. Most common mental health problems have no significant link to violent behaviour at all. However there is an increase in violent behaviour in a small proportion of patients with severe mental illness. Treatment of these conditions reduces the risk of violence.
There are lots of reasons someone might commit a violent crime, and factors like drug and alcohol misuse are far more likely to be the cause of violent behaviour.