Alarm systems on mental health wards: the need for change

In order to alert staff on mental health wards of the possibility of an incident or issue that requires urgent attention, loud alarm systems are often used to get help as quickly as possible. However, more research is needed on the ways in which current alarm systems effect staff and service users.

I have been working as a peer support worker on a men’s mental health ward in the East of England for just under a year now. In my experience, as someone with lived experience of schizophrenia and hearing voices, life on the ward can be frightening, hostile and threatening, especially if you are psychotic and hear voices, like I have in the past.

Indeed, I have heard threatening and demonic voices saying: “On the bonfire with him!”, “Get down there!” and “Hot fire in your eyes!”. This distress is not helped by the current alarm system, which I have noticed as a peer support worker to cause panic, distress and anxiety among people with mental health problems on the ward and also staff.

For people who are neurodiverse, or suffering from anxiety, the sudden loud noises can be extremely triggering having a negative impact on the person’s therapeutic recovery. It becomes particularly difficult for those people confined to the ward without any leave privileges due to their detention status under the Mental Health Act.

Loud alarms systems can make psychosis worse

Peer support should promote feelings of safety in the ward, but this becomes difficult to do with a screaming alarm that’s purpose is to alert its listeners to danger. The staff panic and run to the pinpointed location, which must be distressing for them as well as service users. In my work as a peer support worker, many people have said that the alarms made their voices and psychosis worse because of the stress and anxiety.

Comments include:

“I think they’re coming for me”
“It makes me frightened”
“It makes me cry”
“I want the alarm to end”
“It’s anxiety”
“It’s about to kick off”
“I need to stay out the way”
“I feel numb”
“It makes my headache”,
“I feel like screaming”.

One person said: “It doesn’t bother me. I feel nothing”, so feelings about the alarms are inherently subjective.

A pocket buzzer alarm, perhaps an App or traffic light system might help calm the ward, diminish people’s voices/ psychosis and promote feelings of safety. The traffic light system might involve: Red (Suicide attempt or severe aggression/ violence), Amber (Early warning signs of these), Green (All clear and safe on the ward).

Having said that, the types of alarm systems and use of them varies across wards and so there is an inconsistency of approach, which again causes confusion for staff and service users who may have their care, or work, across different sites.

Therefore, there is a need to review the current alarm system to make it more acceptable to people with mental health problems and staff. The Health and Safety at Work Act 1974 (HASWA) lays down wide-ranging duties of employers. Employers must protect the health, safety and welfare at work of all their employees, as well as others on their premises, including health and social care staff, service users, bank staff, families and carers, visitors, clients, and the general public.

The current alarm system could be argued to contravene policy and put people at risk in what is sometimes a distressing and hostile ward environment. Current alarms create an unsafe working environment for staff and feelings of unsafety for service users, which as shown in the above quotes works to negatively impact people’s mental health, feelings of a safe environment and their welfare.

Certainly, it could be counterargued that the present alarm system is necessary to reduce and manage risks, such as self-injury, assaults or violence, aggression toward staff and other service users, suicide and other adverse incidents. However, the present alarm system requires reconsideration, further research and upgrading.

Research needed on service users’ views on alarm systems

There is some research on the benefits of silent or personal alarms for staff¹ and indeed in one instance this improved a Trust’s Care Quality Commission rating.² But this is not based on service users’ perspectives of the current alarm system. There is little or no study or research on the people that alarms effect the most, namely service users.

We are therefore in the process of establishing a Centre of Excellence (CoE) for Service User Led Research (SURE) to focus on topics such as alarms as well as many other important and understudied topics and issues. It is vital to get the service user perspective, so a Lived Experience Advisory Panel is being formed to advise on service user-led research, simplify ethics and streamline the research process, to make it quicker, more up to date and less arduous. Of interest is studying how the use of independent advocacy impacts a person’s length of stay on a ward.

Leading organisations, such as Rethink and MIND, could also campaign for better treatment of staff and service users and come up with more healthy alarm options, such as the traffic light system already noted. Or indeed, these leading organisations could start a petition to call for a review of the current alarm system.

It should be noted that the current alarms are not the shortcoming of any one Trust, but rather a systemic shortcoming of many mental health wards throughout NHS England.

Ben Gray is a peer support worker in the East of England and also a Research Ambassador at Healthwatch Essex. He was a Service User Expert at Rethink Mental Illness between 2011-2014.

Matthew Sisto is peer team leader and a Director of Patient Experience at the Trust.