Psychiatric unit subject of 4,600 police calls in two years

Families have shared their concerns about a mental health unit that was the subject of more than 4,600 phone calls to police during a two-year period.

The BBC spoke to families about staff reportedly sleeping on shifts and poison being used by a patient at Wotton Lawn Hospital, Gloucester.

In March 2022, one patient William Warrington, 43 absconded and killed his mother, Valerie, and father, Clive, at their respective homes in Bourton-on-the-Water and Cheltenham.

It took two hours for staff to notice that he was missing after he left by taxi. Although the police were notified, his family was not told he had escaped, despite the hospital being sent 11 emails about the risk he posed to them.

BBC Freedom of Information Act requests revealed Gloucestershire Police received 97 reports of patients missing from Wotton Lawn between 1 January 2021 and 31 December 2022 and received 4,611 phone calls relating to the unit.

According to the Gloucestershire Health and Care NHS Foundation Trust (GHC), staff called police 299 times and officers attended on 171 occasions. Patients have the right to have a mobile phone in the unit, and many of the calls would have been made by those being treated there.  

The BBC said that it understood that the calls related to all incidents where the location was given as Wotton Lawn, which may or may not be serious. In some cases, the calls may have related to incidents outside the hospital, but the caller gave their address as Wotton Lawn. 

One father told the BBC his daughter had repeatedly been able to access high-risk items such as cannulas, plastic bags, medication and aerosols while in the unit.                 

Darren Watts claimed staff monitoring doors frequently fell asleep on duty, placing people in the ward at risk. He said that the trust had been ‘in denial’, about this, saying there was no evidence, but patients would be penalised for taking photos of sleeping staff to show it was happening..

He added added that patients have also escaped over the garden walls of the unit and climbed onto the roof. He said: "We had to tell staff patients were stashing a ladder around the back so they could just get it out, climb out and climb back in later on. Those patients were not noticed as being missing."

A spokesman for the hospital's trust apologised and said the issues raised had been "thoroughly investigated."

Director of nursing, therapies and quality at GHC, John Trevains, told the BBC: "We constantly seek to make improvements to make things better and safer for our patients. A lot of our patients have the rights and freedoms to come and go and leave the ward while reporting to staff what they are doing so it's a very difficult balance to achieve, and we work very hard to maintain safety as best we can."

Rochelle Ravenscroft took her own life at Wotton Lawn in March 2020 after being admitted as a voluntary patient. She ordered a poisonous substance and had it delivered to the facility.

Her father Warren Rose said she would frequently be out all day and there would be little monitoring of her whereabouts unless she missed her medication.

He said his daughter had told them about ordering the substance but her level of risk was never reassessed by clinicians and no attempt was made to find it

Mr Rose said: “There was no more supervision than at any other time, even though there was at least a week or 10 days between her telling them she had the product and actually using it.

"There's no guarantee she wouldn't have done it somewhere else, some other time, but the point is she was sent there as a place of safety."

William Warrington pleaded guilty to the manslaughter of his parents at a hearing on 15 November 2022 on the grounds of diminished responsibility.

Passing sentence, Mrs Justice Eady ordered Warrington be detained in a secure psychiatric hospital indefinitely under Sections 37 and 41 of the Mental Health Act.

Justice Eady said the case raised questions about Wotton Lawn. She told Warrington: "I have not heard from those with responsibility for you at Wotton Lawn, and can make no findings as to the adequacy of the arrangements there.

"What is clear, however, is the events that unfolded on 1 and 2 March 2022 raise very serious questions for those involved, particularly given the concerns that had been communicated by your family."