Any fire within a hospital has the potential to create a far more challenging situation for local managers and care staff than one which occurs in premises where all persons are fit and able bodied. Where occupants are diagnosed with mental disorder, and may be especially vulnerable, the seriousness can be compounded to a significant degree. This chapter identifies why fires, including deliberately set fires, are a problem for providers of mental health services. The history of fires in psychiatric premises in the UK is briefly reviewed, and the increased risks associated with people resident in psychiatric units are explained. Recent, major changes in UK fire safety legislation are described and the implications for psychiatric practitioners and managers are identified. Practical steps to employ when conducting a fire risk assessment are described and the legal responsibilities of care providers under the new legislation are detailed. It is vitally important that staff receive appropriate training to ensure the safety of persons from fire, and that a fire safety culture is developed and maintained.

Fires in UK psychiatric premises: a brief history

Over the last 100 plus years a number of major fires involving loss of life have occurred in UK psychiatric premises. One of the worst was at the Colney Hatch Lunatic Asylum in north London in 1903, when 51 persons perished and all five wards were burned down (see Rollin, 2003). In 1988, at the same location, but then known as Friern Barnet Hospital, two fatalities resulted from a fire in a ward. In 1968, at Shelton Hospital in Shropshire, a major blaze killed 21 patients and injured 14 others when what was believed to be a cigarette end discarded by a patient in a locked secure ward ignited combustibles. A subsequent inquiry (Hansard, 1968) revealed that the night staff at Shelton had not received training in fire evacuation procedures for over 20 years. This incident also graphically illustrated the importance of promptly alerting the emergency services: the inquiry found that a 10-minute delay had occurred before a nurse who had first noticed smoke called the fire brigade. In hospital settings many patients may be unable to make their escape unaided, and therefore a sufficient staff:patient ratio can be crucial in the prevention of death and injury.