Inspection Identifies Positive Practice But Clear Areas for Improvement at Carmarthen Mental Health Wards
Healthcare Inspectorate Wales (HIW) has published its inspection report following an unannounced visit of Cwm Seren Low Secure Unit (LSU) and Psychiatric Intensive Care Unit (PICU), part of Hywel Dda University Health Board. The inspection, carried out over three days in November 2025, focussed on care provided on the two specialist wards, which support people with complex mental health needs in secure environments.
Overall, patients told inspectors they felt safe and many described staff as kind, helpful and supportive. Inspectors also observed positive, sensitive engagement, including the active offer of Welsh by bilingual staff and access to advocacy. However, some patients also highlighted areas where patient experience requires improvement, particularly around dignity, respect and active listening. Some patients also raised concerns about uncomfortable mattresses for long‑term stays, as well as limited and repetitive meal variety. Inspectors noted that people who were unable to leave the ward often experienced boredom due to a lack of structured activities, contributing to a less therapeutic daily routine.
Inspectors observed environmental concerns including peeling paintwork, damaged flooring, damp patches, broken equipment, inadequate soap dispensers, a bathroom being used as storage, and unresolved estates issues that had been outstanding for long periods.
Access to physical activity was also limited. Most gym equipment was out of order, and there were not enough gym‑trained staff to support safe exercise. The garden area was poorly maintained, with overgrown grass and slippery surfaces that posed a risk of falls and limited outdoor activity. These issues reduced opportunities for physical activity, an important component of mental health recovery. Safety issues were also identified, such as an expired fire safety blanket in the LSU beverage area and an expired oxygen cylinder in the PICU clinic, which were immediately removed and replaced during the inspection.
Staff were described as hard‑working, caring and resilient, and systems for managing risk, incident reporting and care planning were generally strong. Inspectors noted good reductions in restraint, with staff focusing on early intervention and ensuring safe, compassionate practice when restraint was necessary. However, compliance with mandatory training, especially Basic Life Support, Immediate Life Support and physical restraint training, remained below expected standards. Additionally, the wards had been without a psychologist for more than two years, limiting access to therapeutic interventions and psychological assessments.
While the staff demonstrated strong commitment and compassion, significant improvements are required to address environmental and safety risks, improve training compliance, and strengthen patient experience. The health board has been asked to act promptly on these recommendations and ensure progress is closely monitored.
Alun Jones, Chief Executive of Healthcare Inspectorate Wales, said:
Staff at Cwm Seren are clearly committed to providing safe and compassionate care in what can be very challenging circumstances. While we saw some positive practice and strong teamwork, our inspection identified environmental, safety and patient‑experience issues that must be addressed urgently. We expect the health board to take prompt action to improve the therapeutic environment, strengthen staff training, and ensure patients receive the consistently respectful, engaging and recovery‑focused care they deserve. We will continue to monitor progress closely.