The Care Quality Commission (CQC), the independent regulator of health and social care in England, recently published their report on how the Mental Health Act (MHA) is being used. Click here for details
They found that detentions under the MHA continue to rise with 49,998 new detentions recorded for 2018/19.
There are concerns that human rights principles are not consistently being applied to the care and treatment of detained patients and more needs to be done to understand and address issues of inequality, especially for BAME groups. Astonishingly new statistics for detention show that Black or Black British people are still over four times higher than for White British people.
Community Treatment Orders – an order means that a person will have supervised treatment when they leave hospital and requiring them to follow conditions – continue to be significantly higher for Black/Black British people; 53.8 uses per 100,000 population compared to 6.4 uses per 100,000 population for White British people.
There is a lack of availability of beds both in the community and in hospitals. Coroners made the CQC aware of at least seven deaths of people who were assessed as requiring admission, but for whom no mental health bed was available. There is ongoing use of police cells as places of safety due to lack of beds.
There is continued improvement in the number of people being given information about their rights, which was evidenced via patient records:
- Good evidence of accessible and appropriate info in 91% of all records
- Initial discussion about rights in 87% of all records
- Repeated discussions about rights in 80% of all records.
But, there are still many people who don’t understand their legal rights as they’re not having meaningful discussions or being given information in a format they can understand.
94% of the wards visited were locked on the days of the CQC visit, including wards where patients may be admitted on an informal basis. The CQC raised concerns in 7% of visits about whether informal patients were free to leave the ward at will.
They stated that staff may be concerned about how safe it is to allow informal patients to move freely around the hospital grounds or to leave the hospital. As a result, they may be reluctant to fully explain their rights to them or feel like they must take a risk averse approach and use the section 5 holding powers under the MHA to stop the person leaving when they request to do so.
There are ongoing concerns about patients’ involvement in care planning. The CQC recommended that patient involvement was absent or needed to improve in 37% of care plans that they reviewed. 19% of care plans showed insufficient or no evidence that a person’s diverse needs were considered, and 17% showed insufficient or no evidence that the service had considered the minimum restriction on a patient’s liberty. In 11% of care plans there was no evidence of patient involvement at all.
The CQC also highlighted the complexity between the MHA, the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DOLS) work. It highlights that it is very difficult for people to be clear on what safeguards and rights they have under each of these frameworks. It also calls for the laws to be updated and provide clear guidance on how they interact.
Clearly there is a huge amount of work to be done and many people with an ASD know only too well what it means when MHA is used infectively and without compassion.
It is hoped that the Mental Health Units (Use of Force) Act will come into force soon and it seems the Mental Health Admissions (Data) Bill is progressing. That said, parents and adults are encouraged to keep their representatives updated with regards to mental health failures and, of course, successes.