The Care Quality Commission (CQC) has found that some patients who are subject to the Mental Health Act continue to experience care that does not fully protect their rights or ensure their wellbeing.
While CQC found individual examples of good practice, the quality regulator has concluded that mental health services are not doing enough to ensure that people whose liberty has been restricted under the Mental Health Act are able to exercise their rights; and that this situation is not improving.
Throughout the year, CQC has carried out visits to mental health inpatient services to meet patients, review their care and speak to staff on the frontline of care.
In its annual report to Parliament on how health services in England are applying the Mental Health Act and responding to the wider challenges for the mental health sector, CQC has concluded that there has been:
• No improvement in aspects of care-planning that are important to supporting the recovery of patients and their discharge from inpatient services. These include involving patients in developing their care plans (32% found no evidence); making sure the views of patients are considered (31% found no evidence); whether clinicians had considered less restrictive options for supporting patients (17% found no evidence); or, making a record of the plans for discharging patients back home (24% found no evidence).
• One in ten records showed that people had not been informed of their legal rights on admission.
• Despite the importance of physical health checks for people with serious mental illness, CQC found that 8% of people reviewed had not had a physical health check completed when they were admitted to a psychiatric ward.
These problems are longstanding and they have been raised by the quality regulator in its previous reports to Parliament.
The publication of CQC’s report comes as an independent review of the Mental Health Act is underway. This is an opportunity for these concerns to be addressed. In particular, the review, which is being led by Prof Sir Simon Wessely, could consider whether the requirement on managers to ensure that staff comply with their duties to inform patients and involve them in care decisions should be strengthened.
Dr Paul Lelliott, deputy chief inspector of hospitals (lead for mental health) at the Care Quality Commission, said: “Mental health has never been higher on the national agenda and more people than ever are receiving treatment and care for their problems. The number of people detained in hospital under the Mental Health Act has continued to rise over the course of the current decade. We know from our inspections that services are having to respond to this unprecedented challenge.
“We encourage individual providers and commissioners to review their practice against our findings and to address the long-running issues that we flag up every year. Managers of mental health providers should understand how the Act is being used locally, and use this intelligence to improve their services. This is a feature of an organisation that is well led.
“We support the independent review of mental health legislation, which is being carried out by Prof Sir Simon Wessley. We welcome the fact that his review will also consider the wider practice and service factors that might underpin some of our findings. This is quite likely to be a ‘once in a generation’ review and our report on the Mental Health Act allows us to share the themes from the thousands of interviews we complete with people currently subject to the Act in hospital every year.
“We hope that the evidence from people with a direct experience of the Act will serve as an important lever for improvement in some the areas of concern that we have highlighted in our regulation and monitoring work of mental healthcare across England.
“As the quality regulator, we will continue to play our part in highlighting good practice, encouraging improvement and acting on behalf of people so that everyone gets the help they need, when they need it.”
The Mental Health Act 1983 is the legal framework that authorises hospitals to detain and treat people who have serious mental health needs and who are putting their own health or safety, or of other people, at risk of harm. CQC has a duty to monitor and report on how services do this.
As part of its work to monitor the Act, CQC carried out 1,368 visits to mental health wards from April 2016 to March 2017 and spoke to thousands of patients and their representatives to discuss how the Mental Health Act and its Code of Practice (national guidance that explains how professionals should carry out their responsibilities under the Mental Health Act) were being applied to them.
As well as this, CQC received 2,353 complaints and enquiries about the way the Mental Health Act was applied to patients and CQC Mental Health Act Assessors requested 6,475 actions to change the way care was being delivered to providers.