Faster improvements needed in how people are cared for when detained under the Mental Health Act, warns CQC
The quality regulator has found that there is a lot of good practice in how psychiatric inpatient units are caring for people when detained under the Mental Health Act but that there is still much to be done to improve.
In its annual review of the Mental Health Act, published today (Friday 18 November), the Care Quality Commission (CQC) has outlined how several healthcare services in England are using the Act to maximise people’s recovery, wellbeing and support when they have been detained; however, it raises concerns that progress needs to happen at a faster pace for key issues, such as patient involvement and protection of rights.
More than half of the inpatient psychiatric wards CQC reviewed had not demonstrated that they had trained their staff in the ‘Code of Practice’ (national guidance that explains how professionals should carry out their responsibilities under the Mental Health Act) and more than half had not updated their policies, despite the Code being introduced over eighteen months ago (in April 2015).
Also, in 12% (515 out of 4,344) of the patients CQC interviewed on its visits, there was no evidence that they were informed of their right to an Independent Mental Health Advocate, who would offer support to them and enable them to be involved in decisions about their care. Furthermore, there was no evidence of patient involvement in care planning in 29% (1,214 out of 4,226) of the records CQC examined.
Based on over 1,300 visits to mental health wards and conversations with over 4,000 patients, CQC has also found a lot of good practice across the country, which it is encouraging all providers to learn from.
This includes where services are meeting and exceeding the expectations of the Act, helping people to understand their rights while detained and involving them in both the planning of their care and future treatment.
Dr Paul Lelliott, CQC’s deputy chief inspector of hospitals (lead for mental health), said: “We know that it is a challenging time for all health and care services across the country with rising demand and strained resources; however, the priority must continue to be on patient care, recovery and need. We are frustrated that there has been little progress since last year’s report.
“As the quality regulator, we will continue to play our part in supporting services to improve and taking action to protect people, where necessary. We expect providers and commissioners to recognise this urgent need for change and to do the same.
“Mental healthcare professionals are one of the very few groups in our society that have the authority to deprive people of their liberty. It is absolutely vital that safeguards are in place to guarantee that people detained under mental health legislation both know their right to challenge their detention and are enabled to exercise this right.
“Although, our observations are worrying for people with serious mental health needs overall, there are many examples of good practice in how providers and staff discharge their responsibilities under the Mental Health Act.
“Also, it is notable that two mental health trusts have been rated as outstanding overall in the last round of comprehensive inspections. This shows that services can deliver good practice, and we expect this and future monitoring reports to enable services to learn from these examples.”
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. CQC has inspected all 57 NHS mental health trusts in England. So far, it has rated 55 of these trusts, with their current ratings as follows: two as Outstanding (Northumberland, Tyne and Wear NHS Foundation Trust and East London NHS Foundation Trust), 19 as Good, 34 as Requires Improvement, and none as Inadequate.