There is no single reason why more detentions are being made under the Mental Health Act than ever before, a review by the Care Quality Commission (CQC) has concluded.
Instead, the rise in detentions is down to a range of different factors, which can vary across the country. Some of these are also indicators of a healthcare system that is under considerable strain.
Healthcare professionals can apply to detain people under the Mental Health Act to ensure they receive the treatment, care and support they need in hospitals. Although this is in the person’s best interests, it is against their wishes. For this reason, the law is supposed to be used only when other options have been considered already, such as whether support can be provided in the community or if the patient can be cared for in hospital on a voluntary basis.
In the ten year period between 2005/06 and 2015/16, the number of detentions increased by 40% – from 45,484 to 63,622.
As part of its role in monitoring the use of the Mental Health Act in England, CQC made a commitment to explore what could be causing this trend.
CQC has done this by reviewing the available data, by visiting specialist mental health (independent and NHS) services, and by speaking to patients and to representative bodies to gather their views.
CQC has published the outcome of its review today (Tuesday 23 January).
In it, CQC has found that the causes of the rise in rates of detention can be grouped under four main themes:
1. Changes in mental health service provision and bed management: This can include there being fewer alternatives to inpatient care in some parts of the country (such as support in the community). It might also be due to the high demand for hospital beds preventing admission on an informal (voluntary) basis, early in the course of a person becoming unwell, or leading to premature discharges, which can then lead to readmissions.
2. Demographic and social change: This includes general population growth, as well as growth in sections of the population that are more likely to be detained, such as older people with dementia, people who are homeless and people whose health is affected as a consequence of alcohol and substance misuse.
3. Legal and policy developments: The broadened definition of a mental disorder in the revised Mental Health Act in 2007 is already understood to have led to increased applications for detention. As well as that, there is greater awareness, for example among the police, of mental disorder and among clinicians who wish to ensure there are legal safeguards in place when caring for people who lack mental capacity.
4. Data reporting and data quality: This includes better reporting of detentions, as well as the potential for double-counting, such as when a detained patient moves between wards or from one hospital to another.
In terms of further trends to explain the ongoing rise in detentions, CQC found no evidence that professionals had been misusing the Mental Health Act in any way; for example, patients who did not meet the criteria being detained so that they could be guaranteed an over-night bed in hospital.
Dr Paul Lelliott, deputy chief inspector of hospitals (lead for mental health) at the Care Quality Commission, said: “There is no single reason to explain why detentions continue to rise every year. Population growth, societal changes, better national reporting, duplicate reporting, increased awareness of mental disorder and expanded criteria for detention are all contributing to more and more instances of people being sectioned under the Mental Health Act.
“Some of the factors at play in the rising rates of detention, both nationally and locally, are also signs of a healthcare system under considerable strain. Detentions under the Act can be influenced by gaps in support and provision in the system. This includes limited hospital bed availability, which means that people cannot easily be admitted as voluntary patients early in the course of their illness. This is a particular problem if it is coupled with limited support for people in the community, which can prevent a person’s mental disorder from deteriorating to a point that detention under the Act is necessary.
“It will take more than changes to primary legislation to tackle this fully and to ensure that people with serious mental health problems always get the safe, high-quality and compassionate care they deserve, when, where and how they need it. Changes to the law must happen alongside action to address the wider problems.”
CQC has shared its briefing with the Government to aid its independent review of the Mental Health Act and with providers and commissioners to help them plan and review their services.