The CQC’s annual report published in February. The news? Detention rates up, collaborative care planning down.
In their annual report on the usage of the Mental Health Act (MHA) the CQC provides a range of useful statistics as well as commentary on issues that continue to cause them concern.
The unsurprising headline: detention rates under the MHA continue to rise, with the total number of detentions in hospital at 63,622 in 2015/16, up from 58,399 in 2014/15. Pulling from its report in January this year the CQC suggests eight possible reasons, all of which are likely to be at play to a degree. The report also flags a change in the way MHA data is collected which is likely to result in some unreliability in 2016/17 figures.
There are a number of areas of concern raised in the report, but the one I want to focus on here is the lack, and potentially decline, of collaborative care planning, and steps that can be taken to address this. First of all, some troubling statistics:
- 32% of care plans reviewed showed no evidence of patient involvement. This was 29% last year.
- 17% showed no evidence of consideration of the patient’s particular needs. This was 10% last year.
- 31% showed no evidence of the patient’s views. In 2015/16, 26% had not been recorded.
While a lack of evidence does not necessarily mean these things are not being done, in the CQC’s 2017 Community Survey 24% of patients similarly reported not being involved in their care planning. The CQC note that ‘in every report since 2008, we have highlighted difficulties with care planning processes for people subject to the MHA.’ Given the lack of improvement over this time the CQC pins its hopes on the Independent Review of the Mental Health Act, due to publish its interim report shortly. On care planning the CQC suggests that:
‘… statutory duties (including duties to record or follow specific processes, or duties on managers to make sure that they take place) may provide an additional lever to effect change.
There is a clear need for a statutory framework for care planning for those subject to the MHA. Lessons can be learnt from the relatively recent introduction of the Care Act 2014. Despite its imperfections, what that Act gives you are clear processes for assessing needs, deciding how those need will be met and the provision of any necessary support. The process places clear duties on local authorities to assess, inform and involve, all of which are enforceable.
While the MHA provides a detailed framework for when and how people with mental health conditions can be admitted to hospital involuntarily and when they must be discharged, it is pretty quiet about what happens to them once they are there.
Why the stark difference between the two regimes? People subject to the MHA have a range of needs which should be assessed and met, in the method of their choosing where possible, and involving the people they wish to be involved. While a statutory framework under the MHA would need to differ in a number of ways from that under the Care Act, having a statutory framework allows us to consider what needs to be included. It could provide a way for views to be sought and recorded, in advance and at the time; for decisions on capacity to be made explicit; for the ability to challenge individual bits of your care plan; for discharge planning to start in a timely manner, and a whole host of other things.
Without this the MHA will remain a very one-sided instrument where once you’re in you’re in and you get what you’re given. This power imbalance has to be a focus for the Independent Review.