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CQC: Monitoring the Mental Health Act in 2017/18

The CQC's annual report on usage of the Mental Health Act: more dodgy data but some promising improvement in patient involvement.

Before jumping into the substance, a point about data. Firstly, the report notes that the data on the number of new detentions from NHS Digital is not reliable. It suggests 49,500 new detentions within the period but notes 'these figures are incomplete due to underreporting, and cannot be compared with the data from previous years'. This is the second year in which the data has been unreliable following a change in NHS digital's processes prior to the 2016/17 report.

It hardly needs to be said that good data is essential. Rising numbers of detained patients played a big part in getting the Independent Review. Without reliable data, particularly on top line trends like detention rates, it is more difficult to make the case for reform. We cannot afford a third year where we don't have it.

Last year's report was heavily critical of the lack of patient involvement in care planning and the provision of information, which had failed to improve despite being highlighted in successive annual reports. We, and the CQC, are pleased that this has finally started to improve. Evidence of patients being provided with information about their rights in an appropriate format has improved from 89% of records examined in 2014-16 to 94% in 2016-18. There has also been an increase in evidence of patient's involvement in care plans, from 73% (5,888 out of 8,054) of records examined in 2014-16 to 83% (6,029 out of 7,307) in 2016-18. The report is not too celebratory however, stating that care planning 'is still one of our greatest concerns' as 'a substantial proportion of the care plans of detained patients that we have examined are still of a poor quality.'

This improvement in care planning and information should put hospitals in good stead to implement recommendations made by the Independent Review, including statutory Care and Treatment Plans which will be scrutinised by the tribunal, Intensive Discharge Support Plans setting out post-discharge and multidisciplinary support plans and mandatory recording of whether patients have the mental capacity to consent to their admission. Hospitals that struggle with the currently inadequate requirements for patient involvement will need to considerably up their game.

A welcome addition to this year's report was an analysis of issues of concern raised by patients during monitoring visits, the most common of which was the information provided to patients and their carers and relatives. This chimes with what we hear on our legal helpline. One of the most common concerns raised by friends or family is being denied even basic information about a patient's condition. While the Code of Practice stresses the importance of family involvement, too often people are refused on a Data Protection, "computer says no" basis, without a real explanation or understanding of data sharing rules and how they interact with mental capacity. This can have tragic consequences. There is a real need for improvement, which we're glad the report has highlighted.

Finally, the biggest concern highlighted this year is restrictive practices, including restraint and seclusion, the latter of which the report suggests 'is now viewed to be much more commonplace'. A thematic report by the CQC is due in May this year and we await a commencement date for the Mental Health Units (Use of Force) Act 2018, which will increase reporting on restraint.

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