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CQC monitoring the Mental Health Act in 2018/2019

Report from the regulator Care Quality Commission (CQC) explaining how the Mental Health Act (MHA) is being used.

The Care Quality Commission (CQC) is the independent regulator of health and social care in England. They also monitor how the Mental Health Act (MHA) is used and publish their annual report.

Detentions under the MHA continue to rise with 49,998 new detentions recorded for 2018/19. However, the overall national trend will be higher as not all providers submitted data and some submitted incomplete data.

Human rights principles are not consistently being applied to the care and treatment of detained patients and more needs to be done to understand and address issues of inequality, especially for BAME groups. New statistics for detention show that Black or Black British people are still over four times higher than for White British people.

CTOs continue to be higher for Black/Black British people = 53.8 uses per 100,000 population compared to 6.4 uses per 100,000 population for White British people.

There is a lack of availability of beds both in the community and in hospitals. Coroners made the CQC aware of at least seven deaths of people who were assessed as requiring admission, but for whom no mental health bed was available. There is ongoing use of police cells as places of safety due to lack of beds.

There is continued improvement in the number of people being given information about their rights, which was evidenced via patient records:

  • Good evidence of accessible and appropriate info in 91% of all records
  • Initial discussion about rights in 87% of all records
  • Repeated discussions about rights in 80% of all records.

But, there are still people who don't understand their legal rights as they're not having meaningful discussions or being given information in a format they can understand.

94% of the wards visited were locked on the days of the CQC visit, including wards where patients may be admitted on an informal basis. The CQC raised concerns in 7% of visits about whether informal patients were free to leave the ward at will. They stated that staff may be concerned about how safe it is to allow informal patients to move freely around the hospital grounds or to leave the hospital. As a result, they may be reluctant to fully explain their rights to them or feel like they must take a risk averse approach and use the section 5 holding powers under the MHA to stop the person leaving when they request to do so.

There are ongoing concerns about patients' involvement in care planning. The CQC recommended that patient involvement was absent or needed to improve in 37% of care plans that they reviewed. 19% of care plans showed insufficient or no evidence that a person's diverse needs were considered, and 17% showed insufficient or no evidence that the service had considered the minimum restriction on a patient's liberty. In 11% of care plans there was no evidence of patient involvement at all.

The CQC also highlighted the complexity between the MHA, the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DOLS) work. It highlights that it is very difficult for people to be clear on what safeguards and rights they have under each of these frameworks. It also calls for the laws to be updated and provide clear guidance on how they interact.

Mind's comment

Once again, the quality of the data is an issue. This is despite it being mandatory for NHS funded care providers, including independent sector providers, to submit data to Mental Health Services Data Set (MHSDS). We hope that the Mental Health Units (Use of Force) Act will come into force soon and we are pleased to see that the Mental Health Admissions (Data) Bill will have its second reading in October. This is a Private Members Bill introduced by Dr Ben Spencer to make provision for the collection and publication of statistics on mental health hospital admissions; and for connected purposes. We hope that this will go some way in improving the quality of the data.

Many of the issues highlighted in the CQC report were flagged in the Independent Review of the Mental Health Act. This report was published in December 2018 and we are still waiting for the government's response to it in the form of the White Paper, which was promised last year. We will be pushing for them to adopt the recommendations as a whole and we will continue to hold the UK Government to account on its promises to reform mental health care.

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