CQC publish annual review of the Mental Health Act

policy digest

20 / 12 / 2016

Annual review of the Mental Health Act
CQC, December 2016

In its annual review of the Mental Health Act, published on Friday 18 November, the Care Quality Commission (CQC) outlines 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.

The report notes that a number of previous reports have highlighted implications for the Mental Health Act and inequalities in care for people with mental health problems, which is putting lives at risk. These include The Five Year Forward View for Mental Health, Winterbourne View: Time for Change, The Monitoring of the Mental Health Act in 2015/16, Commission on Acute Adult Psychiatric Care and the NHS England commissioned report on the investigation of deaths at Southern Healthcare NHS Trust.

Key points from the CQC report

  • The CQC highlights examples of good practice and innovative approaches to overcoming areas of concern raised in previous reports.
  • The CQC also notes the thousands of compassionate and dedicated staff who are to providing the best support and treatment they possibly can for their patients. 
  • Staff had received training on the changes in the revised Code on less than half of the wards sampled. From 2016, this has negatively impacted on the provider’s regulatory ratings. 
  • Overall, the figures for care planning, patient involvement and discharge planning subject areas show unacceptable variation in meeting the Code’s expectations, similar to those recorded in the 2014/15 report. Some services need to address quality of care in these areas for people detained under the MHA. 
  • One in 10 records do not show evidence that patients have had their rights explained to them at the point of detention. 

Areas for improvement

  • The report suggests that service contracts should be used to encourage and develop the use of least restrictive practices. Contractual conditions set between commissioners and providers should be aligned with the application of the Code of Practice principles
  • Providers and commissioners should promote co-production, values-based commissioning, procuring, and delivery of services for BME communities. 
  • Informal patients should be made aware that they are allowed to leave wards with locked doors.

Use of the Mental Health Act

It is noted that at the time of writing the report, the 2015/16 data was not available, however data for 2014/15 indicated the highest rise (10 per cent) in use of the Mental Health Act. Reasons for the rise are described as complex and the report encourages rising detention rates to be reviewed at local level. Focused work to understand the issues remains outstanding.

  • Are reductions in the support that would keep patients out of acute crisis and reduce hospital admissions a factor in the rising numbers of detentions?
  • Are rising detention rates related to repeated admissions of the same patient on a rapid cycle?
  • Has the threshold for accessing one of the reduced number of beds changed so that a patient is more likely to meet the criteria for detention under the MHA?
  • Has the Cheshire West court ruling in 2014, which redefined and broadened the test for deprivation of liberty to encompass any patient who is under continuous supervision and control and not free to leave a place of care, led to a reduction in the proportion of patients admitted to mental health beds on an informal basis?
  • Has there been a change in profile of patient? Have the number of beds occupied by patients detained under the MHA at any one time now been surpassed by the number of beds occupied by informal patients?  Prior to 2014/15, there were always more informal than detained patients in mental health beds.

Improved monitoring of the mental health act

The CQC state that they will work closely with NHS Digital, NHS England, NHS Improvement and the Department of Health to publish more detailed reports on areas of monitoring during 2017. This will include carrying out focused visits to look at rising detentions and a review of the way approved mental health professional services are being delivered.

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