Faster improvement needed to improve inpatient mental health care, CQC warns

Much needs to be done to improve how psychiatric inpatient units care for people detained under the Mental Health Act – especially in regards to staff adherence to the Code of Practice – the Care Quality Commission (CQC) has warned.

The regulator found a lot of good practice in how psychiatric inpatient units are caring for people in its annual review of the Mental Health Act, which was based on over 1,300 visits to mental health wards and conversations with more than 4,000 patients, but said that progress needs to happen at a faster pace for key issues, such as patient involvement and protection of rights.

For instance, more than half of the inpatient psychiatric wards CQC reviewed had not demonstrated that they had trained their staff in the ‘Code of Practice’ – national guidance that explains how professionals should carry out their responsibilities under the Mental Health Act – and more than half had not updated their policies, despite the Code being introduced in April 2015.

Also, in 12% (515 out of 4,344) of the patients CQC interviewed on its visits, there was no evidence that they were informed of their right to an independent mental health advocate, who would offer support to them and enable them to be involved in decisions about their care. Furthermore, there was no evidence of patient involvement in care planning in 29% (1,214 out of 4,226) of the records the CQC examined.

But the CQC also outlined how several healthcare services in England are using the Act to maximise people’s recovery, wellbeing and support when they have been detained and encouraged all providers to learn from them. This includes where services are meeting and exceeding the expectations of the Act, helping people to understand their rights while detained and involving them in both the planning of their care and future treatment.

Dr Paul Lelliott, CQC’s deputy chief inspector of hospitals (lead for mental health), said: "We know that it is a challenging time for all health and care services across the country with rising demand and strained resources; however, the priority must continue to be on patient care, recovery and need. We are frustrated that there has been little progress since last year’s report.

“As the quality regulator, we will continue to play our part in supporting services to improve and taking action to protect people, where necessary. We expect providers and commissioners to recognise this urgent need for change and to do the same.

“Mental healthcare professionals are one of the very few groups in our society that have the authority to deprive people of their liberty.  It is absolutely vital that safeguards are in place to guarantee that people detained under mental health legislation both know their right to challenge their detention and are enabled to exercise this right.

“Although, our observations are worrying for people with serious mental health needs overall, there are many examples of good practice in how providers and staff discharge their responsibilities under the Mental Health Act. 

“Also, it is notable that two mental health trusts have been rated as outstanding overall in the last round of comprehensive inspections.  This shows that services can deliver good practice, and we expect this and future monitoring reports to enable services to learn from these examples.”

Dr Adrian James, Registrar of the Royal College of Psychiatrists, said: “The Royal College of Psychiatrists welcomes all attempts to safeguard the human rights of our patients. Better access to services across all levels of care will ensure that patients are cared for in the least restrictive environment and that effective care is given at the right time and in the right place. 

“The report highlights many areas of good practice where mental health teams work positively with patients but support is needed to eradicate out of area placements – a key recommendation of Lord Crisp’s report on acute psychiatric care. However, in order to ensure full implementation across all areas it is essential that we train more mental health workers, including psychiatrists.”