The number of people detained under the Mental Health Act (MHA) rose to more than 50,000 last year, yet crisis care remains inadequate, according to regulator the Care Quality Commission (CQC).
Figures from the CQC’s fourth annual Mental Health Act report found that the number of detentions under the MHA has risen by 12% in the past 5 years.
While the CQC did find examples of outstanding and safe psychiatric care that respects people’s dignity, it also reported that access to crisis care remains substandard and health-based places of safety for people experiencing a mental health crisis are often not staffed at all times.
Some health-based places of safety have been found to be empty while patients are taken to police custody, which contradicts the fundamental principles of the MHA that urge the least restrictive care.
Other findings in the report include:
• One or more blanket rule was in place in more than 75% of the wards visited, which the CQC described as “unacceptable.” These rules most commonly apply to internet or mobile phone use, smoking, access to outdoor space or communal rooms, withholding post or phone calls
• Some patients’ physical health needs were not met: of 550 records examined, the CQC found 14% were on a ward with no access to a GP service
• Staffing levels were linked to the quality of care in some places, with inadequate staffing preventing patients from taking leave and also exacerbating problem behaviour
• Examples of patients in seclusion with inadequate regard for their privacy and dignity were found
• More than a quarter of care plans showed no evidence of patients being involved in creating them
• About a third of care plans do not show evidence of discharge planning – meaning detention periods could be inappropriately long.
CQC chief executive David Behan said: “We have seen great advances in treatment and care for people with mental health needs in recent years. We have also met staff committed to reducing the restrictions placed on patients as far as possible.
“However, we are concerned that access to crisis care is still a problem and that police custody is used when people should be in health-based places of safety. This needs to improve.
“We’re also asking hospitals, other providers and commissioners to act on these findings and make sure that people receive high quality, safe care.”
CQC chief inspector of hospitals Mike Richards added: “We’re committed to making sure people detained or treated under the Act get the least restrictive care possible and that this care is the highest possible quality and designed around the individual needs of the patient.
“These people have the right to safe and respectful care. This is why we are changing the way we inspect, to make sure patients have positive experiences as far as possible during what can be very challenging and distressing periods in their lives.”
Urgent look at services
In response, Paul Farmer, chief executive of mental health charity Mind, called for national and local commissioners to “urgently look at the services they provide and ensure they are adequately resourced and able to cope with demand.
“That more people are becoming so unwell they need to be formally admitted to hospital suggests failings in services that are supposed to help people manage their mental health problems at an earlier stage.
“There are obvious pressures on the system, which are having a significant impact on the care of people who are at their most unwell. Increasing bed shortages and staffing difficulties resulting from cuts to mental health services over two consecutive years mean people aren’t getting the help they need. We are concerned at the evident lack of therapeutic activities available on some wards – it is essential that services focus on recovery rather than simply containing people who are in crisis.
"We welcome and echo the CQC’s call for trusts to reduce their use of seclusion and restraint to a minimum, and to involve people in planning their own care as a means to achieving this. In difficult financial times more than ever people must be placed at the absolute heart of their care and treatment and have as much control as possible over what happens to them. It is good news that access to advocacy is now commonplace, as this helps ensure that people can understand and exercise their rights while under section.
“The government has this month reinforced its commitment to bringing mental health out of the shadows and putting mental and physical health services on an equal footing. Excellent crisis care does exist, but today’s report is a stark reminder of just how much needs to be done to make sure that all people with mental health problems get the help they need.”