Mental health services must do more to ensure that the care they provide to patients in hospitals is based on individual needs, regulator the Care Quality Commission (CQC) has said.
The CQC’s Mental Health Act Annual Report found that 15% of people receiving care under the Act are not being involved in the decisions made about their care. Additionally, 37% of care plans it checked showed no evidence of involvement of the person who had been sectioned.
The report also found that the number of people subject to the Mental Health Act (MHA) is rising. In 2011/12, there were 48,631 detentions, a rise of 5%, and another 4,220 Community Treatment Orders (CTOs) were issued, a rise of 10%.
Other key findings in the report included:
• Services are under increasing pressure, especially in regards to the provision of Approved Mental Health Professionals who contribute to decisions about the detention of patients under the Act. Other areas showing evidence of pressure on services are transport to hospital wards, increased demand for beds, increased workloads and access to psychological therapies
• MHA commissioners are concerned about cultures of control and containment that are enforced over all detained patients. These kinds of rules can become institutionalised and carry the risk of stripping patients of their autonomy and dignity
• Almost half (45%) of patient records reviewed still showed no evidence of consent to treatment discussions before being given medication
• There is a significant gap between the realities CQC observes in practice and the ambitions of the national mental health policy No Health without Mental Health.
However, the report also noted that some hospitals and wards are doing a very good job in treating patients with dignity and respect and, for the first time, it highlights specific examples of good practice.
David Behan, chief executive of the CQC, said: “People who need treatment in hospital for their mental health should have care and support to help them recover.
“Some hospitals are doing a very good job in treating people with dignity and respect – so we know it’s possible. However, CQC is concerned that some hospitals have allowed cultures to develop where control and containment are prioritised over treatment and care.
“We will be making mental health a high priority this year and the information gained through our Mental Health Act visits and from other strategic partners will direct our inspection work. Where we witness poor and unacceptable care we will use all the powers that we have to ensure that these practices change.”
Dr Andrew McCulloch, chief executive of the Mental Health Foundation (MHF), welcomed the CQC’s report, and its finding that the majority of providers seem to be doing a good job in caring for people detained under the MHA.
But he expressed frustration at how some key issues remain inadequately addressed after many years. “We are very disappointed that some organisations still fail to involve patients in care planning,” he said. “Plans must take account of individuals’ needs and aspirations in order to be effective.
“It’s frustrating to see that the findings provided by the report remain pretty much the same year after year in showing large over-representation of certain black and minority ethnic groups. A lot of work has been done to identify the specific problems that need to be addressed, but neither Government nor providers seem willing to make the long-term commitment to working with local communities that will be required to deliver change.”
McCulloch added that the MHF is very concerned by the reported lack of understanding of the Mental Capacity Act amongst many staff. “Urgent work is needed to educate those responsible for implementing this Act on the ground.”
Meanwhile, Paul Farmer, chief executive of mental health charity Mind, expressed concern about the rise in detentions and CTOs. “[This] is very worrying and is symptomatic of problems elsewhere in mental health services,” he said. “Better access to talking therapies, for example, or well-resourced crisis care services that can respond to a person's individual needs can help prevent a person's situation escalating until compulsion appears to be the only option. Yet we know from extensive research that mental health services are failing in all these areas. Detaining people because it's the only way to ensure they have a bed is completely unacceptable.
“The Government says it is keen to do more to improve mental health services across the board. This report shows just how far there is to go in many areas and raises serious concerns about how realistic it is to expect improvements while services are so overstretched. It is a wake-up call for the Department of Health and a clear signal to the NHS Commissioning Board and Clinical Commissioning Groups that, as they begin to assume responsibility for health services, mental health must be a top priority.”