Throughout 2017/18, CQC (Care Quality Commission) carried out visits to mental health wards to meet patients, review their care, and speak to staff on the frontline to inform its annual report to Parliament on how health services in England are applying the Mental Health Act
The Mental Health Act 1983 is the legal framework that authorises hospitals to detain and treat people who have serious mental health needs and who are putting their own health or safety, or of other people, at risk of harm. CQC has a duty to monitor and report on how services do this.
Dr Paul Lelliott, Deputy Chief inspector of Hospitals (lead for mental health) at CQC said it is important that successes do not "mask the fact that many of the wards, in which people are detained under the Mental Health Act, are unsafe and provide poor quality care. We flagged this up in our State of Care report as our greatest concern and this continues to be the case."
Lack of patient involvement in care planning
Despite patient involvement in care planning increasing by 10% from the previous report's findings*, CQC found this area to be concerning:
- 20% of care plans fail to show evidence of consideration of the person's view about their treatment
- 17% show no evidence of patient involvement.
"A substantial proportion of the care plans of detained patients that we have examined are still of a poor quality. We continue to find examples of poor planning, lack of patient and carer involvement, and no evidence of consideration of patients’ consent to treatment on admission to hospital," the report reads.
Concerns raised over failure to give patients discharge plans
The report found that 20% of care plans lack evidence of discharge planning.
"We have also raised concerns over mental health rehabilitation hospitals that are a long way from the patient’s home and which may not work actively to enable recovery and discharge.
"It is vital that national agencies work with local health and care systems to move these patients to a less restrictive setting closer to their home."
Discharge plans, which should be started as soon as the patient is admitted to hospital, are designed to facilitate and aid recovery in the community. Access to health and social care, employment services, supported accommodation, and other cultural, spiritual, or social services to enrich a patients' lives is necessary, yet all too often this does not happen.
Patients must also be given clear information about future goals and plans for their care.
Overrepresentation of Black and minority ethnic (BME) groups detained
The broad BME group ‘Black or Black British’ has the highest rate of detention - they are four times more likely than the 'White' group to be sectioned under the Mental Health Act.
"Concerningly, a more detailed breakdown of the BME categories shows the inequalities to be even more marked: the ‘Black British’ subgroup ‘Any other Black background’ is detained at 10 times the rate of the ‘White British’ group. These figures could be distorted by missing data, but are generally consistent with past findings."
Responding to this report, Alison Cobb, Specialist Policy Advisor at Mind, said:
“It is positive to see some improvements to people’s experiences when they have been sectioned under the Mental Health Act, especially when it comes to the quality of care planning, however there are still huge concerns about how little say people have over their own care. One in five (20 per cent) of care plans don’t take into account the patient’s view of treatment, 17 per cent fail to show any involvement with the patient, and 20 per cent of care plans don’t include planning for people after they’ve left hospital - something which should be done from the start. A key recommendation to come out of the Mental Health Act Review (MHAR) was to give patients more choice and control over their care through shared decision making, so it’s clear this still isn’t happening.
“This report also highlights concerns around patient safety. When people are at their most unwell, they should be treated with dignity and respect. What happens to people while they’re in hospital is as much a concern as the basis on which people are admitted to hospital. Wards should be therapeutic, calm, and well-designed to support people in with their recovery and treatment. Anecdotally we often hear that hospitals can be stark and inhospitable for those receiving treatment. When people are sectioned they can be subject to unnecessary restrictions and practices such as physical restraint, seclusion or forced medication. There must be a focus on both the social and physical environment of wards if we are to see improvements in people’s experiences.
“There is a huge amount of work still to do before everyone gets high quality mental health care and support they need. The cost of getting this wrong can be catastrophic. The recommendations from the MHAR are key, and many of them can start to be put in place now. We do not need to wait for new legislation before we improve people’s experiences. What we need is a joined up and urgent commitment to making sure people are kept safe, helping more people stay well and reducing the chance of people becoming more unwell later on.”
- See more: Volunteering at a psychiatric hospital: "I witnessed uncomfortable truths, the good, the bad, and the very ugly"
- See more: Find out more about our 'In Our Right Mind' campaign in response to the changing Mental Health Act
Alex Kennedy, head of campaigns and public affairs at Rethink Mental Illness said:
“Today the CQC released a report that looked into the standard of the delivery of Mental Health Care in England. It is a vital barometer against which we can check how well the nation is doing.
“Whilst we welcome the news that services are generally moving in the right direction, we should be particularly concerned that many of the wards on which people are treated under the Mental Health Act are unsafe and providing poor quality care. It is a unacceptable that 17% of care plans still don’t show evidence of patient involvement, and 20% have no evidence of care plans for when they leave hospital.
“Today’s report underlines why it so vital that the Government accepts and delivers on the Independent Review of the Mental Health Act’s recommendations, as it is imperative that people who need to be deprived of their liberty to be treated should receive an excellent standard of care.”
Read the full report here.
Join us at MHT Wales 2019 to hear about the ways in which mental health care is changing
* Previous period refers to the report examining April 2014 to March 2016