Sectioning applications up 40 percent in last decade

Applications to detain people in hospitals against their will under the Mental Health Act are up forty percent in the last decade.

The data has been published by regulator the Care Quality Commission (CQC), who have shared their findings with the government's independent committee currently reviewing the law.

In the ten year period between 2005/06 and 2015/16, the number of detentions increased by 40% – from 45,484 to 63,622.

The regulator's review says police and clinicians wish to ensure there are legal safeguards in place when caring for people who lack mental capacity.

It adds that the broadened definition of disorder, established in 2007, are widely acknowledged as making detention applications more likely to succeed.

• See also: In Our Right Mind

Creaking system, lack of community care and outdated legislation

"The rising rates of detention, both nationally and locally, are signs of a healthcare system under considerable strain, Dr Paul Lelliott, deputy chief inspector of hospitals (lead for mental health) at the Care Quality Commission, said.

"Detentions under the Act can be influenced by gaps in support and provision in the system. This includes limited hospital bed availability, which means that people cannot easily be admitted as voluntary patients early in the course of their illness. 

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"This is a particular problem if it is coupled with limited support for people in the community, which can prevent a person’s mental disorder from deteriorating to a point that detention under the Act is necessary."

"Changes to the law must happen alongside action to address the wider problems." 

In a new review just published, the CQC judge that the causes of the rise in rates of detention can be grouped under four main themes:

1) Changes in mental health service provision and bed management: Including fewer alternatives to inpatient care in some parts of the country (such as support in the community). It might also be due to the high demand for hospital beds preventing admission on an informal (voluntary) basis, early in the course of a person becoming unwell, or leading to premature discharges, which can then lead to readmissions.

2) Demographic and social change: This includes general population growth, as well as growth in sections of the population that are more likely to be detained, such as older people with dementia, people who are homeless and people whose health is affected as a consequence of alcohol and substance misuse.

3) Legal and policy developments: The broadened definition of a mental disorder in the revised Mental Health Act in 2007 is already understood to have led to increased applications for detention. As well as that, there is greater awareness, for example among the police, of mental disorder and among clinicians who wish to ensure there are legal safeguards in place when caring for people who lack mental capacity.

4) Data reporting and data quality: This includes better reporting of detentions, as well as the potential for double-counting, such as when a detained patient moves between wards or from one hospital to another.

Response

“The Mental Health Act plays an important role in ensuring the necessary care for those who have reached the point of crisis," said NHS Confederation Chief Executive Sean Duggan. 

“While we welcome the improvement in the data collection around the use of the Act, the trends shown in the report released today by the CQC clearly demonstrate that there are aspects of its application that merit further exploration." 

“We have previously stated our concerns over the trend of rising levels of detention and the disproportionate use of the Act with certain demographics – including those of BAME descent."

“We are grateful that these findings will feed into the independent review of the Mental Health Act, in which we play an active role, and that they will be used to provide support for our members.”

Cllr Izzi Seccombe, Chairman of the Local Government Association’s Community Wellbeing Board, said: “We are pleased that mental health is finally getting the attention and profile nationally that it deserves."

"We want to work with the Government to bring the unique position and expertise that councils have on mental health, and the determinants of mental health, to bear on plans to improve the mental wellbeing of all of our communities."

“The increase in detentions is a concern and, as the CQC rightly notes, are indicative of a system that is under strain because of increased demand and reduced funding. Councils need adequate funding to enable them to fully play their essential part in the mental health system.

“This is why we are calling for councils’ public health grant funding – which has been reduced by £531 million between 2015/16 and 2019/2020 – to be reversed, which will support the £1 billion being invested in the NHS by 2020 to address mental health issues.

“There needs to be a re-focus in mental health policy away from medicalisation and mental ill health to prevention, early intervention and mental wellness."

“The LGA will be feeding into the Independent Review of Mental Health Act to highlight the role that councils play in promoting mental health and wellbeing and safeguarding adults and children.”