Patients continue to experience care that does not fully protect their rights or ensure their wellbeing: this is the conclusion of the Care Quality Commission’s (CQC) annual report to parliament on the application of the Mental Health Act (MHA).

The CQC carried out 1,368 visits to mental health wards from April 2016 to March 2017, and spoke to 4,114 patients and their representatives regarding application of the MHA and its code of practice.

It found that:

  • 32% (1,034 of 3,253) of care plans reviewed showed no evidence of patient involvement. This was an increase of 3% from the previous year
  • 17% (594 of 3,434) showed no evidence of consideration of the patient’s particular needs. This was an increase of 7% from the previous year
  • 31% (550 of 1,788) showed no evidence of the patient’s views. In 2015/16, 26% had not been recorded
  • 17% (588 of 3,372) showed no evidence of consideration of the least restrictive options for care. This compares to 10% of records from the previous year
  • 24% (570 of 2,403) showed no evidence of discharge planning, compared with 32% last year

Whilst acknowledging that the increase in the number of people being detained in hospital under the MHA has led to an ‘unprecedented challenge’, the CQC also found that delays in accessing beds are creating difficult situations where patients are left untended in the community, or held in police custody without lawful authority.

The pressure on beds is reflected in the improvement in discharge planning, although clearly there is still room for improvement.

It was also identified that treatment decisions are not always being properly recorded; this includes clinicians not recording evidence of their conversations, recording the patient’s view on that treatment or if the patient consents, refuses consent or is incapable of consenting.

It is evident that the CQC is measuring provider’s performance against the guidance in the MHA code of practice and that some organisations are struggling to comply.

Dr Paul Lelliott, deputy chief inspector of hospitals (lead for mental health) at the CQC has encouraged providers and commissioners to review their practice in light of the findings. He comments that managers at well-led provider organisations should understand how the MHA is used locally and use that understanding to improve their services.