The Care Quality Commission (CQC) recently published a report on the rise in the use of the Mental Health Act (MHA) to detain people. The report identifies that:
- 80% of patients on acute wards are now detained
- detentions have increased by 40% from 2005-6 to 63,622 in 2015-16
The CQC report suggests that there are ‘signs of a healthcare system under considerable strain’ and a decline in access to mental health services which, it suggests, increases the likelihood of patients in crisis being detained.
The report coincides with the government’s independent review of the MHA. The review, chaired by Professor Sir Simon Wessely is due to report by autumn 2018. RadcliffesLeBrasseur’s Mental health law think tank report is being considered as part of that review.
The CQC report was based on:
- A review of available data
- Visits to eight NHS trusts, two independent mental health service providers and 23 local authorities
- Conversations with patients and representative bodies
The CQC report concludes that:
- All stakeholders agreed that a focus on early intervention and intensive support in the community had the greatest potential to reduce admissions and MHA detention
- Increases in detention rates can result from population and social changes
- An ageing population with a correspondingly higher rate of dementia is more likely to be detained. Staff report using the MHA to shortcut delays for authorisation assessments under the Deprivation of Liberty Safeguards (DoLS)
- An increase in homelessness increases both the incidence of mental illness and the aggravation of existing conditions
- Changes to mental health care law and to policy guidance over the past decade may have contributed to the rise in the rate of detentions as an unintended consequence. The pre-existing declining trend in the numbers of informal patients has been accelerated by the 2014 Cheshire West ruling and the DoLS regime
The CQC found ‘no evidence that professionals had been misusing the Mental Health Act in any way.’ The CQC justified this proposition, relying upon the stable First Tier Tribunal (Mental Health) appeals statistics that indicate no increase in patients being inappropriately detained.
Patients spoken to by the CQC described a lack of access to 24 hour, face to face, practical assistance and ‘a culture based on the level of risk the person poses to themselves and others, rather than a culture that focuses on their recovery.’
Professionals interviewed observed ‘a trend towards repeated, short periods of detention for treatment for some patients, who in the past might have experienced fewer but longer hospital stays’ resulting from ‘pressures on beds causing premature and inappropriate discharge.’
Dr Paul Lelliott, the CQC’s Deputy Chief Inspector of Hospitals (lead for mental health), warns:
‘Detentions under the Act can be influenced by gaps… This includes limited hospital bed availability, which means that people cannot easily be admitted as voluntary patients early in the course of their illness. 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.’ He added: ‘Changes to the law must happen alongside action to address the wider problems.’
Professor Wendy Burn, President of the Royal College of Psychiatrists, endorsed that conclusion explaining that legislative change alone has limitations. She reflected that the report was:
‘Further evidence that declining access to community services is leading to more people reaching mental health crises,’ adding that ‘the best way to prevent someone being detained is to prevent them from falling into a crisis in the first place; to understand that poverty, poor housing and poor physical health impact on a person’s wellbeing and psyche.’