CQC says care for people treated under the Mental Health Act still needs to improve

8 December 2011

The Care Quality Commission today (8 December) publishes its second annual report on the use of the Mental Health Act with a renewed call for better care for patients.

Although CQC found examples of good practice, considerable improvements are still needed in key areas such as lack of patient involvement, consent to treatment and the over use of restrictions placed on the movements of detained patients.

The reports findings highlight:

• Lack ofpatient involvement in the care planning process continues to be one of the issues most frequently reported by Mental Health Act Commissioners after visits to hospitals. On many wards there was little evidence that staff had attempted to ascertain the patients’ own views and wishes. Nor was there much indication that patients had been given copies of their care plans.
• On consent to treatment, CQC found that, in some cases, doctors appeared to assume too readily that patients had the capacity to give their consent to treatment. The report also says the legal powers available to providers in relation to community treatment orders (CTOs) are widely misunderstood, even among mental health professionals. For instance, a former detained patient who is living in the wider community under a CTO has the right to refuse medicines, unless they are justifiably recalled to hospital. In some cases this is being disregarded.
• On minimising restrictionsimposed on patients in hospital, CQC is still finding examples of poor or questionable practice, such as denying patients regular access to the internet, locking them out of their rooms during the daytime, or listening to their telephone calls. In some cases the restrictions seem minor, but they encourage the institutionalisation of the patients.

CQC’s chief executive, Cynthia Bower, said: “The nature of CQC’s role in monitoring the use of the Mental Health Act, focuses on the concerns of individual patients and this report very much looks at and is reflective of those individual experiences, the realties of care shown here vary from one NHS trust to another and in some cases from ward to ward.

“The inclusion to the MHA monitoring information in our broader regulatory role, assessing NHS trusts’ compliance with the regulations of the Health and Social Care Act, will in future enable us to take a wider view of the standards of care in a mental health hospital. Where possible, our compliance inspectors join forces with the MHA Commissioners by sharing information and using each others' expertise to gain the most from the different focus that monitoring and inspection visits take.

“Increasingly, we are using the wider regulatory framework to strengthen the protection given to people who are subject to the Mental Health Act.

“This will allow us to act more swiftly and pick up on abuse when it happens far more quickly and will we hope in future help us prevent the sort of abuse seen at Winterbourne View.”

Other key issues in this year's report

A major concern, according to CQC, is that of delays in admissions to hospital due to bed availability– a long-standing problem that in some cases places the patient at great risk. The report says: “It should be seen as a very serious matter when the admission of someone judged to need detention under the Act is delayed for any significant period because of a lack of resources or because more urgent cases are prioritised above them.”

Many patients detained under the Mental Health Act have a worrying lack of access to independent advocacy services, says the commission.

Although Hospital staff have a legal duty to inform patients and their relatives about the services of independent mental health advocates (IMHA) but some staff do not even know about them.

Despite this, says the report, some IMHA services have waiting lists, which suggests they may be underfunded by the primary care trusts (PCTs) that commission them.

PCTs have been under a statutory duty since April 2009 to commission IMHA services for patients who are detained or subject to community treatment orders In the reorganisation of commissioning proposed in the Health and Social Care Bill, currently passing through Parliament,this duty will pass to local authorities (those councils with responsibility for social services).

The extent of use of the Mental Health Act

The number of people who are subject to the Act continues to increase. At the end of the year it was 5% higher than the year before – 20,938 on 31 March 2011 compared to 19,947 on the same date in 2010.

Almost all of this increase is due to the rise in the number of people subject to a CTO. The number of people who remained subject to a CTO at the end of the year grew by nearly 30%, even though fewer new CTOs were started in this year than in last year, as fewer CTOs ended than were initiated during the year. This suggests that CTO powers, once implemented, may have quite a long duration, and that the population subject to CTO will continue to grow.

For further information please contact the CQC press office on 0207 448 9401 or out of hours on 07917 232 143.

Ends

Notes to editors

CQC is responsible for protecting the interests of people who are subject to the Mental Health Act, by monitoring how mental health services in England – in both the NHS and independent (private) sector – are using their powers and fulfilling their duties for patients who are detained in hospital or subject to community treatment orders or to guardianship.

CQC’s Mental Health Act Commissioners meet patients in private to discuss their experiences and concerns, make sure they understand their rights and check that staff are using the Act correctly. In 2010-11 they made 1,565 visits and met with more than 4,700 patients.

CQC also provides second opinion appointed doctors (SOADs) who decide whether the proposed treatment is appropriate for the patient. There were more than 13,500 requests for a second opinion in 2010-11.