The Care Quality Commission (CQC) has seen some improvement in the quality of care planning for patients who are subject to the Mental Health Act but continues to be concerned about the quality and safety of mental health wards.
Throughout 2017/18, CQC 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.
In its Monitoring the Mental Health Act in 2017/18 report published today, CQC has concluded that there has been an overall improvement in some aspects of care in 2016 to 2018, compared with findings in 2014 to 2016. They found:
- Some improvement in the quality of care planning and patient involvement. A higher proportion of care plans are detailed, comprehensive and developed in collaboration with patients and carers. However, there is still considerable room for further improvement.
- The provision of information about legal rights to patients and relatives is still the most frequently raised issue from visits. In many cases, patients may struggle to understand information given to them on admission because they are most ill at this point.
- The greatest concern from Mental Health Act monitoring visits is about the quality and safety of mental health wards; in particular acute wards for adults of working age.
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.
During 2017/18, CQC worked with the advisory panel for the Independent Review of the Mental Health Act and will be contributing to implementing the recommendations made in the report which was published in December 2018.
Dr Paul Lelliott, Deputy Chief inspector of Hospitals (lead for mental health) at the Care Quality Commission, said:
“We are pleased to see an overall trend of improvement in the quality of care plans for people detained under the Mental Health Act. This is an achievement at a time of increased pressure on services and is in large part due to the dedication of frontline staff.
“However, it is important that this does 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.
“Based on previous evidence from CQC, the independent review of the Mental Health Act recommends that we revise the criteria used to assess the physical and social environments of mental health wards. We welcome this recommendation and will be looking at how we can work with partners to take this forward to ensure that mental health inpatient services are providing a fit environment for safe and dignified care. This will include our work with others in the sector to deliver the improvements for mental health inpatient services outlined in the NHS Long Term Plan.”
As part of its work to monitor the Act, CQC carried out 1,165 visits to mental health wards in 2017/18 and spoke to thousands of patients and their representatives to discuss how the Mental Health Act and its Code of Practice (national guidance that explains how professionals should carry out their responsibilities under the Mental Health Act) were being applied to them.
As well as this, CQC received 2,319 complaints and enquiries about the way the Mental Health Act was applied to patients and CQC Mental Health Act Assessors requested 6,049 actions required from providers to change the way care was being delivered to patients.
CQC’s Second Opinion Appointed Doctor service carried out 14,503 visits to review patient treatment plans, and changed treatment plans in 27% of their visits.
This year’s report presents data that has been collated in two-year periods to more closely reflect CQC’s Mental Health Act review visiting patterns, where all wards in psychiatric units that detain patients under the Mental Health Act are visited at no more than two-yearly intervals.
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