Rise in use of the Mental Health Act, regulator finds

28 January 2014

CQC publishes its fourth Mental Health Act Report

The number of people detained or treated under the Mental Health Act (MHA) has risen by 12 percent in the last five years, the Care Quality Commission (CQC) says in its fourth annual Mental Health Act Report, published today. 

The Act was used 50,000 times to detain or treat people under compulsion last year, the report says, and there were 45,000 uses of the Act in 2008/9.

Examples of outstanding care were also found over the year, with inspectors seeing people with mental health problems benefiting from high quality and safe psychiatric care that respects their dignity.

However, access to crisis care remains inadequate and health-based places of safety* for people experiencing a mental health crisis are often not staffed at all times, the report finds. 

Some health-based places of safety have been found to be empty while patients are taken to police custody, and this this contradicts the fundamental principles of the Act that urge the least restrictive care.

CQC chief executive David Behan said: ‘We have seen great advances in treatment and care for people with mental health needs in recent years. We have also met staff committed to reducing the restrictions placed on patients as far as possible.

‘However, we are concerned that access to crisis care is still a problem and that police custody is used when people should be in health-based places of safety. This needs to improve.

‘We’re also asking hospitals, other providers and commissioners to act on these findings and make sure that people receive high quality, safe care.’

People with mental health problems in a crisis should have an emergency service that equals in speed and quality to that provided to people with a physical health emergency.

The MHA report does not include findings from inspections carried out under the Health and Social Care Act, although these two inspection programmes are merging.

CQC chief inspector of hospitals Mike Richards said: ‘We’re committed to making sure people detained or treated under the Act get the least restrictive care possible and that this care is the highest possible quality and designed around the individual needs of the patient.

‘These people have the right to safe and respectful care. This is why we are changing the way we inspect, to make sure patients have positive experiences as far as possible during what can be very challenging and distressing periods in their lives.’

Other findings in the MHA report include:

• One or more blanket rule was in place in more than three quarters of the wards we visited – this is unacceptable. These rules most commonly apply to internet or mobile phone use, smoking, access to outdoor space or communal rooms, withholding post or phone calls
• Some patients’ physical health needs were not met, of 550 records examined, we found 14 percent were on a ward with no access to a GP service
• Staffing levels were linked to the quality of care in some places, with inadequate staffing preventing patients from taking leave and also exacerbating problem behaviour
• Examples of patients in seclusion with inadequate regard for their privacy and dignity
• More than a quarter of care plans showed no evidence in patients being involved in creating them
• Around a third of care plans do not show evidence of discharge planning – this means detention periods could be inappropriately long

CQC inspections on the use of the MHA use teams of specialists as well as ‘experts by experience’, who are people who have experience of using mental health services.

For media enquiries, call the CQC press office on 020 7448 9401 during office hours or out of hours on 07917 232 143.

For general enquiries, call 03000 61 61 61.

Notes to editors

• *Health-based places of safety are assessment suites in mental health hospitals and acute accident and emergency departments.
• CQC is carrying out a dedicated review to find out more about how crisis mental health care is provided in an emergency. This will publish this year.