1 September 2020 update: Coronavirus (COVID-19) - Changes to Mental Health Act (MHA) interim methodology
Now that most of the national restrictions put in place in response to the coronavirus pandemic are easing, we have reviewed our interim methodology for MHA monitoring visits.
As a result, we may carry out more targeted site visits to:
- help support our interim MHA monitoring
- speak with people that we haven't been able to talk to by phone or video call
- review ward environments
We will always consider any local restrictions before planning a site visit and will aim to be on site for as little time as possible. Our priority is to ensure the safety of people using services, staff in services and our MHA reviewers.
We are therefore taking the following measures:
- Thorough risk assessments ahead of all site visits
- Provision of PPE for colleagues undertaking on-site activity, and training in how to don and doff PPE correctly
- Training in infection prevention and control
Where possible, our MHA reviewers will speak with providers to arrange their visit, but, in some cases, our visits may be unannounced.
Dr Kevin Cleary, Deputy Chief Inspector of Hospitals and lead for mental health, has outlined how we will make sure our regulatory response to the coronavirus (COVID-19) pandemic protects the rights of vulnerable people in his blog published today. You can read the text of the blog below.
During the coronavirus (COVID-19) pandemic, we will be focusing our activity where it is needed most in order to support staff to keep people safe during a time of unprecedented pressure. This means concentrating on areas where we see that the risk to the quality of care is the highest and where we can make the biggest difference. While routine inspections have been stopped, regulation still has a critical role to play, especially in environments where people are detained. Our Mental Health Act Reviewers will still be conducting checks remotely and will still complete site visits if they identify concerns.
We know that some older people and people with disabilities are more likely to have a serious illness if they contract coronavirus. We have published an Equality Impact Assessment (EIA) that identifies our key areas of concern and how we will be working to overcome these during this time. Our work to continue to monitor services that are high risk, is essential to keeping people safe.
A key concern for us is that people that require specialist health and social care support who have long-term conditions may have difficulty accessing regular services and support. It is extremely important we support the national effort to fight coronavirus – and it is equally important we are aware of how these issues can disproportionately affect people.
Social distancing will also restrict people’s abilities to see their families and loved ones, and we are encouraging providers and staff to make every effort to support people to keep contact through alternative ways.
Human rights and equality
Health and social care services may become more “closed” during the coronavirus pandemic and there might be impacts on whether people are safe, including whether their human rights are upheld, in a wide range of services.
Our Equality Impact Assessment looks at how we can incorporate learning from our work on services that are more likely to be at risk of developing a closed culture, into the way that we will regulate services during coronavirus. This will mean we are in a better position to respond where there are particularly high risks to equality or human rights.
Our impact assessment also takes into account specific impacts on other groups such as those with dementia, people from Black and minority ethnic (BME) backgrounds, trans older people, lesbian, gay and bisexual (LGB) older people, pregnant women and others. These groups will all be impacted by the services that they are able to access in this time – from advocacy, to support, to mental health, to regular check-ups.
We are planning some specific work to reach out to advocacy groups and organisations of people who do not have access to the internet, so we can gather their views about services during the coronavirus pandemic.
We know that providers are under unprecedented pressure, so we also want to support providers to ensure equality and human rights are upheld during this time, by providing helpful information and guidance. We have already circulated online resources in alternative formats about coronavirus and are quickly developing guidance for inspectors and providers on maintaining human rights in areas such as people seeing their families and use of the Mental Capacity Act.
Keeping people in secure environments safe
We know that people with mental health conditions, or a learning disability or autistic people may be at risk of not accessing the right care and support. This is particularly the case where people are in secure environments. Our monitoring during this time will be focused on those most at risk. We have also provided a remote Second Opinion Appointed Doctor Service to continue to provide independent scrutiny of treatments for people subject to the Mental Health Act and continue to receive and respond to complaints from or about people who are detained.
It is important that we are aware that there is a risk that people will lack the ability to access mainstream treatment services outside of where they are living. This is particularly relevant to people who are under restrictions, for example if many staff are away from work due to coronavirus this could have a particular impact on people’s human rights if they are reliant on staff for basic needs, for example being cared for in segregation. As a member of the National Preventative Mechanism, we have jointly written to the Secretary of State for Justice, highlighting these risks to those detained.
These pressures may be increased by more people moving into secure environments during coronavirus, for example children and young people on 52-week placements in residential special schools that are closing. Their human rights might be particularly at risk due to the urgent nature of their move.
People with information and communication needs may also receive poorer quality information about coronavirus when staff are working under pressure and where information is being produced quickly. It is therefore important we identify this as early on – and providers, staff and national bodies make the commitment to ensure, where possible, all information is accessible.
These potential human rights issues are exactly why we will be putting in place measures to better gather information from services during this time – despite undertaking less face to face visits. We will be monitoring services where this risk is especially high and will still take action where necessary.
Ensuring we hear the voices of people
We know that it is likely that it will be more difficult to gather the views of people who use services and their families during coronavirus, due to both the conflicting priorities people will face, and our reduced face-to-face inspections. However, it is even more important during this time that people come forward and tell us about their care through other means.
As our Mental Health Act Reviewers will be primarily using remote methods to carry out their reviews instead of a regular programme of unannounced visits, they will be working with local advocates, and groups to reach people and families through the phone, online and Give feedback on care.
We are encouraging people as much as possible to give feedback on their care online. We are also exploring new ways to gathering feedback from people using services and their families. This includes working in partnership with voluntary, community and advocacy organisations, and adapting the work of our Experts by Experience programme to hear from people made vulnerable by their circumstances.
Our primary purpose remains the same, to support staff to keep people safe.