Mental health patients are being ‘detained in all but name’

The Care Quality Commission finds mental health patients denied information, and staff inadequately trained

More people are being sectioned under the Mental Health Act and too many of those detained are subjected to unnecessary restrictions and get too little help to recover, the NHS watchdog reports today.

The Care Quality Commission’s (CQC) annual report into the working of the Mental Health Act 1983 (MHA) paints a picture of some pockets of excellent practice, where patients are treated with dignity and respect. But it also highlights concerns that “some hospitals have allowed cultures to develop where control and containment are prioritised over treatment and care”.

David Behan, the CQC’s chief executive, says: “Our report has found too many instances where people have been restricted inappropriately. It is unacceptable for the current situation to continue.”

In total, 48,631 people were detained in hospital to receive mental health treatment in England in 2011–12 – 5% more than the year before. Another 4,220 people became subject to a community treatment order – up 10%. A further 16,000 people voluntarily admitted themselves for treatment.

The CQC based its findings on visiting 1,546 wards, talking to 4,569 detained patients and checking more than 4,500 detention documents. Its findings include that on one in five visits – “an unacceptably high number” – MHA commissioners (inspectors) found that people who were in hospital voluntarily “might be detained in all but name”. Although such patients are supposedly able to leave any time, “in 88 out of 481 visits there were no signs on locked doors that explained to voluntary patients how they could leave the ward”.

The CQC is worried about staff being inadequately trained in how to correctly restrain those exhibiting disturbed or violent behaviour and wants safeguards improved. Some staff at a learning disability unit had not had refresher training for two or three years, despite the high number of such incidents in their unit.

On one ward, two patients who had become very disturbed were restrained by police using a Taser gun, according to the report. The CQC also found “two further examples of patients who were Tasered while being transferred in detention”. Taser use within hospital premises “is of great concern” and raises questions about staff numbers, it said.

Of the 4,576 patient records checked by the CQC, 4% “showed irregularities that called the legality of the detention into question [which] means that more than 180 patients may have been unlawfully detained”.

Paul Farmer, the chief executive of the mental health charity Mind, voiced concern that “people’s basic human rights are being infringed at a time when they are likely to be at their most vulnerable”. He says the overall rise in detentions and community treatment orders is “very worrying” and “is symptomatic of problems elsewhere in mental health services”. According to Farmer, better access to talking therapies, or well-resourced crisis-care services that can respond to a person’s individual needs, can help prevent a situation escalating until compulsion appears to be the only option. “Yet we know from extensive research that mental health services are failing in all these areas,” he says.

For Paul Jenkins, chief executive of Rethink Mental Illness, the report shows that “the system has become too focused on managing risk, at the expense of quality care and treatment”. The NHS is wasting money because some patients are being “needlessly detained in very expensive settings”, which is “unfair and potentially damaging to the individual”, he says. Mental health needs to undertake “a fundamental shift” and put less into secure care and more into early intervention services, to stop people becoming acutely unwell, he adds.

The CQC is also concerned that mental health services are under growing pressure, with wards overcrowded, staff overworked and too few community services. In some places, patients are being discharged too early, or without enough support. The watchdog is also worried that despite many initiatives, such as improvements outlined in the coalition’s mental health strategy and a mandate to the NHS Commissioning Board, which legally requires the board to pursue the objectives of putting mental health on a par with physical health, there is still “a significant gap between the realities CQC is observing in practice and the ambitions of the national mental health policy”. Its report concludes: “Practice in some areas … is a far cry from the policy vision.”

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