By John Tingle
The Care Quality Commission (CQC) is the independent regulator of health and social care in England and they have recently produced their annual report to Parliament on how health services are applying the Mental Health Act 1983 (MHA) .This report, shines a very strong light on failing health care practices in mental health care relating to the MHA. Shocking failures are revealed and the errors are compounded by the fact that the poor practices have been identified in previous reports and are long standing in nature.
The CQC state that national data from the last 25 years shows an increasing use of the MHA to treat people in hospitals. From 2005/06 to 2015/16, the reported number of uses of the MHA to detain people in hospital increased by 40%. There was a 9% increase from 2014/15 to 2015/16 rising to 63,622 uses of the MHA. The CQC can find no single cause for the increases in detention rates over the last 10 years.
The CQC once again draw attention to the persistent theme present in its previous reports of black and minority ethnic over representation figures in the use of the MHA.
The CQC found that there are still services that continue to fail in their legal duties to give patients information about their rights, verbally and in writing as soon as possible after their detention or community treatment order commences. They found no evidence that staff had discussed rights with the patient on admission in 11 % (378) of patient records that they checked. In a further inspection of 9%, (286) of records, no evidence could be found to say that patients received the information in an accessible format.
Consent to treatment
The CQC state that they have concerns about whether the patient consents, refuses consent or is incapable of consent. They expect to see capacity assessments to support views and possibly evidence that staff have considered ways in which they could help the patient gain or regain capacity. They have frequently raised concerns over whether clinicians have recorded evidence of their conversations with patients who are detained over their proposed treatment and their views.
The CQC states that during their visits in 2016/17, MHA reviewers found no evidence of patient involvement in 32% (1,034) of the care plans they reviewed. This was three percentage points worse than the previous year, and a further fall in quality of care from the year before.
In 17% (594) of care plans there was no evidence that the patient’s diverse needs had been considered. Also in 17% (588) care plans there was no evidence that the least restrictive options for care had been considered.
There will be an Independent Review of the MHA chaired by Professor Sir Simon Wessley which will produce a final report that makes recommendations by the end of 2018.An interim report is due to be published in early 2018.The review will make recommendations to improve the MHA and related practices will be put under the microscope.
Clearly everything is not well when it comes to the application of the MHA in England. Mental Health services can be seen to be failing badly in many areas, and these failures are not new and have been identified regularly by the CQC in earlier reports and even before by the CQC predecessor in this area, the Mental Health Act Commission. History does not serve this area of health care well when it comes to patient rights.Hopefully the forthcoming review of the MHA will significantly improve matters.