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Mental Health Act Annual Report 2012/13

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Our annual report into the use of the Mental Health Act tells you about the experiences of patients who received care under the act throughout 2012/13.

What about the Mental Health Act?

The Mental Health Act is the law in which people can be sectioned or detained against their wishes so that they can be treated in hospital for a mental disorder.

Once discharged from hospital, they may continue to be treated under the Mental Health Act in the community under a 'Community treatment order' (CTO).

What do we do under the act?

Read about our plans to inspect, regulate and monitor mental health services in the future.

A fresh start for the regulation and inspection of mental health services PDF | 619.87 KB

Our job is to check that patients' basic human rights are maintained while they are being cared for or treated under the Mental Health Act.

We visit patients who have been detained and those under CTO and we also appoint Second Opinion Appointed Doctors (SOADs) who check whether the medication that patients receive is correct.

Our work in 2012/13

We...

  • met with 4,478 people receiving care under the Mental Health Act (most of whom were detained).
  • carried out 1,502 Mental Health Act visits.
  • arranged 13,520 SOAD visits.
  • carried out 16 visits to meet people who were subject to CTOs.
  • visited 32 wards to examine seclusion practices.
  • carried out 21 visits that focused specifically on admission and assessment processes.
  • visited four wards to review the way electro-convulsive therapy is administered.
  • carried out 21 visits to non-psychiatric hospitals (most of which were accident and emergency departments).

There were over 50,000 uses of the Mental Health Act in 2012/13 – the highest number ever recorded.

Meeting people's needs

Almost all wards (92 per cent) had access to Independent Mental Health Advocacy (IMHA) services who play a key role in ensuring patients' views and experiences are heard and that they are involved in care planning - this was a big improvement compared to last year.

Helping patients to make advance statements

An advance statement is a way for people to state how they would like to be treated or cared for in the future if they are not able to take care of themselves.

In 2012/13, we saw improvements in the way mental health services help or encourage people to draw up advance statements of how they would like to be treated if they have a mental health crisis.

Case study

Nottingham Healthcare NHS Trust has accessible printed information and booklets that patients can complete at times of crisis. Patients are able to state their preferences for where the crisis should be managed and wishes for medication or other intervention.

This work is excellent in helping patients of all abilities to contribute towards their care planning.

Involving people in their care plans

There are two areas that showed no improvement from last year.

  • More than a quarter (27 per cent) of care plans showed no evidence of patient involvement.
  • More than a fifth (22 per cent) showed no evidence of patients' views being taken into account.

There was also no improvement in evidence of patients' rights being explained to them. Over the last two years, we have not seen adequate evidence of discussions with patients about their rights in at least one in 10 wards.

Continuing use of blanket rules

All hospital wards have rules, whether they are written, matters of custom or practice.

However, we continue to see widespread use of restrictive 'blanket rules' that are applied to everyone at the service - often including people who are in hospital voluntarily (and not detained). Limiting patients' choice and rights due to inflexible rules do not meet the Mental Health Act Code of Practice and may be a breach of human rights.

At least some type of blanket rule was in place in more than three quarters of the wards we visited. The most common restrictions related to the use of the internet, mobile phones, smoking and access to outdoor space, communal rooms or bedrooms.

In 46 per cent of cases we reviewed, the reason given to us for the blanket rules was hospital policy. Other reasons related to historical incidents. In 13 per cent of cases, no-one was able to give a reason.

Care during a crisis

Our reports have consistently reported issues about the availability and responsiveness of services when people are in mental health crisis - and there are nationally recognised problems with access to care in this situation.

Throughout 2012/13, we found that health-based places of safety for people experiencing a mental health crisis were often not staffed at all times.

Carers have told us they were not always provided with enough information on how to get help in a crisis.

There are five key issues that we will look at.

Community care

When we visit and inspect mental health services, we're going to place a stronger emphasis on community services and our understanding of people's experiences of accessing appropriate health care in a crisis.

Reporting on deaths

We will include information we hold on deaths in psychiatric detention in all future annual reports on the Mental Health Act.

Together with our partners, including NHS England and the National Confidential Inquiry into suicide and homicide by people with mental illness, we will look at how we can do this in a way that offers:

  • better intelligence.
  • opportunities to share learning.
  • prevention action.

Emergency and mental health crisis

We will work with key partners to develop the Mental Health Crisis Care Concordat which will focus its attention on the issues that have been highlighted around emergency mental health care.

Throughout 2014, we will also carry out a Themed review of mental health crisis care.

Involving more people who use services

The views and experiences of people who receive mental health care will play a bigger part in our visits.

We will spend more time talking to people affected by the act and with local Healthwatch to make better judgements on services.

Investigating complaints relating to the use of the Mental Health Act

As part of the new way we inspect services, we will be looking at how we review the information in complaints and common trends.

We will also look at the way services:

  • respond to complaints and the processes they have in place.
  • learn from complaints.

In next year's report, we will look at how the voices and experiences of detained patients are heard through the CQC Mental Health Act complaints system, and what we may do to improve the way we respond, collate and share that information.

 

Last updated:
17 June 2014