The Mental Health Act is now 30 years old and we have been responsible for reviewing uses of the act for the past five years.
Our latest report, Monitoring the Mental Health Act in 2013/14, shows that use of the act continues to grow with 23,531 people subject to the act at the end of 2013/14 - an increase of 6% from 2012/13. The data also shows that black and minority ethnic people continue to be overrepresented in the detained population. We reiterated our call for providers to undertake ethnic minority monitoring of their activities.
84% of records examined showed that patients had received information about their legal rights, with evidence of staff discussing rights with patients in 82% of records – an increase from 71% from last year.
The mental health inpatient system was again running over capacity. The number of available mental health NHS beds in Q4 2013/14 had decreased by almost 8% since Q1 2010/11. This is putting Approved Mental Health Practitioners under extreme pressure to admit people under the Act just obtain a bed.
In 2012/13, there were reported 21,814 uses of section 136 in England, which rose to 24,489 in 2013/14, an increase of 12%.
While there have been small improvements, we again found that the provision of and access to child and adolescent services was not good enough. The needs and best interests of patients under 18 must be taken into account when accessing mental health services.
Services for people with a learning disability continue to vary. We are particularly concerned that hospital placements for people with learning disabilities are still not appropriate. In 2013, the HSCIC learning disabilities census showed that 40% of inpatients were in hospitals 50 kilometres from their home.
Inspectors continued to find issues with processes around consent to treatment. Practice has improved over the last five years. However, it is unacceptable that, in over a quarter of the records checked in 2013/14, there was no evidence of a patient’s consent to treatment on admission.
Use of treatments subject to special rules have continued to be monitored and procedures. In 2013/14 there was a decline in the number of requests for electroconvulsive therapy certification, with 127 Second Opinion Appointed Doctor (SOAD) visits per month in 2013/14.
However, data on physical restraint practices is still incomplete, with only 27 organisations submitting data to the Mental Health Minimum Data Set. This is unacceptable. All providers must make sure that they are consistently recording all incidents of restraint.
24 visits were made to look at the use of community treatment orders (CTOs) and spoke to 175 people under CTOs. We are concerned that CTO patients still report feeling that they have little or no choice about the conditions of the CTO and that they are bound by law to take their medication.