Kent and Medway Mental Health NHS Trust

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Staff at the health-based places of safety (HBPoS) did not have the necessary systems and processes in place to detain people in a section 136 suite under section 136 of the Mental Health Act 1983, once their detention has expired. It was not always clear from patient care records under which legal framework they were detained once their detention under the MHA had expired. This meant patients were being held and treated unlawfully.

Staff assessed the physical and mental health of all people who used services on assessment or admission to the health-based place of safety (HBPoS) They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for people who used services based on national guidance and best practice. The team included or had access to a range of specialists required to meet the needs of people who used services. Staff from different disciplines worked together as a team to benefit people who used services.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. Staff carried out comprehensive assessments of people who used their services mental and physical health needs. They were aware of the impact of social issues on patients’ mental health. We reviewed 19 care records from the home treatment and rapid response teams and 16 care records from the health-based places of safety (HBPoS). All records had comprehensive risk assessments in place at the time of admission. All records for the home treatment and rapid response teams had a crisis care plan in place. All patients received a comprehensive physical health assessment. Staff formulated an initial care plan with people who used services when they were admitted into the service. Care plans were personalised, holistic and recovery focused. Families and carers were able to input into care plans if the person who used the service consented. Staff reviewed and updated care plans weekly or when patients' needs changed. Staff assessed people who used services’ physical health needs in timely manner. Each home treatment and rapid response team had a physical health nurse to support staff in assessing physical health. At the HBPoS all patients were assessed as to whether the patient had a mental disorder and whether a further assessment for admission under the Mental Health Act 1983 was required. Staff made sure that patients had a full physical health assessment and knew about any physical health problems. Staff at the place of safety completed a physical health check as part of the core assessment and performed observations.

Staff did not always detain patients in line with the Mental Health Act (MHA). The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff did not always detain patients in line with the MHA. In the health-based places of safety (HBPoS) it was not clear in patients notes, under which legal framework they were detained. The legal status of patients who had been approved for detention in an inpatient ward and whose section 136 detention had expired was not always clear in their records. The trust’s Section 136 Escalation Standard Operating Procedure advised that when a patient had been detained for more than 24 hours in the HBPoS, staff “should inform the person of their rights that they are no longer detained under the MHA and seek their agreement to remain and await admission.” However, there was no robust process to follow if the patient did not agree to remain and await admission, or how this should be documented. The trust had relevant policies and procedures that reflected the most recent guidance. Staff had access to local Mental Health Act policies and procedures and to the Code of Practice. Staff were required to completed mandatory Mental Health Act training in line with the responsibilities of their role. The completion rate for this training for the West Kent home treatment and rapid response team was 90%. The completion rate for the 4 other rapid response and home treatment teams was at 100%. Staff requested an opinion from a second opinion appointed doctor when necessary. Staff stored copies of patients' detention papers and associated records correctly so that they were available to all staff that needed access to them. Staff provided a range of care and treatment interventions suitable for people who used services. The interventions delivered were in line with guidance from the National Institute for Health and Care Excellence. Staff could access psychological treatments and interventions dependent on the needs of people who used services, along with medical and nursing interventions. Staff on the health-based places of safety (HBPoS) made sure patients’ needs for food and drink were met. Staff provided food from the adjacent inpatient wards. Staff participated in clinical audit, benchmarking and quality improvement initiatives. The clinical lead and physical health nurse undertook audits on care records to ensure all parts were being completed. Staff were taking part in quality improvement work to ensure handover notes were completed correctly. This was to address an issue of staff copying and pasting previous handover notes and overwriting them, without always updating them correctly. The mental health home treatment and rapid response teams included or had access to a range of specialists required to meet the needs of people using the service. This included social workers, psychologists and occupational therapists. There were some vacancies across the multidisciplinary team in the crisis and home treatment teams. The Maidstone team had a social worker and part time social worker vacancy. Each crisis and home treatment team had psychologists. Staff in the teams were able to refer people who used the service to a clinical psychologist. The teams also had occupational therapists in each team to help people who used services acquire living skills. Managers told us they had seen improvements in compliance with physical health monitoring since they had started working within their teams. Managers made sure staff attended regular team meetings or shared information with those that could not attend. The teams had monthly team meetings scheduled and we saw from team meeting minutes these were taking place. However, it was sometimes difficult for staff to attend due competing work priorities or absence. When staff missed meetings they reviewed the meeting minutes and urgent matters were discussed at daily morning meetings. The Maidstone home treatment team had 2 peer support workers to provide support to people who used the services. A peer support worker is someone that has lived experience of using services. The peer support worker attended all staff interviews to provide feedback on applicants. The other home treatment teams were actively recruiting peer support workers for their services.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. Staff from different disciplines worked together as a team to benefit people who used rapid response and home treatment team services. They supported each other to make sure people had no gaps in their care. They had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation. Staff held regular multidisciplinary meetings to discuss people and improve their care. We attended morning planning meetings with all home treatment and rapid response teams. These were attended by nurses, social workers, consultant psychiatrists, other medical staff and support staff. We observed that the different disciplines were complimentary about each other’s work and their contribution to the team. Teams had effective working relationships with other teams in the organisation. Staff carried out joint reviews of people who used their services involving other teams such as the community mental health locality teams. The North East Kent and South East Kent rapid response and home treatment teams met monthly to share information and concerns. Teams had good working relationships with external teams and organisations. They worked well with the local authority services and GPs. The teams shared information with the early intervention psychosis team and substance misuse services

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support. The service supported people who used services to live healthier lives. The care records we reviewed included support for physical health, lifestyle and wellbeing needs. The trust had a Physical Health and Examination Policy that emphasised the increased risk of poor physical health experienced by their service user group. It contained clear assessment tools and guidance for clinical staff to monitor physical health and any side effects people may have from medication. Each home treatment and rapid response team had a physical health nurse to assess physical health risks of the people who used their services and to lead on physical health for the team. The service referred people to external organisations such as substance misuse services if there was a need. Staff told us they had helped promote a healthy lifestyle for people who used services. For example, they would meet with people for appointments while going for a walk in the park.

The service routinely monitored people’s care and treatment to continuously improve it and to ensure that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. Staff took part in clinical audits. Managers used results from audits to make improvements. For example, staff took part in clinical audits of risk assessments and care plans and medicines. At the time of inspection, the home treatment and rapid response teams had recently introduced quality audits on care records. Where gaps were identified these were addressed. The trust did not conduct audits of physical health checks, however they received a quarterly report that updated them on physical health status, good practice and any issues across the trust. There were no physical health incidents reported from the home treatment and rapid response services. In March 2025, the trust’s clinical audit programme included 64 different audits. We saw learning and actions were identified to improve care following audits. Staff took part in quality improvement initiatives. For example, the Maidstone home treatment and rapid response team had implemented a quality improvement initiative to improve how handovers were documented. The team had identified that staff were copying and pasting the handover template and not always updating correctly. Pharmacists completed weekly audits of medicines which identified that staff needed to ensure they were filling in all required boxes and this learning was shared with staff at their team meetings.

Staff at the health-based places of safety (HBPoS) did not always use the Mental Capacity Act correctly. However, staff at the home treatment and rapid response services told people about their rights around consent and respected these when delivering person-centred care and treatment. At the health-based places of safety (HBPoS) it was not clear in patients notes which legal framework they were detained. We reviewed 15 care records for patients of HBPoS and of these 9 had been detained beyond the time permitted by law. Sometimes patients were described as ‘liable to be detained,’ and sometimes they were noted to be held under ‘common law’ or the ‘Mental Capacity Act’. However, there was no evidence of a capacity assessment or best interests being completed. When medication was given to patients in the place of safety, staff did not always record under what legal authority this was being given. Patients detained under section 136 powers cannot be treated under the Mental Health Act; medication can be given either by the patient giving valid consent or as a best interests’ decision under the Mental Capacity Act. The entries we saw where patients in the place of safety were given medication, did not state the legal basis for this decision. Section 136 is part of the Mental Health Act that gives police emergency powers to take someone to a place of safety. Under section 136 of the Mental Health Act 1983, a person can be detained for up to 24 hours, though this can be extended by a further 12 hours if an assessment cannot be completed due to the patients condition. If the patient has not been discharged when this detention period has expired, the patient is deemed to be held and given medication unlawfully unless they have capacity and have consented to stay and be treated. Across the home treatment and rapid response teams staff assessed and recorded capacity to consent appropriately. We reviewed 19 care records of people who used home treatment and rapid response services and found capacity to consent was considered at each initial assessment when people were admitted to the service. We observed a home visit where the staff member enabled the person that used the service to make their own decisions about their care and treatment. The trust had a Consent to Treatment Policy. The policy showed clear expectations and responsibilities for staff regarding seeking and recording consent from people who use services. This protected people from receiving treatment without their consent. Staff were required to complete mandatory Mental Capacity Act training, and there was a clear policy on the Mental Capacity Act. The Dartford home treatment and rapid response team had 100% compliance with this training. The Medway home treatment and rapid response team had 97% compliance, the South East Kent home treatment and rapid response team had 94% compliance, the West Kent home treatment and rapid response team had 89% compliance, and the North East home treatment and rapid response team was at 88% compliance.