Alliance members welcome Care Quality Commission report on Mental Health Act

30 January 2013

Members of the Mental Health Alliance today responded to the publication of the Care Quality Commission's Mental Health Act monitoring report for 2011/12.

Paul Farmer, Chief Executive of Mind, said:

"Being involuntarily detained under the Mental Health Act is one of the most serious things that can happen to someone in terms of their mental health. For this reason it should only happen if it is absolutely necessary, with great care and in strict adherence with the procedures laid out in the Act. Todayís report shows that, in many cases, peopleís basic human rights are being infringed at a time when they are likely to be at their most vulnerable.

"The overall rise in detentions and Community Treatment Orders is very worrying and is symptomatic of problems elsewhere in mental health services. Better access to talking therapies, for example, or well-resourced crisis care services that can respond to a personís individual needs can help prevent a personís 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. Detaining people because itís the only way to ensure they have a bed is completely unacceptable.

"The government says it is keen to do more to improve mental health services across the board. This report shows just how far there is to go in many areas and raises serious concerns about how realistic it is to expect improvements while services are so overstretched. It is a wake-up call for the Department of Health and a clear signal to the NHS Commissioning Board and Clinical Commissioning Groups that, as they begin to assume responsibility for health services, mental health must be a top priority."

Dr Andrew McCulloch, Chief Executive of the Mental Health Foundation, said:

"We very much welcome this transparent and informative report.

We are pleased to see that the majority of providers seem to be doing a good job in caring for people detained under the Mental Health Act and we welcome the inclusion of good practice examples in the report.

However, the report raises some key issues many of which remain inadequately addressed after many years. We are very disappointed that some organisations still fail to involve patients in care planning. Plans must take account of individualsí needs and aspirations in order to be effective.

Itís frustrating to see that the findings provided by the report remain pretty much the same year after year in showing large over-representation of certain black and minority ethnic groups. A lot of work has been done to identify the specific problems that need to be addressed, but neither Government nor providers seem willing to make the long term commitment to working with local communities that will be required to deliver change.

Finally, we are very concerned by the reported lack of understanding of the Mental Capacity Act amongst many staff, which we highlighted in our Best Interest Decisions Study (BIDS) report in January. Urgent work is needed to educate those responsible for implementing this Act on the ground."

Professor Sue Bailey, President of the Royal College of Psychiatrists, said:

"The CQCís report shows that while there is welcome progress, many challenges remain, particularly with the current pressures on acute psychiatric services to respond to those with severe mental illness. Worrying trends such as increased rate of detentions may have many causes, but are something that should concern all of us.

"While the report is about those receiving care under the Mental Health Act, we should not ignore the need for high quality community mental health services, as this should mean that fewer people would need to be admitted to hospital.

"We support the CQCís intention to increase service user involvement in its monitoring work. As a Royal Medical College we are committed to working with the CQC, service users, health trusts, other service providers and commissioners to deliver the best possible care for this group of people. We have outlined our own ten point plan for what good quality care should look like and were pleased that this was acknowledged in the report."

Marjorie Wallace, chief executive of SANE, said:

"It is disappointing that in so many cases both detained and voluntary patients still do not receive sensitive, therapeutic care and treatment.

"Patients given over to the safekeeping of the state should not be made to feel insecure and their privacy and dignity should be respected."

Paul Jenkins, Chief Executive of Rethink Mental Illness, said:

"Sadly, the concerns raised in this report very much echo the problems many of our members have experienced first hand. The system has become too focused on managing risk, at the expense of quality care and treatment.

"One example of this is the huge amount of money wasted on people being kept in secure care for longer than necessary, because of red tape. This means people who have been judged by psychiatrists to be ready for a step down in levels of security, are needlessly detained in very expensive settings. This is unfair and potentially damaging to the individual - it is also wasting money which could be used to prevent others getting to this acute stage of illness. We want to see a fundamental shift in the system, which diverts this funding away from secure care and reinvests it into early intervention services.

"The findings around patients not being properly involved in their own care, very much reflect concerns raised by The Schizophrenia Commission last year, in their report, The Abandoned Illness.

"Patients should be treated as genuine partners by health professionals, but too often this involvement can be tokenistic. Mental health treatments are much more likely to be effective if patients are properly involved and feel listened to.

"The report also found that some wards are not therapeutic environments, staff are often demoralised and pessimism pervades parts of the system. It's therefore perhaps unsurprising that people are increasingly refusing to be readmitted, and are increasingly being detained against their will.

"All of us know someone with a mental health condition, so we should all be pleased that the CQC is making mental health a priority this year as mental health services still lag far behind those available for physical health."

Andy Bell, Deputy Chief Executive of Centre for Mental Health, said:

"The Care Quality Commission has drawn attention to rising use of the Mental Health Act both to detain people in hospital and to continue to use compulsory powers when they return home.

The Mental Health Act should be used as a last resort and only for as long as it is needed. And when people are detained services should be working with them and their families to help them on their way to Recovery from the start.

Too many people are still not involved in making decisions about their care and treatment, and too few people are offered access to independent advocacy. Local authorities must ensure they commission sufficient high quality advocacy services when they take over responsibility for this in April.

The report also draws our attention to the continued high rates of detention and use of community treatment orders among Black people. Action to address this inequality in health remains vital."

Mencap and The Challenging Behaviour Foundation said:

"The CQC report highlights that mental health services are failing to protect vulnerable people. Mencap and The Challenging Behaviour Foundation are deeply concerned that in many hospitals, abusive practices, such as patients being over-restrained, locked up and over medicated, are being allowed to continue. People's needs are simply not being understood.

People with a learning disability are particularly vulnerable, because they often can't speak up for themselves. At Winterbourne View, where shocking abuse was uncovered in 2011, most of the people with a learning disability had been sectioned under the Mental Health Act. The abuse, bullying and humiliation which took place there included the inappropriate use of restraint.

The CQC recognises that urgent action is needed. This must address the needs of people with a learning disability."