People not being offered enough support to exercise their rights under Mental Health Act, CQC finds

Greater attention needs to be given to supporting people who are subject to the Mental Health Act, including how they are involved in their care, empowering them to exercise their legal rights and if they receive the safeguards provided by the Act when they are detained in hospital or subject to conditions in the community, a report has found.

The Care Quality Commission’s (CQC) 6th annual report found there is insufficient staff training and monitoring the impact of the Mental Health Act and outcomes for patients by leadership and management teams. This means that the protections offered to people by the updated (April 2015) Mental Health Act Code of Practice are not being consistently delivered. The Code, which must be observed by all services, offers statutory guidance for patients, their families and professionals in how people should be treated while subject to the Act, how their rights will be protected and what they can expect as a minimum from services. 

In the report, which assesses how NHS mental health trusts and independent mental health hospitals have used the Mental Health Act in the last year (2014/15), the CQC found examples of good practice where staff have made sure that people affected by the Act are supported and empowered to make decisions about their care and treatment and encouraged to help shape the planning of services. It also champions the many services who are seriously addressing their rules and procedures to ensure that they are not unfairly restrictive to individual patients.    

But the CQC also found “unacceptable” variation in practice. For instance, in some cases staff had received no training on the revised Code in half of 58 wards visited in September and October. Throughout the year, they found no evidence of patient involvement or patients’ views being considered in 25% of the 3,836 care plans that it examined during visits to hospital settings: There has been no improvement in this from the figures reported in 2013/14.

Furthermore, 10% of the records CQC examined in 2014/15 did not show whether patients had had their rights discussed or explained to them, even though this is a strict legal requirement. This is a slight improvement from the 13% of records that lacked such evidence in the previous year.

The need for the NHS and independent mental health providers to get this right is greater than ever as the data from the Health and Social Care Information Centre has shown that the Mental Health Act is being used more than ever before. In the past year, the Act has been used more than 58,000 times, 10% more than the 53,176 times in 2013/14.

As part of its work to monitor the Act, CQC carried out 1,292 visits to mental health wards from April 2014 to March 2015, assessing how people had been treated, meeting some 5,900 patients to discuss how the Mental Health Act and its Code of Practice were being applied to them. 

The report recommends a number of changes to be made to practice across the system including specific calls to action for providers, NHS England and the Department of Health to tackle the issues and improve the care being provided for patients affected by the Mental Health Act. 

Dr Paul Lelliott, deputy chief inspector of hospitals (lead for mental health), said: “Although we have seen some good and caring practice in mental health facilities, we remain concerned that services are not ensuring staff understand the Act or how they can ensure people are fully involved in decisions about their care. This is about more than a person simply having a right to know what is happening to them. Failure to engage a person fully in their treatment can hinder their recovery, and lead to potential breaches in meeting their human rights.

“The revised Code has presented us all with an opportunity to improve the way people affected by the Act are receiving care and how their rights are protected. This will only be possible if providers are making sure staff have the understanding and knowledge of the Code and its guiding principles but we have found this is not the case. We will be looking at ways leadership teams are embedding the revised Code, measuring its impact and supporting their staff to improve the care delivered to patients

”A system-wide effort is needed to ensure that people receive the care and support they need. We cannot do this alone but as the regulator, we will continue to identify, highlight and follow up on these issues though our more robust inspection programme and our separate patient focussed monitoring visits. Where we see people’s rights are not being protected we will always take action to improve their situation and make sure they receive better care.”