Monitoring the Mental Health Act: what’s happening in Wales?

Just enough time this morning to note this week’s publication of the Care Quality Commission’s annual report into the use of the Mental Health Act in England, and to pose a question. Here are word-for-word snips taken from the CQC report’s summary, covering the year 2012/13:

Our findings on the experience of people detained under the MHA are in the context of a system where:

  • The number of people subject to the MHA continues to rise.

  • There are nationally recognised problems with access to care during a mental health crisis. There is evidence that pressure on services continues to obstruct timely access to less restrictive crisis treatment. Service commissioners in local authorities and clinical commissioning groups need to give a higher priority to translating local needs assessments into evidence-based commissioning of services.


  • On almost all wards, patients had access to independent advocacy services. This is a considerable improvement.

  • We saw improvements in helping patients draw up advance statements of their preferences for care and treatment.

  • But more than a quarter (27%) of care plans showed no evidence of patients being involved in creating them. More than a fifth (22%) showed no evidence of patients’ views being taken into account. This is no improvement on the previous year, and is unacceptable. Services who do not demonstrate good practice in this area should learn from areas who are demonstrating that it is possible to deliver best practice.

  • We continue to see widespread use of blanket rules including access to the internet, outside areas, room access, and rigid visiting times. Some type of blanket rule was in place in more than three quarters of the wards we visited. Such practices have no basis in law or national guidance on good practice and are unacceptable.We continue to hear accounts of patients’ experiences of being restrained. In this report we promote examples of good practice where providers of inpatient mental health services have taken positive steps to reduce the use of restraint.

  • Health-based places of safety, for people experiencing a mental health crisis, are often not staffed at all times. Some have lain empty while a patient has been taken to police custody.

  • Only 17% of recorded uses of hospital-based places of safety under section 136 resulted in further detention, following assessment by mental health professionals.

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

  • In one area police told us that 41 young people had been detained in police cells over the previous year; the youngest was 11. This is unacceptable.

  • In 2011/12 and 2012/13 we were notified of 595 deaths of people subject to the Act. There were 511 deaths of detained patients, and 84 deaths of patients subject to CTOs. The majority of deaths reported to us were natural causes with a third of those taking place before the person reached the age of 60. Attendance to the physical health needs of people with mental illness must be a priority for all services. We will be working with partner organisations to review national data on all deaths and how this can be combined and shared to improve scrutiny and embed learning.

There’s plenty here to think about and act upon, but as a COCAPP researcher I immediately spot the CQC’s observation on the general lack of service user involvement in care planning. In its coverage, The Guardian emphasised the rise in numbers of detained patients, whilst Community Care ran with the headline, ‘Mental health system failings breaching patient rights and damaging care’.

In this part of the UK the work of monitoring the Mental Health Act falls to the Healthcare Inspectorate Wales. In addition, statistics on admissions in psychiatric hospital in Wales are published here, from which data from 2012/13 can be downloaded. Back on the HIW site I see a Mental Health Act monitoring report for the year 2010/11, which states in its summary:

We generally found detained patients to be cared for and treated by staff who have the necessary knowledge and skills, however, there were gaps in provision. We are particularly concerned that record keeping in relation to consent to treatment was not always appropriately followed. As the Act allows for some medical treatment for mental disorder to be given without an individual’s consent it is important the correct procedures are followed by organisations. We are also concerned that patients were not always being made aware of their rights in a timely manner.

The lack of activities and therapeutic input that was evident in many settings needs to be addressed and we will continue to focus on this matter in the year ahead. Access to therapies including psychologists was found to be variable between organisations. This is concerning as such therapeutic input can assist in recovery and lead to shorter periods of detention.

The HIW states in this document that it has responsibilities to publish its Mental Health Act monitoring findings on an annual basis. It is entirely possible that I’m looking in the wrong place, but I find it odd that the last report available online appears to be that covering the year 2010/11. Am I missing something?


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