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More Mental Health detentions than ever before

Findings systematic of a system under ‘strain’ according to report conducted by CQC

Jo Carlowe

Wednesday, 24 January 2018

More detentions are being made under the Mental Health Act (MHA) than ever before, a new report shows.

The findings, published this week in the Care Quality Commission’s report: Mental Health Act: The Rise in the Use of the MHA to detain people in England, reveal detentions have increased by 40% over a ten year period.

The CQC could identify no single reason for the increase but suggested the ongoing rise was symptomatic of a system ‘under considerable strain’.

And the Royal College of Psychiatrists saw the report as further evidence of declining access to community services driving more people to reach mental health crises.

In its report, the CQC grouped the causes of the rise under four main themes:

  1. Changes in mental health service provision and bed management: This can include there being fewer alternatives to inpatient care in some parts of the country (such as support in the community). It might also be due to the high demand for hospital beds preventing admission on an informal (voluntary) basis, early in the course of a person becoming unwell, or leading to premature discharges, which can then lead to re-admissions.
  2. Demographic and social change: This includes general population growth, as well as growth in sections of the population that are more likely to be detained, such as older people with dementia, people who are homeless and people whose health is affected as a consequence of alcohol and substance misuse.
  3. Legal and policy developments: The broadened definition of a mental disorder in the revised Mental Health Act in 2007, and greater awareness, for example among the police, of mental disorder and among clinicians who wish to ensure there are legal safeguards in place when caring for people who lack mental capacity.
  4. Data reporting and data quality: This includes better reporting of detentions, as well as the potential for double-counting, such as when a detained patient moves between wards or from one hospital to another.

The CQC found no evidence that professionals had been misusing the Mental Health Act in anyway.

Commenting, Dr Paul Lelliott, deputy chief inspector of hospitals (lead for mental health) at the Care Quality Commission, said: "There is no single reason to explain why detentions continue to rise every year. Population growth, societal changes, better national reporting, duplicate reporting, increased awareness of mental disorder and expanded criteria for detention are all contributing to more and more instances of people being sectioned under the Mental Health Act.

"Some of the factors at play in the rising rates of detention, both nationally and locally, are also signs of a healthcare system under considerable strain. Detentions under the Act can be influenced by gaps in support and provision in the system. This includes limited hospital bed availability, which means that people cannot easily be admitted as voluntary patients early in the course of their illness. This is a particular problem if it is coupled with limited support for people in the community, which can prevent a person’s mental disorder from deteriorating to a point that detention under the Act is necessary.

"It will take more than changes to primary legislation to tackle this fully and to ensure that people with serious mental health problems always get the safe, high-quality and compassionate care they deserve, when, where and how they need it. Changes to the law must happen alongside action to address the wider problems."

Professor Wendy Burn, president of the Royal College of Psychiatrists, said: “The report is further evidence that declining access to community services is leading to more people reaching mental health crises and highlights the limitations of relying on legislative change to reduce rates of detention under the Mental Health Act.

“The government is right to look at why detentions under the act have risen and why some ethnic groups are detained more often than others in the Mental Health Act Review. But they must remember that the best way to prevent someone being detained is to prevent them from falling into a crisis in the first place; to understand that poverty, poor housing and poor physical health impact on a person’s well-being and psyche. With many services struggling to keep up with demand it can be hard to provide the early intervention needed to prevent people becoming seriously ill.”

She added: “Psychiatrists are seeing these ‘considerable pressures’ on mental health services highlighted in the report first hand, in part because of a workforce problem. Without enough psychiatrists to lead specialist mental health teams we cannot deliver the high-quality care that our patients deserve - care that could perform crucial early intervention to prevent the need to detain someone under the Mental Health Act in the first place.”

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