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Report highlights crisis in mental health care

MPs call for enquiry as voluntary patients are being sectioned due to massive bed shortage

Mark Gould

Wednesday, 14 August 2013

A damning report by the influential Commons Health Committee reveals that desperate bed shortages are forcing psychiatrists to section voluntary patients so they can get urgent hospital care.

In its report of the effects of the 2007 Mental Health Act, the Committee heard that many NHS psychiatric wards are desperately short of beds, with some 15% of wards operating at over 100% occupancy.

“Many psychiatric wards are over capacity and there is huge pressure on beds, nevertheless, we were shocked to learn that there is evidence that patients who need hospital treatment are being sectioned unnecessarily in order to access a bed”, Committee chair Stephen Dorrell said.

“This represents a serious violation of patients’ basic rights and it is never acceptable for patients to be subjected to compulsory detention unless it is clinically necessary."

The Committee is worried that the Department of Health does not know what is driving increased rates of detention. It says a lack of data on readmissions means that there is no information to illustrate whether pressure on beds is detrimentally affecting the treatment of those patients eventually detained under section.

It also fears bed pressures might be driving the use of supervised community treatment orders (CTOs) controversial measures which allow patients to be discharged under threat of readmission should they breach its terms.

Mr Dorrell wants a ministerial review of CTOs in the light of a "convincing body of evidence" that they have not prevented readmission to hospital or reduced the number of people detained in hospital. The report also raises concerns over a wide variation in use of CTOs across the country and their disproportionate use among black and minority ethnic patients.

The Committee was also concerned that Deprivation of Liberty Safeguards (DOLS), designed to protect vulnerable patients with dementia or learning severe difficulties, are being ignored "leaving many people at heightened risk of abuse".

Mr Dorrell said: "DOLS are seen as complicated and difficult to implement, but this is no excuse for the extreme variation in their application across the country. The current approach to these vital safeguards is profoundly depressing and complacent and the Government must immediately instigate a review which details an action plan for improvement.”

The report highlights also promises about a "parity of esteem" between mental and physical health services, but finds a lack of parity in the face of evidence of community mental health cuts and restricted access to independent Mental Health Advocates.

The Mental Health Alliance, an umbrella body representing clinicians, patients and campaigners, backed calls for an investigation into CTOs, and improved use of DOLS and access to Mental Health Advocates. Its chair Alison Cobb said: "When a person is detained under the Mental Health Act, they are at their most unwell and every possible care must be taken to ensure that it is done in the right way.

"We particularly back the committee's call for a review of Community Treatment Orders (CTOs). The Alliance expressed serious concerns about the criteria for CTOs when they were first proposed and has since raised serious concerns that they are being used far more frequently that originally intended, meaning more and more people are being treated coercively in the community. They should not be used routinely as a way of discharging people from hospital. The Department of Health needs to understand why CTOs are being used so often and to investigate whether in fact they are having a beneficial effect on people's lives and recovery."

Dr Julie Chalmers, the Royal College of Psychiatrists’ lead for mental health law, said the college would be happy to contribute to any investigation into CTOs. She said the issue of severe pressure on beds must be urgently addressed as the college is "very worried" by the suggestion that mental health professionals are sectioning patients in order to access in-patient treatment, and believe this requires further investigation. "Whilst admission under the Mental Health Act may be necessary on some occasions the principle of using the least restrictive option must always be followed."

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