Detentions under Mental Health Act continue to rise

Author: Mark Gould

Detentions under the Mental Health Act continue to rise with the over-representation of some black and minority ethnic (BAME) groups giving "particular cause for concern" according to inspectors.

The Care Quality Commission’s (CQC) Monitoring the Mental Health Act in 2018/19 report, reveals that use of the Mental Health Act (MHA) continues to rise, with 49,988 new detentions recorded for 2018/19 compared with 49,500 recorded in the previous 12 months.

Black people were four times more likely to be detained under the Act than white people, and are more likely be given Community Treatment Orders.

The report also found that mental healthcare providers are failing to protect the human rights of some people who are sectioned.

The report also concludes:

  • Human rights principles and frameworks must be applied and their impact on people continuously reviewed and updated to improve people’s experience and make sure they are protected and respected.
  • People must be supported to give their views and offer their expertise when decisions are being made about their own care and treatment. Providers must take this seriously and look for evidence that this is being done across their services.
  • People who are in long-term segregation can experience more restrictions than necessary and experience delays in receiving independent reviews of their situation. This is particularly true for people with a learning disability and autistic people.
  • People are not always receiving the care and treatment they need, with services struggling to offer appropriate options, both in the community and in hospital.
  • It is difficult for patients, families and carers to navigate the complexity of the interface between the MHA, the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

The CQC carried out 1,190 visits to mental health wards in 2018/19 and met with 4,436 detained patients to discuss how the MHA and its Code of Practice were being applied to them. Assessors requested 4,477 actions from providers to change the way care was being delivered to patients.

On the positive side inspectors found that there has been an improvement in the number of people being given information about their rights and being offered the support of an Independent Mental Health Advocate (IMHA). However, services need to do more to ensure that they are complying with their human rights duties.

Dr Kevin Cleary, CQC’s deputy chief inspector for Mental Health and Community Services, said: “When a person is detained under the MHA it is essential that healthcare services apply human rights principles to ensure that the person is treated with dignity and respect. Through our review of use of the MHA over the past year we have been concerned to find that frequently this is not the case.

“The use of the MHA continues to rise and the overrepresentation of some Black and minority ethnic groups is a particular cause for concern. More needs to be done nationally to address issues of inequality, but providers also have a responsibility to oversee how the MHA is working, including any impacts on human rights and equality issues.

Dr Cleary also stressed that staff shortages in mental health services must be resolved if people who are detained are to be truly empowered and involved in decisions about their care and treatment in therapeutic environments that are least restrictive.

“We welcome commitments made in the NHS Long-Term Plan to address these issues.

“The upcoming government white paper detailing future reform of the MHA is a real opportunity for a more human rights based approach. We will continue to work with our partners to ensure it supports people to have a real say in their care, that they are treated equitably and that their rights are protected.”

Vicki Nash, head of policy and campaigns at the mental health charity Mind, says the report provides “indisputable evidence that our mental healthcare system is on its knees”.

“It is disgraceful that people are dying because of a lack of beds, more people are being detained under the Mental Health Act than ever before and Black people are still four times more likely to be sectioned than White people. These deep injustices are among the multitude of reasons why mental health legislation needs a complete overhaul.”