CQC Publish Second Mental Health Act Annual Report

23rd December 2011

Categories: Advocacy, Mental Health,

This month, in their second Mental Health Act Annual Report for 2010-2011, the CQC identified that “independent advocacy services are an important safeguard that help and support patients to understand and exercise their legal rights.”

The report follows 1565 visits to mental health facilities throughout the country, including private interviews with over 4700 patients receiving care for mental health conditions.

As part of the CQC’s responsibility for monitoring care services, the report aimed to identify how well the Mental Health Act was understood and used by professionals to benefit and safeguard those suffering from mental health conditions.

In positive cases, the CQC reported high levels of patient participation and involvement in the care they received. “Participation is one of the five key underpinning principles of the Mental Health Act Code of Practice” and inspectors found that where this Code of Practice was upheld, patients were given opportunities to influence the running of the wards and the activities provided. Patients were also given opportunities to provide feedback on the care they received, and were able to see the changes made as a result of their comments.

In other successful cases, CQC inspectors found a good understanding amongst patients regarding their care and the decisions being made. This was particularly apparent in cases where patients and families were made aware of the advocacy services available and were able to gain the support and information needed to understand their rights and restrictions under the Mental Health Act.

Angela’s Story:

“Angela is a grandmother who had been in and out of hospital as a result of her mental health problems. In 2009 it was decided that she posed a risk to herself and she was placed in a care home, away from her partner, children and grandchildren. In the care home, she was held under the Mental Capacity Act and deprived of her liberty.

Whilst in the care home, a VoiceAbility advocate worked with Angela to ensure that her voice was heard and that the rights afforded to her under the Mental Capacity Act were upheld. Angela told her advocate that she did not want to challenge her section as she was seeking a different resolution.

The advocate made sure that Angela was kept up to date on these resolutions and worked with her to have more access to her family and to activities taking place outside of the care home.

As the months passed, Angela’s plans had started to slow down and the advocate revisited the option of taking the issue to court and challenging Angela’s deprivation of liberty. The advocate explained the process carefully to make sure Angela understood what would happen if they decided to go ahead. Angela decided that this is what she wanted to do and agreed to an application being made to the Court of Protection. The advocate worked with Angela to decide what should be included in the report and to raise the question over whether deprivation of liberty was still appropriate, taking into account the risk of harm for Angela.

Following the report, an immediate hearing took place and Angela’s case was transferred to the High Court. Angela was then assessed by the local authority, who found that she did have capacity and that deprivation of liberty no longer applied.

The advocate played a vital role in bringing Angela’s wishes into the centre of the decisions being made, and in making sure that Angela had a clear voice in this very complex process. Through working with an advocate, Angela was able to challenge the restrictions placed on her and demonstrate her capacity to the local authority.”

IMHA involvement in Angela’s case gave her the skills, understanding and empowerment to navigate the Mental Health Act and find a solution which suited her needs. However, in cases where such services were not made available, the CQC found worrying examples of poor adherence to the Mental Health Act’s Code of Practice. In too many cases the report found that access to advocacy was unavailable, and staff with a responsibility for explaining the service to patients did not understand it or even know of its existence.

Patients with learning disabilities were found to be detained far longer on average than those without, indicating a lack of engagement with learning disability patients, resulting in their slow progress through the mental health system. A lack of support to identify what was expected of them and how to remain involved had a noticeable impact on the wellbeing of people with learning disabilities in secure settings.

Patient wellbeing was also affected in cases where mental health professionals deprived patients of their liberty too readily, without taking the time to fully assess the need for individuals to be held under the Mental Health Act. Examples of excessive restrictions were also found in the supervision of patients, who reported having their calls monitored and their movements curtailed unnecessarily by staff in hospitals and care homes. 

Focussing on the number of patients who died whilst being held under the Mental Health Act, the report noted that 115 deaths were recorded as resulting from ‘unnatural causes.’ Of these, most were found to be due to suicide or self harm. Taking into account the mental status of patients in secure settings, enhanced patient wellbeing and an active involvement in their care was found to make a hugely positive difference to patient experiences of mental health services.

The CQC report clearly identifies the areas of improvement in the use of the Mental Health Act. Participation, involvement and access to advocacy are key areas which enhance patient experiences of detention. These not only aid recovery but also contribute to the ongoing improvement of services for future patients in secure settings.

A key part of an advocate’s role is to ensure that professionals are aware of their responsibilities. Working in a secure setting in Croydon, the number of people being referred for advocacy was very low due to a disorganised system and the staff not being fully trained on how to recognise a need for advocacy within the Mental Health Act. Towards the end of last year, VoiceAbility provided training to all doctors and nurses in the unit, leading to an increase in referrals of 13% in the last quarter alone. We expect to see this increase continuing in 2012.

Our thanks to:

• Care Quality Commission
• Mind
• VoiceAbility IMHA Services