CQC: more focus on human rights needed by healthcare services when using the Mental Health Act

Services need to improve how they provide care and treatment for people detained under the Mental Health Act (MHA) in a way that respects their human rights, the Care Quality Commission (CQC) has found

This is an edited version of an article first published by the CQC.

CQC’s Monitoring the Mental Health Act in 2018/19 report, published today, finds 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.

The Mental Health Act 1983 (MHA) is the legal framework that provides authority to detain and treat people who have a mental illness and need protection for their own health or safety, or the safety of other people. CQC has a duty to monitor and report on how services do this.

Throughout 2018/19, CQC carried out visits to mental health wards to meet patients, review their care and speak to staff to inform its annual report to Parliament on how health services in England are applying the MHA. It concludes that:

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.

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.

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“The use of the MHA continues to rise and the overrepresentation of some Black and minority ethnic (BME) 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.

“Positively, we have seen a continued improvement in the number of people being given information about their rights and being offered the support of an Independent Mental Health Advocate. However, providers must do more to involve people in decisions about their care and treatment and ensure that this is happening in their services. We also want to see regular and independent reviews of the care being provided to people who are segregated from their peers to ensure their human rights are being safeguarded.

“The national workforce challenges 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.”

As part of its work to monitor the Act, CQC carried out 1,190 visits to mental health wards in 2018/19 and met with 4,436 detained patients to discuss how the Mental Health Act 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.

CQC’s second opinion appointed doctor (SOAD) service carried out 14,354 visits to review patient treatment plans. A change of treatment plan or no authorisation was given in 31% of visits to consider medication for detained patients; 22% of visits to detained patients to consider electroconvulsive therapy (ECT); and 18% of visits to consider medication treatment for patients on community treatment orders (CTO).

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