A recent report published by the Care Quality Commission (CQC) – The rise in the use of the MHA to detain people in England –
highlighted a 40% rise between 2005/6 and 2015/16. In response to these and other concerns, the government announced an independent review, which will make recommendations for improvements to legislation and practice later this year.
Following a period of research and consultation, the CQC identified a number of factors that might be influencing the rates of detention under four broad themes:
Changes in mental health service provision and bed management
Demographic and social change
- More frequent readmissions, either as part of a care plan or due to premature or poorly planned discharge.
- Loss of specialist community teams offering alternatives to admission.
- Pressure of beds preventing early, informal admissions, or leading to discharge without adequate support.
Legal and policy developments that have influenced practice
- Increasing population and section of the population ‘at risk’ of detention (especially older people with dementia).
- Rising social exclusion (for example, homelessness).
- Impact of alcohol and substance abuse.
Data recording and data quality
- The 2007 reform of the MHA widened the definition of mental disorder and of treatment.
- Increasing awareness of the factors of detention as a result of the Bournewood judgement, and the Mental Health Capacity Act leading to more use of MHA for those lacking capacity.
- Greater police awareness of mental disorder leading to more diversions from the criminal justice system.
- Improved recording informs national data sets.
- Duplicate entries, including double-counting when a detained patient is moved from one ward or provider to another.
The report indicates that the rise in a part suggests a system under considerable pressure and staff in some areas have limited access to community services that can act as true alternatives to admission. At the same time, services may have no bed available for an admission when it is needed. This creates a dilemma for both patient and staff, and reduces the likelihood that detention can be avoided – either by providing a less restrictive community alternative or by an informal admission to prevent further deterioration. In some cases, this might amount to a vicious cycle where pressure on beds leads to clinical practices that increase the likelihood of patients being detained, which itself increases the pressure on the sector.
Interestingly, the pattern of change in rates of detention over the past 25 years supports the report’s conclusion that any changes in mental health law need to happen alongside an approach that addresses wider problems. Following year-on-year increases during the 90s, the rate of detention fell between 2000 and 2009 before rising again.
The CQC concluded that it’s unlikely that reform of mental health legislation alone will reduce the rate of detention. There must also be action to address the underlying issues that have almost certainly contributed to the 40% rise. The report summary closes by highlighting that the mental health National Service Framework was published in 1999. The decade that followed was a time of significant investment in new community teams, whose purpose was to act as alternatives to hospital admission.
Download the full report