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Monitoring the Mental Health Act in 2011/12

Presented to Parliament by the Secretary of State for Health pursuant to section 120D(3) of the Mental Health Act 1983

The overarching theme of the report is how to embed dignity, recovery and participation in practice when people are subject to compulsory care and treatment. Separate chapters focus on the use of the Act, participation and respect, coercion in practice, care pathways, consent to treatment and CTOs.

CQC’s analysis shows that the context for its findings on the experience of people detained under the Act is one in which:

  • The number of people subject to the Act is rising (those detained as inpatients and those subject to CTOs).
  • Services are under pressure (for example issues relating to provision of Approved Mental Health Professionals and transport to hospital, high bed occupancy, increased workloads, access to psychological therapies).

What we found:

  • Some hospitals and wards are doing a very good job in treating patients with dignity and respect. The report highlights good practice, for the first time naming the relevant providers in order that they may share good practice and learning.
  • CQC found some overall improvement but most of the concerns highlighted in previous reports remain, particularly in respect of care planning, patient involvement and consent to treatment. For example, 37% of care plans checked by CQC showed no evidence of patients’ views; there was no evidence that patients had been informed of their legal right to an Independent Mental Health Advocate (IMHA) in 21% of records reviewed; almost half (45%) of patient records reviewed still showed no evidence of consent to treatment discussions before the first administration of medication to a detained patient
  • There is a significant gap between the realities CQC is observing in practice and the ambitions of the national mental health policy – No Health without Mental Health.
  • CQC is concerned that cultures may persist where control and containment are prioritised over the treatment and support of individuals. In this kind of culture, ‘blanket rules’ can become institutionalised. On one in five visits, CQC expressed concern about the de facto detention of patients who were voluntary rather than compulsory patients.