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Monitoring the Mental Health Act in 2016/17 Summary

Mental health has never been higher on the national agenda. In our report on the state of care in mental health services published in July 2017, we commented on the fact that more people than ever are receiving treatment and care for mental health conditions. In some respects, this is a good thing because it is in part due to more people being willing to seek help because of a reduction in the stigma associated with mental ill-health. However, this increase in demand has also contributed to a mental health system that is showing signs of strain; including problems of access, pressures on staffing and unsafe environments on some mental health wards. The number of people detained in hospital under the MHA has increased in recent years and the proportion of detained to informal patients continues to rise. In some parts of the country, mental health wards now admit few informal patients. In previous MHA reports, we have commented on the limited understanding of the factors that have contributed to this change. In January 2018, we published a report, based on evidence gathered during visits to local areas, and proposed eight hypotheses that could explain the increasing use of the MHA. Our findings support the view that changes to legislation alone may not have a major or immediate effect on the use of the MHA or rates of detention for specific groups.

Our MHA reviewers across the country have reported progress in some aspects of practice relating to the use of the MHA. However, in other aspects, we see no evidence of improvement from previous years. In particular, we continue to be concerned about the quality of care plans, discharge plans and physical health checks.

In 2017, we committed to carrying out focused work on some aspects of the use of the MHA that require closer scrutiny. In our state of care in mental health services report, we highlighted that more than 30 years after the introduction of mental health legislation that enshrined the principle of least restriction, some patients still receive overly restrictive care. To encourage improvement in this area of treatment, our report on restrictive intervention programmes published in December 2017 identified five NHS mental health trusts that have developed strategies and implemented approaches to reducing the need for restrictive interventions; including physical restraint. We will build on this good practice, including working with the Department of Health and Social Care to move towards greater understanding and implementation of the least restrictive option.

It is likely that, for a person whose first experience of mental health care is detention under the MHA, their perception of mental health services, and their willingness to engage with future care, will be greatly influenced by their experience of care provided during that initial admission. It is therefore vital that, while developing community services that can minimise the need for admission, services do not lose sight of the importance of also providing high quality inpatient care for those who need it.