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Monitoring the use of the Mental Health Act in 2009/10

The Care Quality Commission’s first report on the exercise of its functions in keeping under review the operation of the Mental Health Act 1983

Our findings on the experience of detained patients raise important general issues for service providers and commissioners, including how effectively providers are putting into practice the Code of Practice principles of least restriction, respect and participation. We have identified three priority areas for improvement. Service providers should take action to review and ensure progress in the following:

1. Involving detained patients in their care and treatment to enhance their experience of care and promote recovery. We recommend that services focus on ensuring that they involve patients in the following key areas of service planning and delivery:

  • Assessment, care planning and review processes, as a basis for developing the patient’s personalised care plan.
  • Planning of the patient’s community treatment order, if they are subject to supervised community treatment.
  • Ongoing discussions with the patient as part of assessments of capacity and consent, with these discussions formally recorded on the patient’s care plan.
  • Ensuring that detained patients are aware of IMHA services and have access to information about them.
  • Consulting and informing detained patients about their social circumstances reports Even within a system that restricts people’s rights because of their mental ill-health, services can and must respect and involve patients in their care and treatment. Our evidence shows that, in practice, involvement of patients continues to be variable. However, the positive feedback we have received from some patients shows that genuine involvement can be achieved even where people’s rights are restricted.

2. Practice relating to patients’ capacity and consent, ensuring that ongoing discussions of these issues with patients are an integral part of treatment planning. The discrepancies that our visiting Commissioners often see between patients’ recorded consent and their apparent lack of capacity or refusal of consent is concerning. We have identified consent to treatment practice as an ongoing problem in many mental health services, and will be looking for evidence of improvement in 2010/11.

3. Unnecessary restrictions and blanket security measures. We recognise the importance of ensuring the safety of patients, but would nevertheless urge providers to give more thought to how they can minimise restrictions on detained patients and avoid blanket measures that compromise patients’ privacy or dignity, or unnecessarily restrict their autonomy. Not only may these be countertherapeutic, but they could also breach human rights principles and are wrong. To help reduce the chance of incidents that might lead to the use of more restrictive interventions, and to promote dignity and safety, we also emphasise the importance of a positive therapeutic environment, supported by an appropriate staffing level and skill mix.