CQC reports serious concerns monitoring the Mental Health Act
CQC’s Monitoring the Mental Health Act report 2021/22, published in December 2022, raises concerns which have continued to escalate from previous years; mental health services and staff are struggling to recover following pressures placed on them during the pandemic and the resulting fallout.
The CQC report highlights these issues:
- Action is needed to resolve longstanding inequalities, particularly disproportionate use of sectioning and restrictive community treatment orders (CTO) on black people and people from some ethnic minority groups, including those from areas of deprivation. Data suggests that CTO use on black people are over 11 times that of white people.
- Staff and workforce shortages have put further pressure on inpatient and community services which are already overcapacity, creating significant delays in care.
- Gaps in community care are adding to the pressure on inpatient services, with bed availability in many services running close to or above capacity. While some services are managing to accommodate patients without extended delays, many others are struggling to provide a bed, leading to people being cared for in inappropriate environments. Tailored personal support and therapeutic activities are reduced, intensifying the potential for serious incidents, a reduced workforce compromises the service’s ability to respond to developing risks.
- People, particularly those with a learning disability and or autism, are also being admitted to inappropriate environments, resulting in them not getting the care and support they need. The report cites an example of someone no longer detained under the Mental Health Act who was unable to be discharged from a psychiatric intensive care unit due to external delays.
- Children and young people’s mental health services are struggling to meet rising demand. This increases the risk of children ending up in inappropriate environments too. The report shows CQC notifications of under 18s admitted to adult psychiatric wards in 2021/22 increased 30% compared to 2020/21. To manage delays for children and young people's beds, some services invested in new health-based places of safety, to care for people while they are waiting for a ward bed.
- However, good care was observed. Services were better at involving people in their care and the running of the service and using advance planning to support people’s decisions about their care.
- Some services actively identified a lead for promoting equality and diversity across wards, taking responsibility for ensuring the service was inclusive of people’s needs. In some services the lack of beds and gaps in community and social care has led to the development of ‘sub-acute’ wards to accommodate people whose discharge from inpatient care is delayed.
- Refurbished wards reflected positive effects, improving everyone’s experiences, and despite the pressures, some services were taking steps to apply the principle of least restriction to minimise incidents of restraining people.
A response from our Integrated Care Partnership in Milton Keynes
We approached the Bedfordshire, Luton & Milton Keynes Integrated Care Board for a response about how they are monitoring the issues raised in this CQC report. Here is what they told us:
"We work closely with all mental health providers to ensure that services are appropriately and safely provided across our population.“
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