The Care Quality Commission’s annual monitoring report on use of the Mental Health Act has drawn attention to rising use of the Act both to detain people in hospital and to continue to use compulsory powers when they return home. The number of people who have been detained has risen steadily each year since the 1983 Act was amended in 2007, while the introduction of community treatment orders is extending the use of compulsion when people are discharged.
The report shines a light on the way people are treated once they are detained. Like recent reports from Mind and Rethink Mental Illness, it describes wide variations in the quality of experience of detained patients. It shows, for example, that a significant minority of detained patients are not involved in decisions about their treatment or in planning for their discharge from hospital. Yet if people are to be supported effectively in their Recovery journeys, planning for the future should begin as soon as they are admitted to hospital, with families and friends involved as partners throughout. Hope, control and opportunity may be harder to maintain when people are detained but they are key to supporting Recovery in even the most difficult of times in a person’s life.
The report draws our attention to the continued high rates of detention, and in particular the use of community treatment orders, among many Black and minority ethnic groups. Debates about the reasons for this disparity continue, but that should not distract attention from efforts to improve race equality in mental health services and their relationships with community organisations.
Worryingly, the report also finds that too few people are offered access to independent advocacy. Access to an advocate is a fundamental safeguard in the 2007 Mental Health Act and research by the Mental Health Alliance and others has identified a gap in provision of advocacy services, especially for some Black and minority ethnic communities. It is vital that local authorities ensure they commission sufficient high quality advocacy services when they take over responsibility for this in April.
The report sets out how the Care Quality Commission itself will continue to monitor use of the Act and makes recommendations for the reformed NHS in how it manages the use of compulsory powers. As health and social care organisations begin a year of considerable structural change and new ways of working, it is crucial that commissioners and providers maintain a keen eye on the use of the Mental Health Act and the needs, wishes and aspirations of those who are subject to it.