A review by the Care Quality Commission (CQC) has concluded that the rise in detentions under the Mental Health Act is an indicator of a healthcare system that is under considerable strain.
Mental health charity Mind called for a review of the Act and blamed “failings across the system” for the fact that more people than ever before are being detained.
The CQC report explained that healthcare professionals will only detain people under the Mental Health Act when other options have been considered already, such as whether support can be provided in the community or if the patient can be cared for in hospital on a voluntary basis.
Yet in the 10-year period between 2005/06 and 2015/16, the number of detentions increased by 40% – from 45,484 to 63,622.
As part of its role in monitoring the use of the Mental Health Act in England, CQC made a commitment to explore what could be causing this trend. It has done this by reviewing the available data, by visiting specialist mental health (independent and NHS) services, and by speaking to patients and to representative bodies to gather their views.
CQC published the outcome of its review, which found that the causes of the rise in rates of detention can be grouped under four main themes:
1. Changes in mental health service provision and bed management: This can include there being fewer alternatives to inpatient care in some parts of the country (such as support in the community). It might also be due to the high demand for hospital beds preventing admission on an informal (voluntary) basis, early in the course of a person becoming unwell, or leading to premature discharges, which can then lead to re-admissions.
2. Demographic and social change: This includes general population growth, as well as growth in sections of the population that are more likely to be detained, such as older people with dementia, people who are homeless and people whose health is affected as a consequence of alcohol and substance misuse.
3. Legal and policy developments: The broadened definition of a mental disorder in the revised Mental Health Act in 2007 is already understood to have led to increased applications for detention. As well as that, there is greater awareness, for example among the police, of mental disorder and among clinicians who wish to ensure there are legal safeguards in place when caring for people who lack mental capacity.
4. Data reporting and data quality: This includes better reporting of detentions, as well as the potential for double-counting, such as when a detained patient moves between wards or from one hospital to another.
In terms of further trends to explain the ongoing rise in detentions, CQC found no evidence that professionals had been misusing the Mental Health Act in any way; for example, patients who did not meet the criteria being detained so that they could be guaranteed an over-night bed in hospital.
Dr Paul Lelliott, deputy chief inspector of hospitals (lead for mental health) at the Care Quality Commission, said: "There is no single reason to explain why detentions continue to rise every year. Population growth, societal changes, better national reporting, duplicate reporting, increased awareness of mental disorder and expanded criteria for detention are all contributing to more and more instances of people being sectioned under the Mental Health Act.
'Mental Health Act detentions have been rising for years, which is deeply concerning'
"Some of the factors at play in the rising rates of detention, both nationally and locally, are also signs of a healthcare system under considerable strain. Detentions under the Act can be influenced by gaps in support and provision in the system. This includes limited hospital bed availability, which means that people cannot easily be admitted as voluntary patients early in the course of their illness. This is a particular problem if it is coupled with limited support for people in the community, which can prevent a person’s mental disorder from deteriorating to a point that detention under the Act is necessary.
"It will take more than changes to primary legislation to tackle this fully and to ensure that people with serious mental health problems always get the safe, high-quality and compassionate care they deserve, when, where and how they need it. Changes to the law must happen alongside action to address the wider problems."
Vicki Nash, head of policy and campaigns at Mind, said, “Being detained under the Mental Health Act is the most serious thing that can happen in terms of your mental health. Detentions have been rising for years, which is deeply concerning. There is a review of the Act underway, which presents an opportunity to look at what is wrong with legislation, the guidance that underpins it and the way it’s used in practice, and this report will be useful in informing that review.
“Ultimately this report confirms what we hear, every day, about the state of NHS mental health services. Many people are not getting the right care when they ask for help and, as a result, are more likely to become more unwell, reach crisis point and need to be detained under the Act. The steady rise in detentions points to failings across the system, from having to wait for therapy to pressure on beds. This is why the NHS’s Five Year Forward for Mental Health plan is so important. We’re at the beginning of a long road to improving mental health services, and making sure the Government and the NHS deliver on their promises over the next few years is crucial.”
CQC representatives said they had shared the briefing with the Government, to aid its independent review of the Mental Health Act, and also with providers and commissioners to help them plan and review their services.