Mental Health Alliance warns councils over new responsibilities

June 18, 2012

Councils and clinical commissioning groups must ensure that they uphold the rights of people detained under the Mental Health Act as they take up new responsibilities under the Health and Social Care Act, the Mental Health Alliance has warned.

In a report, The Mental Health Act 2007: a review of its implementation, the alliance found that the Deprivation of Liberty Safeguards scheme worked “well in some areas but its implementation has been extremely uneven, can be highly bureaucratic and leaves some people without the protection they need”.

In relation to the 2007 it also concluded that:

While there have been some improvements in the treatment of people detained under the 2007 Act “there remain major concerns about the use of compulsory powers and the availability of advocacy and support for the most vulnerable people”
The provision of independent mental health advocacy and new laws protecting children from being placed in adult inpatient wards had been significant changes for the better
The high use of community treatment orders (CTOs) and a rise in the numbers of detained patients were increasing the overall use of compulsion
Black and minority ethnic communities were disproportionately placed in both “with scant provision of specialist advocacy services to reflect their needs”.

The Mental Health Alliance, a coalition of 75 different organisations, urged health and local government commissioners to ensure that they provided adequate mental health advocacy services for their whole communities.

The report also called for action to address the high use of community treatment orders and a government review of the Deprivation of Liberty Safeguards scheme.

Mental Health Alliance chair Alison Cobb said: “The 2007 Mental Health Act made some far-reaching changes to the laws governing the treatment of people with mental health conditions in England and Wales. While some of these have brought about improvements in the way people are treated we have seen a worrying rise in the use of compulsion over the last five years and a lack of adequate safeguards for people’s rights in some places.

“The Health and Social Care Act creates new structures that will take responsibility for the operation of the Mental Health Act. It is vital that they give these a high priority to ensure that the need to use compulsory powers is reduced and that no one's rights are overlooked.”

A copy of the alliance’s report can be viewed here.

The Mental Health Alliance’s recommendations

Community treatment orders (CTOs)

Research should be conducted into the reasons for disproportionate use of CTOs among black mental health patients, which brings a new dimension to existing disproportionality
The Government should amend the Mental Health Act 1983 to ensure that CTOs are only used for patients with impaired decision-making capacity
Data on how long people are kept on a CTO and the reason for discharge should be collected and published nationally in both England and Wales by the NHS Information Centre and the Welsh Government
Hospital staff should ensure that both patients and relevant community mental health staff and services are fully involved in drawing the patients’ care plans prior to discharge under a CTO and that patients are informed about their rights
Provider organisations should ensure that relevant staff understand the legal powers entailed in CTOs and their limits
Research should be conducted into the impact of the conditions set out in CTO patients’ care plans on their quality of life and their human rights

Deprivation of Liberty Safeguards (DoLS)

The Government should conduct a review of the DoLS scheme with the aim of preserving the essential purpose of DoLS but making its operation such that it:

is much simpler and more straightforward
is applied flexibly across the whole range of care provision
is fully compatible with the Mental Health Act and the rest of the Mental Capacity Act at the points where they interact
avoids conflicts of interest
incorporates effective review processes
does not rely on the Court of Protection as the first stage of appeal.

Independent Mental Health Advocacy (IMHA)

Local authorities should receive sufficient funding to fulfil their duties to commission IMHA services when they take over this responsibility from primary care trusts
Commissioners of IMHA services should be held to account on the level of provision in their area and its availability to people in independent as well as NHS settings, and Health and Wellbeing Boards should monitor this
Commissioners of IMHA services should make it a contractual requirement that these services are explicitly tailored to the needs of the local BME population, and monitor this
Hospital staff should proactively inform patients about their right to access an IMHA service, including if they leave hospital under a CTO

Children and young people

Government should continue to closely monitor the numbers of young people aged under 18 admitted to adult psychiatric wards, and this data should be available for public scrutiny
Commissioners should assess local needs to ensure there are enough beds in CAMHS units to accommodate those previously admitted to adult wards
Commissioners and providers need to ensure that home treatment and intensive community-based interventions are available for young people to reduce the need for inpatient admissions – and the effectiveness and acceptability of these services to young people should be evaluated
Commissioners and providers should monitor the numbers of young people making the transition from CAMHS to AMHS, and ensure that there is continuity of care and that age-appropriate services and education continues to be provided

Race equality

Commissioners should expand and develop community-based services’ focus on responding to the needs of BME communities, particularly those who experience disproprortionate use of the Mental Health Act. This should include advocacy and befriending services that support people’s pathways out of secure mental health settings, move people from CTO to discharge, and enable them to manage productively in society
The Government should commission a review of the experiences of pathways into and through care which looks for differences in experience of Mental Health Act processes between different ethnic groups. It should consider decision-making by psychiatric professionals, with the aim of understanding differences in presentation across the client groups
Research should be conducted into the reasons for disproportionate use of CTOs among black mental health patients which brings a new dimension to existing disproportionality

Section 136 places of safety

Commissioners should ensure that their areas include a range of appropriate places of safety
Data on the number of uses of police cells as places of safety should be collected as part of local monitoring, incorporated into the NHS Information Centre’s data and monitored by the CQC
Provider organisations should review their policy and practice in the use of section 136 to ensure they are not turning people away inappropriately

Regulation (Care Quality Commission)

The CQC should be resourced sufficiently to carry out its statutory functions under the Mental Health Act and related regulatory activity
The CQC should continue to carry out community and inpatient mental health surveys and ensure they can be analysed by ethnic group
The data collected by the CQC and the NHS Information Centre should be published so as to show trends relating to ethnic differences in processes and outcomes, and maintain the focus that the Count Me In census provided
The CQC should maintain a programme of special reports on areas of concern, for example treatment of BME people under the Act, patient involvement in care and quality of life under a CTO

Mental Health Measure (Wales)

Quality standards for implementation of the new Measure should require Care Coordinators to make full use of the holistic format for Care and Treatment Plans prescribed by the Regulations, routinely addressing all the domains, specifically: