The Care Quality Commission (CQC) is highlighting the ongoing impact of the pandemic on mental health services, their staff and the people using them.
In its Monitoring Mental Health Act (MHA) report 2020/21, published today (21 February), the CQC highlights concerns that reduced access to community mental health services during the pandemic may in part have contributed to an increase in the number of people being detained under the MHA. In 2020/21 there was an estimated 4.5% increase in use of the MHA to detain people with mental health problems in hospital for assessment and treatment as compared with the previous year.
CQC has previously reported on the impact of COVID-19 on children and young people’s mental health and services’ ability to meet this increased demand. This report raises concerns about children and young people being placed in unsuitable environments while they wait for an inpatient child and adolescent mental health (CAMHS) bed.
Longstanding inequalities persist, with Black or Black British people over four times more likely than White people to be detained, have more repeated admissions and be more likely to be subject to police holding powers under the MHA. Rates of detention in economically deprived areas are worryingly high too, being more than three and a half times higher than in the least deprived areas.
This year’s report includes findings from Independent Care (Education) and Treatment Reviews for people with a learning disability and/or autistic people which reveal the impact of a lack of community alternatives and poor commissioning decisions which led to people being admitted to hospitals that were a long way from home for prolonged periods of time. Over a third of the IC(E)TR patients reviewed had been in hospital for between 10 and 30 years.
Jemima Burnage, CQC’s Deputy Chief Inspector and lead for mental health said:
“The pandemic has placed unprecedented pressure on all health and social care services, the people using them and staff working in them. Despite strains on services, we have seen many examples of good practice and the dedication of staff. However, the workforce is exhausted with high levels of vacancies potentially risking the delivery of safe, high-quality care that respects human rights.
“Community services are vital to prevent hospital detentions and without access to the right care at the right time, people’s symptoms may worsen contributing to them needing inpatient care. During the pandemic this has been a particular concern for children and young people, with some admitted to inappropriate settings due to a lack of suitable beds. Some community mental health services are rebuilding after the pandemic, but others are not yet in a recovery stage, in part because of staff shortages and staff burnout.
“Longstanding inequalities when accessing mental health care also remain a serious concern, with Black or Black British people, and people in deprived communities being far more likely to be detained under the MHA. Action is needed to address this, and we welcome the patient and carers race equalities framework which will support mental health trusts’ work with Black and minority ethnic communities. Reliable local and national data is also key to closing these gaps and to achieve much needed change.
“We welcome Government’s acknowledgement of the need for improvement in mental health services. We also welcome its proposal to strengthen CQC’s monitoring role to those who commission services under the MHA, this will improve our system wide view of how the MHA is being used across services.”
CQC has a statutory duty to monitor and report on how services apply the MHA to detain and treat people who have a mental illness and need protection for their own health or safety, or the safety of other people. In 2020/21 CQC carried out 682 MHA monitoring remote reviews of wards, and interviews with 1,895 patients and 1,111 carers and handled 2,280 complaints and contacts from patients and others raising issues concerning the MHA.
The Second Opinion Appointed Doctor (SOAD) service, which CQC administrates, reviewed the treatment plans of 14,146 patients, resulting in changes to 30% of 1,030 treatment plans for medication of detained patients who were refusing consent.