Monitoring the Mental Health Act in 2020/21

Jemima Burnage, Deputy Chief Inspector of Hospitals and Lead for Mental Health at CQC

This year’s Monitoring the Mental Health Act (MHA) report makes sobering reading and is another stark reminder of the unprecedented pressure that the pandemic has placed on all health and social care services, the staff working in them and the people who rely upon them. Despite these challenges, staff’s commitment to the people they serve has not wavered and we continue to see many examples of good person-centred care being delivered. We must not take their efforts for granted. The workforce is exhausted with high levels of vacancies, compounding the pandemic’s pressures, and risking the delivery of safe, high-quality care that respects human rights.

It is clear, from our work monitoring the use of the MHA, that the pandemic is creating significant strain on existing mental health services, impacting on access to care and deepening longstanding inequalities people experience. Access to high quality, local community services is key to preventing people with mental health problems from being admitted to hospital. These much-needed community structures and sources of support have been reduced during the pandemic, meaning some patients have struggled to receive the right care when they need it.

‘Staff’s commitment to the people they serve has not wavered and we continue to see many examples of good person-centred care being delivered’

Further work is needed to develop community models of care that bring together a focus on both people’s health and social care needs, offering the right support, at the right time. Another consequence of this is how children and young people have been affected, with some being admitted to inappropriate settings due to a lack of suitable beds when they are needed or the availability of community alternatives.

Sadly, these are not new trends, and we recently highlighted that people’s experiences of community mental health services had been the poorest in years in our Community Mental Health Survey. Over a quarter (26%) of 17,332 respondents said they did not know who to contact if they had a crisis, and almost a fifth of people (17%) said care and services were not available when needed.

‘People’s experiences of community mental health services had been the poorest in years in our Community Mental Health Survey’

It is really worrying that Black or Black British people, and people in deprived communities are increasingly more likely to be detained under the MHA. Urgent action is needed to address this. 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 we should look at the ways we can improve this so that systems have a better understanding of their local people, which in turn will help them achieve change.

Looking forward, we welcome the 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 for people subject to the MHA, this will improve our system wide view of how the MHA is being used across services and will also bring a renewed focus on the wider determinants of health and mental health.

Thank you for taking the time to read this important report. As the independent regulator of health and care In England we have been entrusted with the important role of monitoring the MHA. Through this we can share people’s stories, reflect on the data and our findings so that it can be used to give a voice to people, shine a light on good and poor practice and to ultimately help influence much needed change.

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