Mental health staff caring for people detained under the Mental Health Act are putting them at risk because they lack training in restraint methods, according to an inspectorate report.
The Care Quality Commission raised concerns over “worrying and poorly documented” use of restraint on patients and said the sector had failed to learn from previous tragedies.
It cited three inquests into the deaths of patients who were being treated under the Mental Health Act in 2008. Substandard staff training and knowledge were partly blamed for the deaths.
The CQC’s first biennial report into the care of people detained under the Mental Health Act, covering the two years to 1 April 2009, called for an accredited training programme on restraint. This was first recommended after the death of mental health patient Rocky Bennett, who died after being restrained face-down in 1998.
Suicide and self-harm
Staff also needed further training in observing patients at risk of suicide and self-harm, the commission found. The report cited statistics showing that nearly 40% of self-inflicted deaths on wards had occurred while the patients were under continuous or frequent observation between 2001 and 2008.
The commission also confirmed that NHS trusts were still placing under-16s on adult wards, despite the government’s pledge to end the practice by November 2008 and for any 16- or 17-year-old by April next year.
It found that 80 under-18s were admitted to adult mental health units between October 2008 and February this year, four of whom were under 15.
Community treatment orders
The commission also said that community treatment orders had been putting a “strain” on the service since they were implemented in November 2008. People from ethnic minorities were among those likely to be over-represented among those subjected to the orders.
CQC chair Barbara Young said she was concerned about the safety and quality of care provided to some people who were detained and called for swift change.
“These are some of the most vulnerable people for which the NHS is responsible,” she said. “We have to ensure that services meet their needs more effectively.”