Mental health detention rise amid ‘pressure on hospital beds’

The number of people in Wales detained by social workers and other approved mental health professionals (AMHP) under the Mental Health Act rose by almost 20 per cent in twelve months, a health watchdog has found.

The annual review of use of the Mental Health Act by Health Inspectorate Wales revealed that 1,717 people were detained under the Act in 2010/11, up 18% from the 1,452 detentions in 2009/10.

Social workers told Community Care the rise came amid difficulties in obtaining hospital beds for mental health patients. One AMHP said a detention is “the only way to get a bed these days.”

Section 136 detentions rise for fifth year running

‘Place of safety’ detentions by police officers under sections 135 or 136 of the Mental Health Act rose for the fifth consecutive year. There were 697 place of safety detentions recorded in 2010/11, more than double the 281 used in 2005/06.

Data was only available where hospitals were the “place of safety” used. Patients who were taken to other places of safety and subsequently released were not recorded. 

Use of community treatment orders outstrips forecasts

The number of people discharged from hospital under community treatment (CTOs) orders fell by 10.7% from 261 in 2009/10 to 233 in 2010/11. But the use of CTOs continues to vastly outstrip the levels forecasted by officials ahead of their introduction in 2008.

CTOs place people on compulsory supervised community treatment with strict conditions. The Department of Health originally estimated a total of 259 patients would be discharged under CTOs in Wales between November 2008 and March 2013. The total number discharged on CTOs between November 2008 and March 2011 is already 659.

Martin Webber, a registered social worker and mental health social work academic, said a “risk averse culture” among staff and the “pressure to free up hospital beds” meant CTOs were frequently used.

“The enormous loss of beds in recent years must have had a huge impact on inpatient services and CTOs provide a convenient way to treat people at home. The rise of crisis resolution and home treatment teams makes this all possible, which it wouldn’t have been five to ten years ago,” he said.

Concerns over poor record keeping and communication

Reviewers found there were many “areas of good practice” in Wales. Detained patients were generally “cared for and treated by staff who have the necessary knowledge and skills”, they found.

But several concerns were identified including flaws in security and privacy for patients in some services and poor record keeping. Some patient files contained outdated consent to treatment certificates, leaving staff and employers at risk of legal challenges.

Communication issues between GPs and community mental health teams had also led to “fragmented care being provided” when people were discharged under CTOs, reviewers found.

Daisy Bogg, an AMHP, told Community Care:
 
“Detentions are likely to increase as it’s the only way to get a bed these days. When it comes to communication issues with GPs, I can’t remember the last time I actually managed to get a GP out to do anything. There are lots of letters and not a lot else.”

“With CTOs there’s an issue about our roles as AMHPs in using them – too often it’s a case of us being asked ‘just sign this off will you?’”