The Care Quality Commission’s 2011/12 ‘Monitoring the Mental Health Act’ report raises several issues for mental health patients and professionals.
Many will be all too familiar to social workers – bed pressures, rising demand and falling AMHP numbers, and a chronic shortage of alternatives to hospital detentions in many areas, to name a few (read a more detailed look at the findings here).
So how has the sector reacted to the findings?
Martin Webber, social work reader at York University and a registered social worker
The CQC report reflects the findings of the 2012 national AMHP survey. High caseloads of AMHPs, increasing pressure on a smaller number of beds – which increase the likelihood of detentions – and concerns about the lack of effective crisis services, are just a few of the findings in both reports.
Perhaps of most significant concern are the continually rising numbers of detentions and the falling numbers of AMHPs. The widening of the role to other mental health professionals in 2007 was meant to address this concern, but it clearly hasn’t.
Both the CQC report and the 2012 national AMHP survey illustrate the increasing pressures faced by AMHPs. This has been apparent for at least the last 10 years (including their approved social worker predecessors), with little evidence of significant action being taken to address the problem.
Talking to local and national AMHP forums over the past few months it is apparent that the increasing workload of AMHPs is having a detrimental effect on their ability to undertake all of their various statutory and non-statutory roles.
While they often prioritise their AMHP duties, other aspects of their ‘routine’ practice frequently suffer. It is disappointing that the CQC do not make any recommendations to address this problem.
It is clear from this report and the national AMHP survey that the Department of Health needs to tackle the bed over-occupancy problem and work proactively with local authorities to develop appropriate non-medical crisis care.
The social work role within mental health services needs to be fully understood and respected. It is not just a sectioning service, as some perceive it. The therapeutic potential of mental health social work needs to be realised.
Steve Chamberlain, chair of The College of Social Work’s AMHP leads network
We welcome CQC’s recognition that AMHP numbers are falling in some areas, while caseloads are not reducing, and the evidence from the report is that statutory work is increasing.
This chimes closely with the national AMHP survey last year in which stress was widely reported. It found that statutory work was becoming increasingly squeezed with little or no accommodation for the demands of care coordination.
Trusts and local authorities must address this issue if AMHPs are to continue to work effectively and safely.
Joe Godden, professional officer, the British Association of Social Workers (BASW)
The report highlights many familiar areas of concern: these include serious pressures due to bed shortages, poor alternatives to hospital services and the continued major over representation of black and ethnic minority patients among people detained under the Mental Health Act or subject to community treatment orders.
Poor care plans for far too many people is stressed yet again by the CQC, as is the continued unacceptable problems preventing AMHPs from undertaking their work properly.
Ministers, care trusts and social service departments need to take the report seriously. It is totally unacceptable that the same issues recur as in previous similar reports, with certain practices actually getting worse.
Patients in a number of units are benefiting from good care planning, but it is concerning that more than a third of care plans showed no evidence of discharge planning. This is at the heart of social work and social care.
The reasons for this are not fully explored in the report. Undoubtedly pressure on beds is a factor. BASW members report their frustration that referrals for discharge planning are not always made to social workers, or community mental health teams. We would like further exploration and analysis of this problem.
The CQC report stresses the importance of integrated working, yet in some areas integration with social services is decreasing.
Our social work reference group has also heard concerns from frontline staff about the toxicity of some mental health units generally, and specifically concerns about the continued overuse and inappropriate use of restraint.
Paul Farmer, chief executive of Mind, the mental health charity
Being involuntarily detained under the Mental Health Act is one of the most serious things that can happen to someone in terms of their mental health. For this reason it should only happen if it is absolutely necessary, with great care and in strict adherence with the procedures laid out in the Act.
Today’s report shows that, in many cases, people’s basic human rights are being infringed at a time when they are likely to be at their most vulnerable.
The overall rise in detentions and community treatment orders is very worrying and is symptomatic of problems elsewhere in mental health services.
Better access to talking therapies, for example, or well-resourced crisis care services that can respond to a person’s individual needs can help prevent a person’s situation escalating until compulsion appears to be the only option.
Yet we know from extensive research that mental health services are failing in all these areas. Detaining people because it’s the only way to ensure they have a bed is completely unacceptable.
The government says it is keen to do more to improve mental health services across the board. This report shows just how far there is to go in many areas and raises serious concerns about how realistic it is to expect improvements while services are so overstretched.
It is a wake-up call for the Department of Health and a clear signal to the NHS commissioning board and clinical commissioning groups that, as they begin to assume responsibility for health services, mental health must be a top priority.
Dr Andrew McCulloch, chief executive of the Mental Health Foundation
Andy McNicoll is Community Care’s community editor
The report raises some key issues many of which remain inadequately addressed after many years. We are very disappointed that some organisations still fail to involve patients in care planning. Plans must take account of individuals’ needs and aspirations in order to be effective.
It’s frustrating to see that the findings provided by the report remain pretty much the same year after year in showing large over-representation of certain black and minority ethnic groups.
A lot of work has been done to identify the specific problems that need to be addressed, but neither government, nor providers, seem willing to make the long term commitment to working with local communities that will be required to deliver change.