Last week the Care Quality Commission released the 2011/12 edition of its annual review of use of the Mental Health Act (MHA) in England and Wales. It is a readable and engaging piece of work, and the CQC deserves credit for using an advisory group, including service users as well as a variety of professionals, to work on the major themes throughout the year in preparing the report.
What does the CQC report mean for mental health social workers? Writing from the particular point of view of an Approved Mental Health Professional (AMHP) my interest is inevitably drawn towards those activities where people are detained in hospital or made subject to Community Treatment Orders (CTO).
These are of course the areas where my work and the work of my colleagues is most immediately focused.
The CQC found that the number of people subject to MHA detentions continued to rise – MHA detentions were up 5% from the previous years and use of CTOs increased by 10%. This chimes closely with anecdotal information shared between AMHP leads across the country, where there is widespread identification of increasing MHA activity.
Worryingly, this increase in activity is often taking place against a backdrop of falling numbers of AMHPs and reducing bed availability. Concerns over bed shortages have been raised in numerous previous reports but the CQC’s findings suggest little progress has been made on addressing the issue.
The Royal College of Psychiatrists has recommended an optimal occupancy level of 85% to maintain quality of care. Yet one in ten wards visited by the CQC’s commissioners had occupancy rates of 100%. More alarmingly, in a further 6% of visits, occupancy was over 100%. In some areas AMHPs felt the only way to access a bed was to detain someone under the Act.
These problems are often impacting acutely mentally unwell patients in need of urgent hospital care. They can’t be ignored if AMHPs are to continue to practise safely and services are to be able to provide quality care.
It is positive that the CQC report recognises the growing pressures on AMHPs to juggle their statutory mental health duties alongside their regular caseloads. But the report offers plenty of cause to reflect on how AMHPs go about our jobs too, particularly concerning our role in CTOs.
CQC have been concerned that they have often found a lack of reasoning for the AMHP decisions on CTOs. For Mental Health Act detentions there is a statutory duty on AMHPs to complete a social report, with full reasons for the decisions made. But there are far less statutory requirements for AMHPs to record reasons for CTOs.
This is just a snapshot of some of the report findings. The comprehensive CQC report covers a number of other vital issues for professionals and service users: the continued over-representation of certain ethnic groups among people subject to the Act; care planning shortfalls; dignity – particularly important for detained patients who have had a fundamental right removed – that of their freedom; consent to treatment and identification of capacity of patients.
This last point has generated some controversy, as the report’s view that any detained patient must have their capacity tested and recorded sits uneasily with the Mental Capacity Act’s first principle of the assumption of capacity.
Of course, different sections of the CQC report will interest different professionals. I recommend you to have a look, irrespective of your particular role in the system.
Steve Chamberlain is an AMHP in west London and chair of The College of Social Work’s AMHP Community of Interest