AMHPs ‘unnecessarily’ detaining people under Mental Health Act due to bed shortage

People are being “unnecessarily” detained under the Mental Health Act as professionals struggle to find alternative ways of securing increasingly scarce psychiatric bed places for patients in need of hospital care, MPs have warned.

Patients are “being sectioned unnecessarily” by AMHPs and clinicians as a means of securing treatment as a shortage of bed places means psychiatric units are increasingly refusing to accept patients under voluntary admission, the all-party Commons health committee found. In some areas “being detained is the ticket to getting a bed”, the committee heard.

Health committee chair Stephen Dorrell called on ministers to urgently investigate the scale of the issue, which he said represented a “serious violation” of patient rights. Professionals have a duty to report such breaches, he added.

“It is never acceptable for patients to be subjected to compulsory detention unless it is clinically necessary,” said Dorrell.

“A clinician who is complicit in this approach has compromised their professional obligations; both the professional regulators and the Government should urgently investigate the prevalence of this practice within the mental health system,” he added.

The committee also raised concerns over ‘de facto’ detentions – situations where people have been told by ward staff, “If you try to leave, we will put you under section.” This issue was being “picked up repeatedly” by Care Quality Commission inspectors, the report found. 

An absence of resources

Ruth Allen, chair of The College of Social Work’s (TCSW) mental health faculty, said frontline social workers have been warning for some time that the pressure on the mental health system “is compromising quality at a systemic level”.

TCSW research published in June found that the beds crisis was placing Approved Mental Health Professionals (AMHPs) in “intolerable situations” and leading to delays in hospital admissions.

“Social workers and AMHPs must be at the forefront of promoting people’s rights – this is their professional duty and it is what they are trained to do,” said Allen.

“But when individual practitioners are put in situations where there are no other resources available to prevent admission through effective and specialist crisis support in the community, they will be forced to make more decisions to admit, and often under detention,” she added.

Faye Wilson, chair of the British Association of Social Workers’ mental health forum said she was “surprised” the committee had not invited evidence from AMHPs to hear how bed pressures have impacted their role.

“We have serious concerns over the lack of inpatient beds and, in several areas, the threats of more bed cuts despite wards having occupancy levels over and above 95%,” said Wilson.

Social workers are concerned that the crisis is also seeing more patients sent out-of-area for beds, miles from their friends and family, said Wilson.

The issue was also piling pressure on ambulance services and heightening tensions between social workers and the police “even where relationships have been good”, with agencies being asked to support the admissions and transport of very ill patients across several local boundaries, she added.

Mental health system running ‘too hot’

Around 2,000 mental health beds were closed in 2011/12, a reduction of 12%, according to a ‘rough’ estimate included in the latest NHS figures released in February. In the same year, the number of Mental Health Act detentions hit its highest level.

The committee found that the Department of Health did not have a “clear picture” of what is driving the rising numbers of Mental Health Act detentions but officials admitted that the system was running “too hot”.

TCSW’s Allen said that cuts to AMHP numbers in many areas could be prompting ‘risk averse’ decision making, increasing decisions to detain people. A Community Care investigation published in March found that AMHP numbers fell at two-fifths of local authorities in the last year despite rising demand for their services.

“We need a whole system look at how to reverse this trend in detention. Pointing the finger at individual clinician practice, which this report does in some places, is not enough to resolve such a complex challenge in the health and care system that must keep thousands of people safe while helping them back to mental health, every year,” said Allen.

In a statement, the Department of Health said that the “local NHS must ensure acute beds and appropriate and appropriate services are there for patients who need them.”

“Vulnerable people deserve to be fully protected at all times, particularly when they need to be deprived of their liberty in their own best interests. However, there are still unacceptable variations across the country and we are working with the CQC, health services and local authorities to ensure that these protections are used whenever they are needed. We will take swift action where necessary to protect individual patients,” the statement added.

The wide-ranging report by the Health Committee recommended the Department of Health reviewed several other elements of mental health care. These included:

• An urgent review of the Deprivation of Liberty Safeguards (Dols), amid evidence showing that their implementation was “woefully inadequate”. The Dols are supposed to protect people who require care in hospital or a care home but lack the mental capacity to consent. The committee said substantial variations in applications for Dols by care homes and hospitals and authorisations by councils meant service users were not benefiting from the safeguards and were “widely exposed to abuse”
  
• A review of the number of children detained under section 136 of the Mental Health Act. The committee heard that at least 300 children were detained under this power last year. 
  
• A review of the current operation of Community Treatment Orders in light of evidence concluding that they fail to cut hospital admissions and the benefits “do not justify” curtailing a patient’s liberty.
  
• An independent assessment of how a Mental Health Act power for police to convey patients to hospitals is being used and its impact on patients.

The committee also heard “worrying” evidence of a reduction in community-based mental health services as commissioners find mental health care “easier” to cut compared to other areas of care. The government’s commitment to ensuring parity of esteem between mental health and physical health was not a reality on the ground, the report found.

More on the mental health beds crisis:

*Emergency mental health admissions delayed up to 3 weeks due to bed crisis, social workers warn
*Number of mental health patients placed in private hospitals rises by a third amid bed cuts
*AMHPs ‘pressured to delay detentions’ as thousands of mental health beds lost
*‘Severe pressure on AMHPs amid job cuts, rising workloads and bed shortages
*‘This crisis in mental health care is damaging patients and professionals’

Andy McNicoll is Community Care’s community editor