CQC: Mental health services risk breaching patient rights

Mental health services risk breaching patients' human rights by placing unnecessary restrictions on their care, the Care Quality Commission warned today. Chief executive Cynthia Bower said the regulator had found 'unacceptable practice'.

Mental health services risk breaching detained patients’ human rights by placing unnecessary restrictions on their care, the Care Quality Commission warned today in its first annual report on the use of the Mental Health Act.

The regulator found mental health hospitals were becoming more security-focused, with low-secure settings imposing blanket rules, such as mobile phone bans, that were difficult to justify for all patients and risked breaching human rights law.

It found cases where “the disregard for privacy and dignity in the name of patient security was verging on unsafe or potentially abusive practice”, including instances where patients had restricted access to toilet paper.

The report, based on visits to 1,700 wards and 5,000 patients in 2009-10, also found that patients had been certified as consenting to treatment when they either appeared to be refusing consent or were incapable of giving consent. CQC said the assessment and recording of patients’ consent was an area that required “significant improvement”, adding that many patients often showed limited understanding of their treatment.

Many services also needed to “substantially improve” the extent to which they involved patients in decisions about their care. The report raised concerns about patients being “intimidated or patronised by staff” during meetings about their care, or being presented with a completed care plan to sign rather than being involved in drawing it up.

The report also raised concerns about the potential over-use of community treatment orders, under which people discharged from hospital are required to comply with conditions on their treatment in the community. There have been ten times as many CTOs issued since their introduction in November 2008 as had been anticipated by the Department of Health.

Of a sample of 208 CTOs, the CQC found that 30% of patients had no reported history of refusing to comply with treatment, suggesting that CTOs were wrongly being issued as a preventive measure.

“We have found too much poor and unacceptable practice and this must be tackled,” said CQC chief executive Cynthia Bower. “Our top priority is to protect the interests of patients, and we will use our powers to ensure that care providers address these issues and make real improvements.”

Steve Shrubb, director of the Mental Health Network, which represents mental health trusts, said: “The rise in the use of compulsory treatment orders is a source of serious concern and we need to get to the bottom of what is happening. One factor could be demand for services is continuing to rise in the light of the recession. We need to find alternative ways to support people.

“Many services already provide excellent services and the challenge is to bring everyone up to the standard of the best.

Rethink chief executive Paul Jenkins described the findings as “worrying” and said they showed that some services were “causing distress and hampering recovery”.  He called on the CQC to use its powers to ensure the Mental Health Act powers was only used to aid recovery, not impose undue restrictions on patients.

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