Compulsory Mental Health Act treatment ‘hinders’ recovery, service users warn

Many people with severe mental health needs feel that being subjected to compulsory treatment under the Mental Health Act has “hindered” their recovery, research has found.

A study of over 80 service users’ experiences of the Care Programme Approach (CPA) – a Department of Health policy designed to boost coordinated care for people with complex mental health needs – revealed that most participants with experience of forced care felt it had damaged their recovery.

The use of compulsory treatment under the Mental Health Act continues to grow. Last month the Care Quality Commission revealed that 17,503 patients were detained under the Mental Health Act in England in 2011/12, a rise of 5% from the previous year. Some 4,220 people were subject to community treatment orders (CTOs), up 10% from 2010/11.

Some participants in the user-led study, which was conducted by the National Survivor User Network and the Mental Health Foundation, told researchers that compulsory treatment was “discriminatory, punitive” and a breach of human rights. 

A minority of participants reported positive experiences of compulsory care, often because they felt “sectioning had kept them safe” or helped them regain control, the report found.

While 59% of respondents felt that prescribed medication was supporting their recovery “a lot”, almost one in five (18%) participants with experience of compulsory treatment said that drugs, when prescribed, “never” aided their recovery. 

One participant, who was on a community treatment order, said he felt “coerced and threatened” into taking medication that adversely affected him.

Researchers at the National Survivor User Network said they had found some evidence of “good practice” in the implementation of the CPA. But they warned that feedback from service users had exposed a number of perceived shortfalls in care, including reports that:

• A “disproportionate” focus on risk management by professionals had harmed many people’s recovery.
  
• Professionals’ over-reliance on psychiatric diagnoses alone had often undermined service users’ hopes for a “whole person” approach to care. Over a fifth of participants (23%) felt that professionals “never” acknowledged alternative ways of explaining mental health issues than psychiatric diagnoses.
  
• Professionals had threatened service users, with some voluntary patients told that “they would be sectioned if they tried to leave” wards.
  
• A “sexist” approach to care was provided in some services. Specific concerns included a failure to address issues such as childbearing or physical changes in female patients, such as the menopause.
  
• “Racist treatment” in some services had damaged the recovery of people from African and African Caribbean communities.
  
• Budget cuts had already made it “difficult to obtain adequate support”, and the impact of potential further cuts to services could worsen the situation. 

Daisy Bogg, a social worker and co-chair of the social perspectives network, said clinical treatment “should not be applied at the exclusion” of social elements of mental health recovery. 

“While it is clear that compulsory treatment can be a traumatic experience, I believe that it is the culture of our mental health services and the dominance of medication and risk management above all else that needs to be urgently addressed if we are to see any real changes in the way services are delivered and ultimately received,” Bogg said.

“For recovery to be more than rhetoric a holistic approach, taking into account the person and their varying social and psychological needs, needs to be available. Yet this is increasingly being shown to be far from the reality in our services.”

Eva Cyhlarova, head of research at the Mental Health Foundation, said the report highlighted the failure of services to “adequately reflect service users’ concept of recovery”.

“Until service users’ views are fully taken into account and a holistic approach becomes the norm, it will continue to be difficult for people to achieve recovery,” Cyhlarova said.

Dorothy Gould, who led the project, said the research raised questions over the efficacy of the Care Programme Approach.

“Good practice seems to be selective rather than the norm, still more so in the case of service users from marginalised communities,” Gould said.

“Whether the approach, in its current form, is capable of altering the situation might itself be debated. Unless and until there is significant change, however, mental health service users will continue not infrequently to feel let down by the services on offer to them.”

Andy McNicoll is Community Care’s community editor