You may have noticed the Care Quality Commission published a report this week on the State of Mental Health Care. Â Or maybe you were getting on with your life or your job, but Iâ€™ve given it as much time as I have spare and was very interested in what I read. Â The CQC run an ongoing programme of inspections across the mental health trusts of England (there is a separate inspectorate for Wales) and they are also the statutory regulator for the use of the Mental Health Act 1983. This weekâ€™s report seems, to me at least, to be a overview of the individual reports they produced in their last inspection round, peppered with a sprinkling of MHA insights. I hope I understood it correctly.
As ever these days, with so many reports to read and keep an eye on, I tend to sometimes use my iPad just to search for terms within the report that will be relevant to my work. Â Things as obvious as â€˜policeâ€™ often through up little nuggets and so it proved with the CQC report.
Page 38, worth quoting a block of the text, if you have a spare moment! â€“
â€œThere is national concern about the difficulty of finding a bed when a young person requires inpatient care. When a bed is found, it is often a long way from the young personâ€™s home. We do not always detect this unmet need because our assessment focuses on the quality of the care provided to patients who are already on the ward, and not to those that require or are awaiting admission. However, we have received reports of the impact of the unavailability of inpatient care. This includes a letter from an assistant chief constable about a 17-year old who was kept in a police cell for 78 hours because no bed was available. The assistant chief constable commented that â€œthe majority of this time in police custody was unlawful and it amounts to a human rights violation, given that Article 5 of the European Convention on Human Rights prevents detention by the state except in accordance with processes outlined by domestic lawâ€.
Three things from me, on this â€“
Oh, no, four things â€“ at no place in the entire report about the state of mental health care does the report mention Approved Mental Health Professionals, the AMHPs. Simply staggering!
I would love to see this looked at. Everytime an AMHP fills in an application for a patientâ€™s admission under either s2, 3 or 4 of the Act, they fill in a statutory form â€“ they also complete an AMHP report. This means that somebody, somewhere is sitting on a goldmine of information because the two, taken together will outline when an AMHP was notified of the request for an assessment, when they secured the DR(s) to assist them in undertaking it and when the assessment took place. It will note the conclusion they reached, what the outcome needed to be and when a bed was notified to the AMHP after any assessment indicated admission. Itâ€™s all there to be reviewed â€“ and of course, the location of the MHA assessment is recorded, so we could even examine whether any difficulties vary across Emergency Departments, police stations or community based assessments, for example in patientâ€™s homes.
If we have Assistant Chief Constables writing to regulators with a 78hr example, does it occur to wonder how often such examples are occuring? I have recently done work on this which has formally been reported via Chief Constables to the Home Office and Department of Health. Â 78hrs, or just over three days detained, is just one of the lesser examples â€“ another was 97hrs, which is an interesting number because thatâ€™s 1hr longer than the police in England and Wales may detain a criminal without charging them with something and remanding them to appear at court. And some of the examples are measured in three figures, if weâ€™re still counting in hours, not days. If these situations do amount to an Article 5 violation â€“ detained by the state without an obvious authority in domestic law â€“ then how many of these situations do we have nationally in a given month or year?
Section 6(1) of the Human Rights Act 1998 prohibits public authorities including the mental health trust, the CCG, the local authority and the police from failing to ensure the Convention Rights of vulnerable people in these situations. Iâ€™ve said before and I will say again, there are two issues in domestic law that are conveniently forgotten in the creation of these situations. CCGs have a duty to ensure the health needs of their populations are met and section 140 MHA in particular imposes a clear duty to designate hospitals which can receive patients in circumstances of special urgency. How many CCGs comply with this in any meanginful way? My Freedom of Information requests suggest, most donâ€™t comply â€“ some donâ€™t even know what the question means. This, in turn, creates a situation where Approved Mental Health Professionals canâ€™t comply with their duties under s13 of the Act â€“ the duty to make applications where the grounds for doing so are met.
Weâ€™ve had police forces threatening and starting legal action against the NHS over this, weâ€™ve had Assistant Chief Constables tweeting publicly to pressurise managers to resolve ongoing situations, weâ€™ve now got them writing to regulators and escalating to senior officials in the Government. Iâ€™m merely suggesting itâ€™s way beyond time we dusted off those MHA applications and those AMHP reports and see what they reveal. Â
Winner of the Presidentâ€™s Medal from
the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award.