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‘Deficits in mental health practice may not be picked up and dealt with speedily’

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The proposed Care Quality Commission may have sharper teeth than the existing watchdog but will it improve care for mental health patients, asks Andy Young

Each year around 15,000 people are detained in locked units under the Mental Health Act 1983. Since the early 1980s visits by the Mental Health Act Commission (MHAC) have provided direct evidence of the patient’s experience. Their monitoring visits have involved listening to service users, looking round mental health units, observing the quality of interaction between staff and patients, and deciding whether a ward area is satisfactory or not.

However, the powers of the Mental Health Act Commission are limited and, invariably, mental health commissioners try to resolve problems informally by talking to managers and nurses. That said, as a last resort they can send a report to a trust and the trust has a statutory duty to respond.

Currently there are fears surrounding a new bill – the Health and Social Care Bill – that seeks to abolish the Mental Health Act Commission and replace it with a new body: the Care Quality Commission. If the new law is passed by parliament, standards in psychiatric hospitals will become its responsibility.

Some users, practitioners and commissioners have expressed concern that these radical changes may mean issues and deficits in mental health practice will not be picked up and dealt with speedily.

The Mental Health Act Commission visits all psychiatric hospitals once a year and mental health ward areas every 18 months. It is questioned whether such regular and frequent visits would continue under a new regime if the new Care Quality Commission is not given adequate resources.

Significantly, the proposed remit of the new commission is much broader than that of the existing Mental Health Act Commission. The Care Quality Commission will have a large number of responsibilities and there may be less money to target mental health monitoring. Fears expressed by organisations such as Mind relate to ringfenced funding and concern that mental health patients may not be viewed as a priority.

Government ministers envisage that the new commission will ‘continue a visiting programme’ and provide ‘sufficient visits’ but it is not clear how these words will translate into valuable face-to-face contact with practitioners and service users.

The Department of Health has tried to assure us that the existing approach of the Mental Health Act Commission is
set to continue but critics say there are no guarantees.

The Mental Health Act Commission uncovers bad practice – abuses of patient rights, incorrect detention under the law, inappropriate use of restraint and seclusion, and instances of alleged physical or sexual abuse. In one hospital visited by mental health commissioners a patient was detained on the wrong section 11 times. Such cases may be the tip of the iceberg.

The latest biennial MHAC report, published in 2008, entitled In Place of Fear? shows that quality mental health services can deteriorate very quickly and highlights the importance of proactive nurse managers who can work responsively and collaboratively with detained patients. Even high standards can drop away quickly with a poor manager, and there is a continuing need to be meticulous to ensure proper care and best practice in mental health services.

In some respects the Mental Health Act Commission is a toothless watchdog that can bark but has no real bite. Advocates of the change say that the new regulator will streamline inspection and reduce bureaucracy. Also, it will have wider powers and be able to shut down sub-standard providers. However, these increased powers will only be useful if mental health patients are visited regularly and interviewed.

The new commission will be headed by Baroness Young who, hopefully, will insist upon qualified people visiting detained patients on a regular basis, and secure a ringfenced budget to support a meaningful and robust visiting programme capable of ensuring the civil, legal and human rights of detained mental health patients.

Andy Young is senior lecturer in mental health nursing, Sheffield Hallam University

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