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Staff 'lack understanding' of statutory mental health guidance

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Statutory guidance issued to help healthcare professionals properly apply key mental health legislation is not being used as intended, inspectors have warned. 

They found that mental health staff and healthcare providers “lack awareness and understanding” of the government’s Mental Health Act Code of Practice.

“We found that many providers lack understanding about how to apply the code’s guiding principles”

Dr Paul Lelliott

As a result, the inspectors from the Care Quality Commission called for more training on the code to be made available to ensure it was being utilised by those involved in mental health services. 

The call comes after the CQC was asked by the Department of Health and Social Care to carry out a review of how well the guidance has been implemented since it was last updated in 2015.

In a report of its findings published this week, the CQC said there was variation in providers’ understanding of the code and how it should be applied.

According to the CQC, the code should help healthcare professionals to interpret and apply legislation in decision making in mental health services and to provide safeguards for protecting people in those services.

Specifically, the code has guiding principles that staff should always consider when decisions are being made about care, support or treatment in services that detain patients under the Mental Health Act.

However, according to the CQC’s review, providers “lack understanding about how to promote, apply and report on the guiding principles” set out in the code.

In addition, inspectors found that providers did not support staff well enough to enable them to have “meaningful and productive conversations with patients”.

Feedback from stakeholders and experts throughout the CQC’s review identified that the current format of the code “is not easy for staff and professionals to use”.

“While we saw some examples of good practice, the size and breadth of the code was a challenge”

CQC report

It was also flagged that the “quality, content and focus” of training for staff on the code was varied.

The report stated: “While we saw some examples of good practice, the size and breadth of the code was a challenge, with some providers still not having updated their training to reflect the 2015 code.”

The review noted that over the years the code had grown from 135 pages to over 450 pages.

Based on the findings, the CQC recommended that the DHSC take the lead in developing standardised resources, support and training for staff.

The health watchdog said it also wanted to see the DHSC promote the use of guiding principles to improve practice and enable meaningful engagement with families and carers.

It said the principles needed to be “recognised as a support tool for human-rights based approaches” by both staff and services.

In addition, the inspectors advised that the DHSC worked on improving the usability of and access to the code. As part of this, the CQC noted that making the code digitally accessible to clinicians, patients and carers should also be considered.

The CQC also recommended that the DHSC should work to ensure that the code gave “clear and consistent” guidance on providers’ governance arrangements.

Care Quality Commission

Dr Paul Lelliott

Paul Lelliott

Deputy chief inspector of hospitals and lead for mental health at the CQC, Dr Paul Lelliott, said: “Use of the MHA to detain people in mental health services is more common than when the Code of Practice was first created 26 years ago.

“That makes it even more important that the code is clear, accessible and supports the legal safeguards that protect people’s human rights and autonomy,” he said.

“From our review of how well the code is being used in practice, we found that many providers lack understanding about how to promote, apply and report on the code’s guiding principles,” he added.

“As a result, they were not always being used by services to empower and involve people in decisions being made about their care,” said Dr Lelliott.

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