Voluntary patients are being kept on locked wards, says commission

BMJ 2010; 341 doi: (Published 28 October 2010) Cite this as: BMJ 2010;341:c6103
  1. Clare Dyer
  1. 1BMJ

Voluntary patients are being kept on locked psychiatric wards with restricted patients and are at risk of being unlawfully deprived of their liberty, the Care Quality Commission concludes in its first annual report on the use of the Mental Health Act.

The commission, the independent regulator for health and social care in England which took over responsibility for monitoring the use of the act in April 2009, said more people than ever were being detained under its provisions.

Figures from the NHS Information Centre show that the numbers of formal admissions to hospital were 7.3% higher in the year ended 31 March 2010 than in the previous year, and 10 times as many people were being subjected to community treatment orders than was envisaged when they were introduced in November 2008 (BMJ 2010; 341:doi:10.1136/bmj.c5596).

The commissioners, who aim to visit every psychiatric ward in England where patients are detained, “encountered a number of situations where the service’s disregard for privacy and dignity in the name of patient security was verging on unsafe or potentially abusive practice.” Examples included restricted access to toilet paper; keeping observation panels to bedrooms locked open on a unisex corridor; and assigning male nurses to night time observation of vulnerable women patients.

The report also raises concerns about whether services are properly fulfilling their duties to assess patients’ capacity to give consent to treatment. “A patient’s capacity and consent status should be under continuous review, especially when they have been certified as consenting to treatment by the clinician in charge of their treatment. Despite this, our visiting commissioners have met with many patients who were certified as consenting, although they appeared to be refusing to give consent or to lack the capacity to do so,” it says.

Community treatment orders were intended to cope with “revolving door” patients who fail to take their medication or engage with community services after they leave hospital. During 2009-10 some 4000 patients were given such orders.

But a sample of 200 cases found that 30% had no history of non-compliance or disengagement, posing questions about the criteria on which orders are being made.

Steve Shrubb, director of the NHS Confederation Mental Health Network, which represents the majority of NHS 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. We need to find alternative ways to support people.

“The key is to offer services based on listening to staff and service users that is tailored to meet individual needs. The current white paper reforms, which put commissioning power closer to patients, offer a real opportunity for early intervention, and improved mental wellbeing will be an important indicator of their success.”


Cite this as: BMJ 2010;341:c6103

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