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MPs call for investigation into how psychiatric patients are being detained

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5135 (Published 15 August 2013) Cite this as: BMJ 2013;347:f5135
  1. Mark Gould
  1. 1London

Psychiatrists facing a desperate shortage of beds are sectioning patients so that they can get hospital care, say MPs who are calling for urgent government reviews of mental health services.

In its report on the effects of the 2007 Mental Health Act, the House of Commons Health Committee heard evidence that many psychiatric wards are still desperately short of beds, with some 15% operating at over 100% occupancy.

The committee concluded, “It is now acknowledged that there appears to be an inverse relationship between the number of available beds and rates of detention.”

Stephen Dorrell, the committee’s chairman, and a former health secretary, said that patients’ basic rights were being “violated.” He called for a government investigation into whether voluntary patients were being sectioned to get a bed, adding, “It is never acceptable for patients to be subjected to compulsory detention unless it is clinically necessary. A clinician who is complicit in this approach has compromised their professional obligations.”

The committee was concerned that the Department of Health did not know what was driving increased rates of detention. It said that a lack of data on readmissions meant that there was no information to illustrate whether pressure on beds was detrimentally affecting the treatment of those patients eventually detained under section.

MPs fear bed pressures might be driving the use of supervised community treatment orders (CTOs), which allow patients to be discharged under threat of readmission should they breach the terms of the order. In the absence of clear guidelines, the report called on the Royal College of Psychiatrists to develop a “consistent approach to CTOs.”

Dorrell said that the committee was calling for a ministerial review of community treatment orders in the light of a “convincing body of evidence” that they have not prevented readmission to hospital or reduced the number of people detained in hospital. The report also raised concerns over a wide variation in use of CTOs across the country and their disproportionate use among black and minority ethnic patients.

Dorrell added that Deprivation of Liberty Safeguards (DOLS), designed to protect vulnerable patients with dementia or severe learning difficulties, were being ignored “leaving many people at heightened risk of abuse.” The safeguards provide the person with an independent representative, allow a right of legal challenge against the unlawful deprivation of liberty, and provide a right for deprivation of liberty to be reviewed and monitored regularly.

Dorrell said, “DOLS are seen as complicated and difficult to implement, but this is no excuse for the extreme variation in their application across the country. The current approach to these vital safeguards is profoundly depressing and complacent and the government must immediately instigate a review which details an action plan for improvement.”

The report highlighted promises about a “parity of esteem” between mental and physical health services, but found a lack of parity in the face of evidence of community mental health cuts and restricted access to independent mental health advocates.

The Mental Health Alliance, an umbrella body representing clinicians, patients, and campaigners, backed calls for an investigation into community treatment orders and improvements to deprivation of liberty safeguards and in mental health advocacy.

Simon Lawton-Smith, head of policy at the Mental Health Foundation, who gave evidence to the committee, said that the report indicated that the whole rationale of community treatment orders, whose stated aim is to reduce admissions and save money, had been undermined. He added, “Perhaps it’s time for the legislation to be repealed?”

Julie Chalmers, the Royal College of Psychiatrists’ lead for mental health law, said that the college would be happy to contribute to any investigation into CTOs. She added that the issue of severe pressure on beds must be urgently addressed as the college was “very worried” by the suggestion that mental health professionals were sectioning patients in order to access in-patient treatment, and believed this required further investigation.

“Whilst admission under the Mental Health Act may be necessary on some occasions, the principle of using the least restrictive option must always be followed,” she said.

Notes

Cite this as: BMJ 2013;347:f5135

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