Pressure on psychiatric wards has become so great that doctors are sectioning mentally ill patients unnecessarily, because it is often seen as the only way to gain access to a bed, MPs have found.
The House of Commons Health Select Committee said it was shocked by “disturbing” evidence that it was becoming increasingly difficult for mental health patients to gain access to hospital on a voluntary basis, resulting cases of doctors declaring patients a risk to themselves and others in order to speed admittance to a ward.
Patients who are detained under the Mental Health Act can be held in hospital against their will for up to 28 days before further assessments that can extend their detention indefinitely.
The decision to section someone activates a legal obligation for the patient to be granted immediate access to an appropriate health facility.
The Health Select Committee’s report of its scrutiny of the outcomes Mental Health Act 2007 is published today. Giving evidence to MPs, the consultant psychiatrist Dr Julie Chalmers said that, in some areas, “being detained is the ticket to getting a bed”.
Another witness, Simon Lawton-Smith, head of policy at the Mental Health Foundation, accepted that is was possible a clinician might section a patient who in the past would not have been sectioned in order to access a psychiatric unit, MPs said.
Stephen Dorrell MP, chair of the Health Select Committee, said that the claims amounted to “more than anecdotal evidence” and should be urgently investigated by the Department of Health.
“This represents a serious violation of patients’ basic right and it is never acceptable for patients to be subjected to compulsory detention unless it is clinically necessary,” he said.
The number of detentions under the Mental Health Act is increasing. The Care Quality Commission has found that detentions were up 5 per cent in 2011-12, with 48,631 detentions in hospital.
Mr Dorrell told The Independent that mental health services were also under disproportionate pressure from local healthcare cuts because commissioners found them easier to cut than “more politically sensitive acute services”.
According to the CQC, 50 per cent of psychiatric wards are at 90 per cent occupancy, and 15 per cent of wards were operating above 100 per cent capacity.
The lack of hospital beds for psychiatric patients was also driving an increase in the number of Community Treatment Orders (CTOs) issued, MPs said. Originally planned to reduce hospital admissions by treating more psychiatric patients in the community, CTOs had done nothing to ease pressure on hospitals, MPs said. The mental health charity Mind called for CTOs to be repealed.
MPs also found evidence of patients being subject to de facto detention – whereby they are sectioned if they try to leave hospital having been admitted voluntarily, although they said the practice appeared to be rare.
Vicki Nash, head of policy and campaigns at Mind, said: “The committee’s report paints a picture that, sadly, will be all too familiar to many who have found themselves subject to the Mental Health Act. People with mental health problems ought to be able to feel confident that, should they be detained under section, powers to detain and treat them and make decisions on their behalf will be used with great care and for the right reasons. It is clear from the evidence presented to the committee that, too often, this is not the case.”
In further criticism, MPs said the Department of Health should urgently review the implementation of Deprivation of Liberty Safeguards (DOLS), which outline the rights of patients detained under the Mental Capacity Act, who are usually dementia patients in care homes.
“The evidence the Committee heard regarding the application of DOLS revealed a profoundly depressing and complacent approach to the matter,” the committee said in its report. “There is extreme variation in their use and we are concerned that some of the most vulnerable members of society may be exposed to abuse because the legislation has failed to implement controls to properly protect them.”
A Department of Health spokesperson said: “Vulnerable people deserve to be fully protected at all times, particularly when they need to be deprived of their liberty in their own best interests. However, there are still unacceptable variations across the country and we are working with the CQC, health services and local authorities to ensure that these protections are used whenever they are needed. We will take swift action where necessary to protect individual patients.”
“We remain committed to improving mental health services for everyone and will consider this report carefully.”
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