Counsellor talking with young male about his mental health

Mental health services coped well, but still ‘significant unmet need’

The Care Quality Commission (CQC) has revealed where mental health services made the most significant gains during the Covid-19 pandemic, empowering patients and supporting staff to manage restrictions.

In the newly-published report – Monitoring the Mental Health Act in 2019/20 – the CQC found mental health services which focused on applying the principles of least restriction were most successful during the pandemic – both for the quality of care received by patients engaging with the services, and in managing the additional restrictions imposed on the staff delivering them.

Well-performing services also put emphasis on care planning to involve patients, as well as co-production with patients to improve ward environments.

However, for the positives identified in the report, fewer beds and limited community support being able to be delivered through remote contact, there was also understood to be significant unmet need during the first national lockdown.

This may increase the risk of people accessing services in a crisis through coercive pathways, including detention under the Mental Health Act.

For groups already disproportionately likely to enter mental health services through these routes, it has the potential to further exacerbate existing overrepresentation of some Black and minority ethnic (BAME) groups among admission statistics through these coercive pathways.

CQC has a statutory duty to monitor and report on how services apply the Mental Health Act 1983 (MHA) to detain and treat people who have a mental illness and need protection for their own health or safety, or for the safety of others.

The newly-released CQC report puts particular focus on the impact felt from the coronavirus pandemic on detained patients, and on the services that care for and treat them, setting out actions needed to support people subject to detention under the MHA.

It concluded:

  • It is vital that discharge planning is carried out in co-production with patients and their families/ support networks in order to ensure better outcomes.
  • Patients must be involved in decisions about their care, including infection control, and where this is done the negative impact of restrictions on detained patients during a pandemic can be limited.
  • Carrying out modernisation of the physical estate would help with infection control measures.
  • Services should recognise the significant impact restrictions of leave of absence and activity can have on detained patients and ensure these are lifted as quickly as safely possible to avoid very damaging ‘closed cultures’ from emerging.
  • The relaxation of rules around use of personal technology such as mobile phones should continue in future, and services should prioritise linked issues such as Wi-Fi connectivity in future estates development.
  • Advocacy should move to be offered on an opt-out basis in future.
  • Careful evaluation of use of remote technology for care, treatment and contact purposes needs to be undertaken should aspects of them continue after the pandemic.

Dr Kevin Cleary, CQC’s Deputy Chief Inspector of Hospitals and Lead for Mental Health, said: “The coronavirus pandemic has presented mental health inpatient services with an unprecedented challenge.

“For the most part we have found that services have coped well, with some showing exemplary practice in the co-production of care with patients. Staff have shown exceptional resilience by continuing to provide care, particularly in those services that have tragically lost patients or staff to coronavirus.

“However, our monitoring of the MHA during the pandemic has further highlighted concerns we have previously raised, including the importance of patient-led and effective care planning with a focus on discharge and access to advocacy for all patients.

“The pandemic has also shone further focus on the need for modernisation of many mental health wards, primarily to improve the patient experience but also to assist with infection control.

“We saw examples of patients’ leave being cancelled or restrictions placed on their movements, as well as limits on visits from friends and family. We are clear that if services make blanket restrictions, they can demonstrate that they have considered the least restrictive option. We have seen examples of services managing this well, with increased mobile phone access and the use of video calling. We continue to monitor services and will intervene when necessary.

“With limited community support delivered through remote contact, and fewer inpatient beds, there will have been significant unmet need during lockdown. This may increase the risk of people accessing services only in crisis, increasing the risk of hospitalisation and detention under the MHA.

“We urge providers to collect data on trends in MHA practice during the pandemic, to inform decisions and ensure learnings can be applied as quickly as possible in the current wave of coronavirus and any future resurgence.”

National Health Executive, Jan/Feb, Cover

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