Section Three The second year – activities and key issues by type of detention Detention under mental health law In the UK, people with mental disorders may be detained under mental health law to ensure that they receive the care and treatment necessary for their own health and safety or for the protection of others. This is subject to strict criteria and safeguards set out in mental health legislation. The precise legal provisions and processes vary between jurisdictions in the UK, as do the independent monitoring arrangements. However, the four NPM members responsible for monitoring detention under mental health law in the UK communicate regularly with one another, sharing information and experience.32 This communication is particularly important, as cross-border placements sometimes take place. England In England, CQC regulates health and adult social care. It has a statutory duty to monitor the operation of the Mental Health Act 1983 (MHA) and to carry out visits to those whose rights are restricted under it. Visits are carried out by MHA commissioners who are separate from compliance inspectors carrying out the regulatory activities of CQC. During their visits to services where people are detained, MHA commissioners check that detained patients’ rights are being safeguarded and meet patients to find out more about their individual experience of detention. In 2010–11, MHA commissioners carried out 1,565 visits in more than 670 hospitals in England. They met in private with more than 4,700 detained patients. Reports of individual visits are submitted to hospital managers but are not published. Instead, CQC publishes annual statements on each mental health trust or independent provider. CQC also publishes an annual report to Parliament of its monitoring of the use of the MHA. The MHA Code of Practice includes a statement of principles to guide those who have responsibilities under the Act and to which all those involved in the operation of the Act should adhere. In monitoring the MHA, CQC checks that any restrictions imposed on a patient’s liberty are the least restrictive and that MHA powers are exercised with respect for the patient’s wishes and feelings and within a wider approach that focuses on promoting recovery and autonomy. Patients and, where appropriate, carers or families should be involved in planning, developing and reviewing their own treatment. This can help lessen the perception of coercion in psychiatric care. CQC’s monitoring shows that there continue to be variations in the extent to which patients are involved in assessments and care planning. While it has observed excellent examples of patient participation, CQC has also visited many services where practice is deficient. Some patients have been excluded from care planning and decision making and report feeling intimidated or patronised by staff. Some patients are presented with care plans which are not personalised to them and in which they have had no input. CQC recommends that service providers ensure that staff are appropriately skilled and encourage patient participation. Through its ‘Acting Together’ programme, the CQC itself promotes the participation of service users in its monitoring work. A panel of service users, comprising people who are currently subject to detention or who have been previously detained, informs CQC’s approach to monitoring the operation of the MHA. 32 See page 13. 37