Section Four National Preventive Mechanism member profiles To safeguard patients, certain treatments (such as electro-convulsive therapy) provided under mental health legislation require a patient’s consent, or the agreement of an independent doctor that the treatment proposed is appropriate for the patient’s specific needs. HIW provides these independent doctors through its ‘second opinion appointed doctors’ service. In 2009– 10, HIW received 836 requests for second opinions. Summary of activities and key issues In 2009–10, HIW carried out 91 visits to 51 hospitals where patients were detained under mental health legislation. It spoke to more than 200 patients, either informally in private interviews or as part of group meetings. It also examined the documents of around 200 patients to monitor whether detaining authorities were following statutory procedures and national guidelines. HIW has identified recurring issues as a result of its visits, many of which relate to the quality and environment of care rather than the legalities of detention. Several concerns related to consent and capacity such as a lack of understanding by staff of capacity issues, failure to make clear assessments of capacity, difficulties in managing fluctuating capacity and difficulties in adhering to legal processes. In 2009, HIW commenced a special programme of visits to mental health services where people may be detained, the purpose of which was to assess the dignity and respect afforded to patients. Thirteen hospitals were visited and HIW interviewed patients, carers and staff, examined patient records and observed the environment and the care and treatment provided. A key finding arising from these reviews was the lack of therapeutic input on many of the wards visited. Also in 2009, HIW published a report on child and adolescent mental health services in partnership with other regulatory and inspecting bodies in Wales, including CSSIW. The report detailed findings of a review of inpatient provision for those under the age of 18, including those detained under mental health legislation. It also touched on mental health services for young people in prison or secure accommodation. The report identified several concerns, including inconsistency in provision across Wales, the inappropriate placement of children in paediatric or adult mental health wards, a lack of specialist mental health services, inadequate arrangements for the transition to adult services and a failure to involve children in planning their care. Looking forward Like the CQC in England, HIW has found that health services in Wales are making lower than expected use of the deprivation of liberty safeguards. HIW will explore the reasons for this and will undertake a more systematic data gathering exercise in 2010– 11. It will also undertake a number of special reviews which will include looking at the care and treatment of detained patients. One review concerns the use of physical restraint and whether it is used safely and only when absolutely necessary. Another will examine how mental health service providers manage the risk of suicide. 35