Section Four National Preventive Mechanism member profiles common. At the same time, there are also concerns that the safety, privacy and dignity of those admitted to dedicated child and adolescent services may be compromised given that gender separation in such services is less observed than in adult services. A recurring issue relates to the application of mental health law by the police. Section 136 of the MHA authorises any police officer to remove a person to a place of safety if they find that person in a public place, apparently suffering from mental disorder and in immediate need of care or control. Once at the place of safety, the person can be detained for up to 72 hours to determine whether hospital admission or another form of help is required. There has been a significant increase in the availability of hospital-based places of safety leading to the less frequent use of police cells. However, CQC is concerned at the lack of consistency in the use of section 136 powers, with detention sometimes appearing to be unlawful (such as the initial detention taking place in a person’s home rather than a public place). It is also concerned that patients are being inadequately assessed prior to being transferred or discharged from the place of safety. Other issues identified by CQC include: • the failure of some services to involve the patient in their own assessments and care planning • the lack of independent advocates for detained patients and those subject to compulsory treatment in the community • the increasing emphasis on security within hospitals and the blanket application of rules which risk infringing the rights of detainees • insufficient trained staff in psychiatric wards resulting in reduced staff-patient interaction and unnecessarily restrictive conditions of detention • the inappropriate use of seclusion. As part of its wider role in monitoring health and adult social services in England, CQC has identified concerns around the ‘deprivation of liberty safeguards’. These safeguards were recently introduced to protect those who are not detained under mental health law but who lack capacity to consent to care or treatment that is deemed by others to be in their best interest. Such care or treatment may involve depriving a person of their liberty in either a hospital or a care home. The safeguards seek to ensure that any decision to deprive someone of their liberty is made following defined processes and in consultation with specific authorities.26 CQC is concerned that limited use is being made by services of the deprivation of liberty safeguards. While reasons for the low uptake are not yet known, there is a fear that there may be patients who are de facto detained, without legal recognition and without the added protection that the safeguards are intended to provide. CQC will continue to monitor this issue in 2010–11. Looking forward In an organisation of CQC’s size and broad scope, there will always be a tension between the different functions it performs. In 2010–11, an internal restructuring of CQC threatens some roles dedicated to the monitoring of the MHA. A review of visits to those detained under mental health law is also underway, although this is designed to enhance effectiveness. As CQC’s overall budget comes under pressure it will be a challenge to maintain its focus on its OPCATrelated work. Nonetheless, in 2010–11, CQC will continue to visit places of detention and will publish a report focusing on its monitoring of the MHA. In the next year, it also intends to focus on the care and treatment of forensic patients, that is, those patients who fall within both the criminal justice and mental health systems. CQC will also continue to make available its own experts to deliver training to other NPMs in Europe. 26 The deprivation of liberty safeguards are set out in the Mental Capacity Act 2005. 33