The latest statistics on inpatientsformally detained in hospitals under the Mental Health Act 1983, and patientssubject to supervised community treatment was published on 30th October 2013. This is an interesting and easy to understand report, and I would urge everyone with an interest in mental health and the use of the Mental Health Act to read it.
This is the third time I have reviewed these annual reports from the Health and Social Care Information Centre, which is part of the Government Statistical Service. The authors clearly love statistics as much as I do (my previous reviews are here and here).
Two years ago I wrote: “What is clear is that, after only two full years of its use, CTO’s are beginning to seriously impact on the overall use of the MHA. There appears to be an inexorable rise in the number of people in the community subject to CTO’s, as once made, CTO’s can be extended indefinitely.”
One year ago I wrote I quoted from last year’s report: ““The total number of people subject to detention or CTO restrictions under The Act has continued to rise. On the 31st March 2012, this figure stood at 22,267 people, representing a 6 per cent increase since the previous year… There were 4,220 CTOs made during 2011/12, an increase of 386 (10 per cent) since last year.”
So what do the statistics show this year?
The report notes that “there were 4,647 CTOs made during 2012/13, an increase of 427 (10 per cent) since last year”. The report also notes that “in spite of larger numbers of CTOs being ended each year, the number issued continually outweigh this, resulting in an increasing number in place at the end of each reporting period.”
Despite some (potentially flawed) evidence that CTO’s are ineffective in keeping people out of hospital, it appears that this is not deterring clinicians from using these orders.
Last year, I observed that, as an AMHP, I was “finding increasing amounts of my work relate to CTO’s. In the last 12 months, I have been involved in 4 new CTO’s (Sec.17A). But I have also been involved in the extension of CTO’s on 6 occasions (Sec.20A).”
And what of my own personal statistics for the last 12 months? Well, a significant amount of my time as an AMHP continues to be occupied in work relating to Supervised Community Treatment. I was involved in 3 new CTO’s, I extended 4 CTO’s, and was involved in revoking 3 CTO’s. These tasks involve an interview and assessment of the patient each time, involvement in S.117 planning meetings, written reports each time I am involved in a new CTO, or an extension, or a revocation, and frequently the necessity to prepare Managers and Tribunal reports and attend Tribunal hearings.
I’ve just calculated that I have spent 85 hours in the last year on work relating to CTO’s. That’s more than two working weeks. It amounts to a significant proportion of the overall time I spend discharging my statutory functions under the MHA.
Two years ago I posed the question: Are Community Treatment Orders taking over the Mental Health Act? The evidence is increasingly pointing in that direction.
Although of course I am ignoring the increasing time that formal assessments under the MHA are taking in general. What with problems in finding a bed, coupled with increasingly long delays in getting an ambulance, assessments can often take 6 hours or more, especially when you are covering a large, mainly rural area, with hospitals few and far between. However, these latest official statistics cannot cover this area.
The Report makes another, rather telling, statement:“Detentions on admission to hospital increased in both independent and NHS services during 2012/13. For NHS hospitals there was an increase of 3 per cent since 2011/12 but for independent hospitals the increase was much larger at 13 per cent, although the numbers involved were smaller. A large proportion of this increase was attributable to a 31 per cent (313) increase in uses of Section 2 in independent hospitals.”
This is a continuing trend. The Report for 2011-12 noted: “Total detentions in independent sector hospitals increased by 21 per cent; a large proportion of this increase was attributable to a 45 per cent increase in uses of Section 2.”
Last year, I said that “over the last year it has become not unusual in my fairly rural area to have to travel 50 miles or more to admit a patient to hospital. There have been times when there have been no psychiatric beds at all in the entire region. When this happens, the only alternative is to use an independent hospital, at huge expense, of course. This has in any case tended to be the default for young people under the age of 18, and also for people with eating disorders, for whom there are no specialist Trust beds in the region at all.”
The continuing closures of NHS psychiatric beds nationwide is not surprisingly continuing to increase pressure on Mental Health Trusts to use private hospital beds.
I am finding it difficult to understand how the extensive and prolonged use of extremely expensive private beds does not outweigh the savings supposedly gained by the closure of NHS beds, and the reduction in the numbers of frontline clinical staff who might be able to provide alternatives to hospital admission.
Emergency detentions under Sec.4 (where it is not possible to obtain two medical recommendations) continue to reduce year on year. In 2008-9, over 727 people were detained under this section; last year the figure was less than 400, representing almost a 50% reduction overall.
And what about use of Sec.136 (police detentions for people in “a place to which the public have access”)? Well, there appears to have been a slight reduction in overall use of this power. However, outcomes have not changed: in 2012-13, 82% of the use of Sec.136 did not result in detention under Sec.2 or Sec.3.
Although there are no figures for the numbers of people detained under Sec.136 who are subsequently admitted informally, the overwhelming conclusion to be drawn from these figures is still that the police, who to be fair do not have the training in the identification of mental disorder that mental health professionals have, are still using Sec.136 inappropriately.