Thursday, 31 October 2013

Detentions under the Mental Health Act 1983: The Latest Statistics 2012-13

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.


  1. I also was under the impression that CTO's were ineffective at keeping people out of hospital. Particularly those with psychosis *(are they ever used for other client groups?), They are not complied with

    Sooner or later patients will realise - once advocates go down this road - that they should probably refuse CTO on the grounds that it bypasses the principle of least restriction when there is a MHA.

    What can the clinician do? If you have been detained for a while then a couple more weeks wont make a difference for most people. You know as a patient that you are near discharge if this is being considered. And that the clinicians can only bed block for so long! At a minimum of £330 p/n hospital stay sooner or later you will be released and the few enshrined rights you have left in MH legislation will be preserved.

    Just a human rights angle for you....Masked AMHP please tell me if this will work!

  2. "..the police, who to be fair do not have the training in the identification of mental disorder that mental health professionals have..." - true enough, they don't - and this after thirty years of the Act!

  3. No one should be surprised at the inexorable rise in admissions and CTOs. The two are surely connected. There was research evidence from other countries available before the 2007 MHA changes that CTOs don't reduce admission rates but the Blair government buried it until after the Bill went through parliament.

    Anyone who thought that handing our risk-averse, medication-obsessed psychiatrists a fast track means of recall to hospital would reduce admissions was clearly not living in the same world as me!

  4. s136 is surely primarily designed to allow the police to remove people who are posing a threat to themselves or others to a place of safety. There are many reasons why admission tto hospital may not be appropriate. Just because they aren't admitted to hospital doesn't mean they didn't need to be removed to a place of safety at that point in time. Presumably nooen thinks that peopel who are self harming, threatening suicide etc should just be left to get on with it?

  5. Of course there is link between admissions and CTOs, you have to be sectioned before you can be put on a CTO! So as long as people become mentally ill and are sectioned for the first time there is a chance they will be placed on a CTO. As CTOs are relatively new you would expect some of the existing population of chronically ill people to be added to the CTO count year on year and for the total to stabilse, or at least reduce exponentionally after a number of years,

    As the spouse of someone who has been sectioned twice this year, I only wish the "Responsible" Clinician had taken the AHMP's recommendation and my views that my spouse should be discharged on a CTO, instead the clinician was charmed by my very intelligent wife. Once discharged she played the game for a month and gently told the CMHT that they were no longer welcome. Unfortunately you have to be "cruel" to be kind sometimes.

    I'm surprised no comment was made on the 3% fall in the mental hospital population at 31 March 2013 compared to the previous year and the first in five years despite a rising population. I appreciate its would take more effort, but the average daily population of hospitals is perhaps the most interesting statistic.