Yesterday, via Twitter, I was alerted to the publication of the ‘Mental Health Bulletin – Fourth Report from Mental Health Minimum Dataset (MHMD) returns 2010’. I know it’s a bit of a mouthful but briefly, it means statistics about admission, treatment and care by Mental Health Trusts around England.
There are a few tidbits of information that are worthy of comment and commentary.
The most obvious ‘headline’ figure presented is that there has been a 30.1% rise in people held in hospital under the Mental Health Act between 2008/9 and 2009/10
‘from 32,649 in 2008/9 to 42,479 in 2009/10’.
That’s a staggering initial figure for a change in a one-year period so I wanted to look at some of the possible reasons for this.
The survey itself indicates a large part of the change – being that
Some part of this increase was due to improved recording between 2008/09 and 2009/10, because a small number of trusts failed to provide MHA information in 2008/09. On a like for like basis, excluding the data for trusts that failed to return information in 2008/09, there was an estimated increase of about 17.5 per cent in the number of people being detained under the MHA – from 32,649 to 38,369
I’m not entirely confident I understand the baseline statistics but taking advice from those who know better, I’m happy to stick with that 17.5% increase.
My initial gut feeling and certainly the situation that tallies with my own practice experience is that the influence of the Mental Capacity Act has been crucial in leading to an increase in detentions that I, personally, have signed over the last year.
I understand that I might have a slightly non-representative view as I am a specialist in older adults’ mental health and primarily carry out Mental Health Act Assessments for Older Adults therefore I may see a disproportionately high number of people who may lack capacity due to organic mental ill-health (e.g. dementia).
However, the impact of DoLs (Deprivation of Liberty Safeguards) has led, through something of a drip-drip process and through caselaw – particularly GJ v Foundation Trust which established that there can be no ‘choice of law’ between the use of the Mental Capacity Act and the Mental Health Act for a ‘mental health patient’ in a ‘mental health hospital’, to an increase in admissions under the Act. Actually, I genuinely believe it allows a far far greater protection than the DoLs process allows but I might be getting over-technical. Suffice to say that there has been a substantial increase in the amount of people on the older adults wards who are now detained ‘under section’ – who may well have, last year, been informal patients.
Of course, the issue of capacity or lack of it doesn’t solely relate to older adults but the examples I give are from my direct experience.
I’ve turned down a couple of Eligibility Assessments under the DoLs framework, suggesting the people whom I have assessed have been ineligible for a Deprivation of Liberty Order because they would otherwise be eligible for detention under the Mental Health Act. I’m just one person, I know, but I know of other people in my Trust who have made similar decisions.
It may be a reason for some of the increase in detentions.
I’m not sure if the cuts agenda has had a significant impact on status of admissions yet save the generalised increased levels of distress and higher potential levels of mental illness that may occur when the economy is in a depressed state.
In our Trust there have been a massive reduction in the amount of inpatient beds available. Does that mean people who might have been brought into hospital earlier are not? Possibly. It may mean fewer informal admissions take place due to the lack of beds and therefore situations deteriorate so an admission has to be on a compulsory basis. That may also explain why the length of time of stays has increased.
The other unsurprisingly depressing point made from the data is that
Whilst the number of people using services rose across all ethnic groups, the percentage rise was noticeably larger for the Mixed ethnic group (a rise of 17.7 per cent). The Mixed and the Black and Black British groups now both have rates of access to services that are over 40 per cent higher than for the majority White group (at approximately 3,800 per 100,000 population compared with about 2,700 for the White group).
The most obvious explanation of this relates to institutional (and overt) racism and a differentiation of the way the treatment and treatment decisions are made on the basis of cultural backgrounds.
If anything needs to be actively addressed it is this inherent difference in the system and services that seem to allow such disparity to exist.
Another interesting point that was in the main document was that
‘The number of women detained under the MHA who came into hospital via the prison or the courts rose by more than 85% since 2008/9 …. The number of men in this category rose by 48.1% since the previous year’.
Again, staggeringly high figures. I wonder what significance changes to prison services has and will have on admissions to psychiatric hospitals via the court system. It’s not an area I have more than perfunctory experience of so I can’t comment in detail, except that it’s an interesting aside.
In fact, looking at the bare figures, it seems that these increases have made up a good proportion of the overall rise in compulsory admissions under the Act across the board.
As I’ve been reading through the document I came to the conclusion that I could easily cover about 10,000 words worth of analysis of the information provided!
What I would say though it that it’s worth checking the entire document because the information contained on the breakdown of admissions on the basis of gender, age and race make for lots of potential analysis and interest in the nature of work and how it is changing in mental health services in England.