Rise in mental health detentions shows strains in system, report says

A rise in the number of detentions under the Mental Health Act, due to reasons including population growth and fewer alternatives, may indicate a healthcare system under considerable strain, a report says

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A rise in the number of detentions under the Mental Health Act may indicate a healthcare system ‘under considerable strain’, a report says.

The rise could be due to a range of factors that can vary across England, but which include population growth and fewer alternatives to inpatient admissions, the Care Quality Commission (CQC) says in a review of the causes of increasing use of the act to detain people.

The review found no evidence that professionals in the sector had been misusing the legislation to admit people who do not meet the criteria for detention.

Over the decade to 2015/16 the number of detentions increased by 40%, to 63,622 from 45,484, the CQC says.


As part of the review it looked at available data and visited eight NHS trusts, two independent mental health service providers and 23 local authorities.

The CQC report grouped possible reasons for the overall increase in detentions into four areas:

  • Changes in mental health service provision and bed management.
  • Demographic and social change.
  • Legal and policy developments.
  • Data reporting and data quality.

CQC recommendations include improved models of partnership working between services and a greater focus on recovery, goal-oriented detentions and outcomes-based commissioning.

A report published this month by health think tank the King’s Fund said the fall in the number of mental health nurses is affecting quality and safety of care.

The number of mental health nurses has fallen by 13% since 2009, and one in ten of all posts in specialist mental health services is vacant, it said.

Shortfalls in services

RCN professional lead for mental health Catherine Gamble said: ‘More people are developing mental illness at the same time as we’re seeing a fall in the numbers of specialist mental health nurses, so this factor must not be ignored.

‘We know consultant nurses working as approved clinicians and responsible clinicians provide a very different kind of expertise in reviewing the rationale for detentions and meeting the needs of those held under the act.

‘Despite the changes to the act in 2007, it is hard to believe there are still only 18 nurses in approved clinician and responsible clinician roles.’

Last October prime minister Theresa May announced a review of the act, saying existing legislation is ‘leading to shortfalls in services and is open to misuse’.

‘Detention rates under the act are too high and it is people from black and minority ethnic populations who are affected the most,’ she said.

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