Mental Health Act Reviewers: Understanding Our Powers and Responsibilities

1. Mental Health Act Reviewers (MHAR) Tanveer Akhtar and Judy Davies

2. What do we want to talk about? • CQC - our powers • Role of the Mental Health Act Reviewer (MHAR) • Focussed visits • Complaints • s134 High Secure Hospital appeals • Other MHAR activity • Any questions

3. CQC – our powers There are 7 MHA powers and duties that we have: The protection of detained patients (carried out through visits to registered locations both as part of comprehensive inspections and separately, producing reports, and requiring action statements). Providing a Second Opinion Appointed Doctor (SOAD) service. Reviewing, and investigating where appropriate, individual complaints from people subject to the MHA. Adjudicating on appeals against the withholding of correspondence in high secure hospitals. Producing an Annual Report on our activities and policy assessment. Keeping under review the MHA Code of Practice. Receiving notifications of deaths of detained patients and patients absent without leave.

4. MHARs – what we do MHAR’s carry out unannounced monitoring visits to wards where patients are detained under the powers of the MHA. The visit entails: • Speaking to patients, carers, staff and advocacy. Expert by experiences can accompany MHARs on visits. • Reviewing relevant patient records including detention paperwork, section 132 rights, section 17 leave, consent to treatment, mental capacity assessments and care plans. • Look around the ward environment including where patients’ consent, their bedrooms. • Review relevant policies and procedures (e.g. seclusion/long term segregation). Following the visit, MHARs draft a report to inform the provider of the outcome of the visit.

5. The Mental Health Act (MHA) monitoring role extends to those subject to Community Treatment Orders or Guardianship who may not be detained, but will nevertheless have some legal restrictions placed upon them. • Section 120 of the MHA also provides us with the power to carry out an investigation into how a provider exercises their responsibilities and obligations under the MHA and we have wide discretion about the circumstances in which we may decide to do this.

6. There are many areas where requirements on hospitals under the Mental Health Act (MHA) and its Code of Practice overlap with similar requirements under the Health and Social Care Act 2008. For example, the MHA Code of Practice principle of service user participation and respect, alongside the MHA legal requirements regarding giving information to patients overlap with the statutory duty of providers and managers registered under the Health and Social Care Act 2008 to respect and involve all people who use services. MHARs continually monitor how well people are involved both in planning their care and in decisions about their treatment across both our MHA and compliance monitoring functions.

7. During their visits Mental Health Act Reviewers may also identify concerns or make observations that are not specifically about the MHA or its Code of Practice. For example, issues about the hospital environment, catering, patient activities, bed management, or any other matter raised by patients or noted by the visiting MHA reviewer. MHA reviewers may raise such matters with providers by themselves, and/or refer them to inspectors within CQC for further follow-up.

8. Domain Pathways • We have divided our framework for monitoring the patient pathway into three parts. We have called these ‘domains’ and they broadly map to different stages along a hypothetical patient’s journey. The three ‘domains’ are: • Assessment and application for admission. • Detention in hospital • Community treatment orders, discharge from detention and aftercare

9. Focussed Visits • MHAR’s carry out focussed thematic visits, such as the use of seclusion and long term segregation, ECT, acute hospitals and section 136 health based place of safety. • We may do this in conjunction with a comprehensive inspection of a registered provider (for example, looking at the arrangements they have in place with acute hospitals for patients with physical healthcare needs); or on a responsive basis as a consequence of patient experience; or as part of a focussed monitoring visit. • Following this visit, reports are produced in order for the provider to respond to and action upon. For example, as part of the recent inspection at Rampton Hospital, MHARs focussed primarily on the use of seclusion and long term segregation. Their findings fed into the main core service inspection report.

10. Complaints The Mental Health Act 1983 gives CQC the power to investigate certain complaints. It states that we can look into: “the exercise of powers or discharge of duties, in respect of people who are or were subject to the restrictions of the Mental Health Act.” Our powers under the Mental Health Act mean that we can only look into complaints from, or about, people who are, or have been: • Detained in hospital. • Subject to a Community Treatment Order. • Subject to Guardianship.

11. Section 134 Appeals Care Quality Commission (CQC) is required by law to review decisions made by high security psychiatric hospital managers in the following areas, and has the power to overturn such decisions: • Withholding outgoing post • Withholding incoming post or other items • Withholding internal post • Telephone monitoring

12. Other MHAR activity • MHARS take part in well-led inspections. These are completed in collaboration with inspectors. The role involves: • Interviewing MHA administrators and managers, hospital managers, MHA executive leads, advocacy, AMHP’s. • From time to time, MHARs will be involved in engagement activity with providers, for example, meeting with MHA managers and attending MHA forums.

13. Any Other Questions?