Hot off the press is the CQC, ‘Monitoring the Mental Health Act in 2023/24’ (15 March 2025) - Mental Health Law Online. If you have 20 or more hours to spare reading all of it please go right ahead. Alternatively - if like me you value not wasting your time too much - then I provide an AI-assisted summary below of some key points. [‘Summary’ and ‘some’ are key words]. All facts and figures have been checked which does not mean there may not be a errors.
1. System Pressures and Inpatient Care
- High Demand and Capacity Issues: Mental health services are under significant strain, with a 43% increase in people accessing secondary mental health services since 2019. This has led to delays in care, deteriorating mental health, and increased admissions. (p14, para 2)
- Out-of-Area Placements: Patients are often detained far from home due to bed shortages, leading to isolation and delayed recovery. In 2023/24, there were 5,500 inappropriate out-of-area placements, a 25% increase from the previous year. (p17, para 4)
- Discharge Challenges: Pressure to free up beds has associated with premature discharges, often without adequate community support, resulting in readmissions. (p19,20)
2. Workforce Challenges
- Staff Shortages: Despite a 35% growth in the mental health workforce since 2019, shortages in medical and support roles persist, negatively impacting patient care. (p8, para 8)
- Training Gaps: Staff, particularly agency workers, often lack necessary training, especially in caring for autistic individuals and those with learning disabilities. (p26)
- Second Opinion Appointed Doctor (SOAD) Service: The SOAD service faces sustainability issues due to a shortage of doctors and increased demand, with 28% of requests cancelled in 2023/24, often because patients were discharged. (p27-30)
3. Inequalities in Care
- Ethnic and Deprivation Disparities: People from ethnic minority groups and those in deprived areas face significant barriers to accessing mental health care. Black individuals are 3.5 times more likely to be detained under the MHA than white individuals. (p33, middle of page)
- Communication and Rights: Many patients are not adequately informed of their rights, and there are gaps in meeting cultural and religious needs, particularly for autistic individuals and those with learning disabilities. (p35)
4. Children and Young People
- Access and Delays: Demand for children’s mental health services has surged, with long waits for beds and inappropriate placements, including adult wards. Detentions for children and young people have increased, with median lengths of stay rising from 15.3 days in 2019/20 to 21.5 days in 2023/24. (p41 - 44)
- Transition Challenges: Young people often face difficulties transitioning from child to adult mental health services, leading to gaps in care and support. (p49)
5. Ward Environments and Restrictive Practices
- Quality of Environments: The quality of inpatient environments varies, with some wards poorly designed and unsuitable for patients with mobility issues or sensory sensitivities. (p9, 54)
- Restrictive Practices: The use of restrictive practices, such as restraint and seclusion, remains high, with over 14,200 incidents reported monthly in 2023/24. Blanket restrictions on access to outdoor spaces, kitchens, and electronic devices are common. (p59)
6. Deaths and Safety Concerns
- Deaths in Detention: In 2023/24, there were 288 deaths of detained patients or those on community treatment orders (CTOs). Of these, 71 were from unnatural causes, including ligature-related deaths. (p69)
- Sexual Safety: There has been a concerning rise in sexual safety incidents, including assaults, in mental health wards, with 292 mixed-sex accommodation breaches reported in 2023/24. (p62, para 2)
7. Mental Health Bill and Future Reforms
- Proposed Reforms: The Mental Health Bill, introduced in November 2024, aims to enhance patient rights, reduce compulsion, and address inequalities. However, the CQC warns that legislation alone will not resolve systemic issues without adequate funding, workforce investment, and improved community support. (p39)
8. Regulatory Activity
- Monitoring Visits: The CQC conducted 823 MHA monitoring visits in 2023/24, speaking with 4,634 patients and 1,435 carers (p63). They identified ongoing concerns about patient rights, care quality, and the impact of system pressures on mental health services.
My opinions:
- When you accumulate a debt that grows to such an enormous size that even the interest payments become impossible to manage, you find yourself in a perilous situation. The weight of the debt compounds over time, creating a cycle where you’re constantly struggling to keep up, yet falling further behind. This strains your financial resources whilst limiting your ability to invest in the future. In other words you’re trapped in a downward spiral with no easy way out.
- The health-debt created from 2008 and worsened by the pandemic ‘trauma’ is now unserviceable. Health debt - the post-pandemic trauma - Investigative Psychiatry
- The human mind has the capacity to imagine its problems away.
- Reality is a painful place where imaginations evaporate.
- Hope has no power to bend reality external to ‘craniums’.
- Many will continue to escape into ‘fantasy’ - a far more ‘positive place’.
Supplemental:
Lord Darzi Report: NHS State Investigation 2024
Sir Keir Starmer Unveils NHS Reform Blueprint