Mental Health Act Code of Practice not being used as intended

The Mental Health Act (MHA) Code of Practice is not being used as intended due to a lack of awareness and understanding of the statutory guidance amongst providers and staff.

The code helps staff working in mental health services to interpret and apply the legislation to decision-making in day-to-day practice and provide safeguards for involving and protecting people.

It also includes guiding principles that should always be considered when decisions are being made about care, support or treatment in services that detain patients under the MHA.

However, a Care Quality Commission (CQC) report found that providers lack understanding about how to promote, apply and report on the principles set out in the code. This supports a recommendation by the Independent Mental Health Act Review that the guiding principles are moved into the MHA and have statutory force.

The report, titled, Mental Health Act Code of Practice 2015: An evaluation of how the Code is being used, highlighted issues with section 140 of the MHA which is designed to ensure the safe and appropriate admission of people in need of urgent care in their local area.

Feedback from stakeholders, including mental health providers and services user representatives, identified issues regarding how the code was being used, such as how its format was not easy for staff and professionals, having grown from 135 pages to more than 450.

Also, the report found quality, content and focus of training for staff varied, with some providers still not having updated their training to reflect the 2015 code.

Based on its findings, and as part of their response to the independent review of the MHA, the CQC recommends the Department of Health and Social Care (DHSC) takes a lead in developing standardised resources, support and training for patients, carers and staff so that they understand how the code applies to individuals, practice, services and local partnerships.

The healthcare watchdog also encouraged the DHSC to promote the use of the guiding principles to improve practice and enable meaningful engagement with families and carers.

‘Use of the MHA to detain people in mental health services is more common than when the Code of Practice was first created 26 years ago,’ said Paul Lelliott, deputy chief inspector of hospitals (lead for mental health), at the CQC. ‘That makes it even more important that the code is clear, accessible and supports the legal safeguards that protect people’s human rights and autonomy.’

Lelliott went on to say that the CQC would like to see more work undertaken to raise awareness of the code’s principles and to improve its usability: ‘This might include using digital technology to make the content of the Code easier to access by patients, carers and clinicians,’ he concluded.