This code of practice provides guidance to mental health professionals and other practitioners on how they should carry out their duties under the Mental Health Act. As well as providing guidance for professionals, the revised code of practice also guides patients, their families and carers on their rights. Chapters are grouped into seven areas: Using the Act; Protecting patient’s rights and autonomy; Assessment, transport and admission to hospital; Additional considerations for the needs of specific patients; Care, support and treatment in hospital; Leaving hospital; and additional information for professional with specific responsibilities under the Act. Subjects covered in individual chapters include: the nearest relative; independent mental health advocates; mental capacity and deprivation of liberty; detention in hospital; police community treatment orders; guardianship; after care; and care programme approach. The code of practice will come into force on 1 April 2015, depending on Parliamentary approval.

This annual report on CQC monitoring of the Mental Health Act (MHA) puts a specific focus on the impact that the COVID-19 pandemic has had on patients detained under the MHA, and on the services that care for and treat them. The findings indicate that: planning for individuals’ discharge from hospital continues to be essential and is particularly important during the pandemic period due to the increased burden on all services, including those in the community; some services showed exemplary practice in the co-production of care with patients, including infection control measures; in many services the physical environment requires modernisation and doing so would have the added positive impact of making infection control easier; some services continued to uphold restrictions on patients’ movement, activities and leave for longer than seemed necessary; many services invested in software to help detained patients to stay connected with their family and other sources of support during the pandemic; detained patients’ access to advocacy services was made more difficult during the pandemic, but such services played an even more crucial role where patients’ lives were more limited by infection control measures; there needs to be careful evaluation of using remote technology should aspects of them continue after the pandemic abates.

Annual report on the use of the Mental Health Act (MHA), looking at how providers are caring for patients, and whether patients’ rights are being protected. The report sets out CQC’s activity and findings from our engagement with people subject to the MHA and review of services registered to assess, treat and care for people detained using the MHA during 2020/21. It is largely based on feedback letters on the 620 remote monitoring letters following reviews of 682 wards carried out during 2020/21. These involved private conversations with 1,895 patients and 1,111 carers. The report highlights three key findings. Firstly, the workforce is under extreme pressure; the pandemic has placed additional stresses on staff, patients and carers; staff are now exhausted, with high levels of anxiety, stress and burnout, and the workforce is experiencing high levels of vacancies. The negative impact of working under this sustained pressure poses a challenge to the safe, effective and caring management of inpatient services and to the delivery of care in a way that maintains people’s human rights. Secondly, community services are key to reducing levels of detention in hospital. Not getting the right help at the right time can lead to symptoms worsening and people needing inpatient care. During the pandemic this has been a particular concern for children and young people. We have seen an increase in the numbers of children and young people being cared for in inappropriate settings while they wait for an inpatient bed. Thirdly, urgent action is needed to address longstanding inequalities in mental health care. We remain concerned that Black or Black British people are more likely to be detained under the MHA, spend longer in hospital and have more subsequent readmissions than White people.

Purpose: The Mental Capacity Act (MCA, 2005) provided a new legal framework for decision-making practice in England and Wales. This study aims to explore qualitative research on practitioners’ knowledge and experiences of the MCA in health and social care settings to inform practice and policy. Design/methodology/approach: Four electronic databases and Google Scholar were searched in November 2019 for peer-reviewed, qualitative, English language studies exploring practitioners’ experiences and knowledge of the MCA in health and social care settings. Nine studies were included and appraised for methodological quality. Data were analysed using thematic synthesis. Findings: Data revealed both positive aspects and challenges of applying the MCA in practice within five main themes, namely, travelling the “grey line”, the empowering nature of the MCA, doing the assessment justice, behaviours and emotional impact and knowledge gaps and confidence. Practical implications: The fundamental principles of the MCA appear to be adhered to and embedded in practice. However, practitioners find mental capacity work remains challenging in its uncertainties. While calling for more training, they may also benefit from further MCA skills development and support to increase confidence and reduce apprehension. Originality/value: This is the first systematic review to synthesise qualitative literature on practitioners’ experiences and knowledge of the MCA. Findings offer insight into practice experiences of the MCA and provide a basis for the development of training and supervisory support.

Purpose: This paper aims to examine reform of mental health legislation in England and Wales. It covers the period from the introduction of the 1983 MHA to the proposed reforms outlined in the Wessley Review that was published in December 2018. Design/methodology/approach: This is a literature-based project. Findings: Reform of the mental health legislation reflects two potentially conflicting strands. One is the state’s power to incarcerate the “mad”, and the other is the move to protect the civil rights of those who are subject to such legislation. The failures to development adequately funded community-based mental health services and a series of inquiries in the 1990s led to the introduction of Community Treatment Orders in the 2007 reform of the MHA. Research limitations/implications: The development of mental health policy has seen a shift towards more coercive approaches in mental health. Practical implications: The successful reform of the MHA can only be accomplished alongside investment in community mental health services. Originality/value: The paper highlights the tensions between the factors that contribute to mental health legislation reform.

Record of informed consent for voluntary admission/stay in mental health units.

A case study focusing on a patient wanting more independence upon moving from a mental health rehabilitation unit. It describes how the patient, supported by an IMCA, was able to move into supported living accommodation where he can be more independent. The case study has been drawn together by the Department of Health, the Care Quality Commission, and POhWER, a major provider of advocacy services, showing how IMCAs can act as a powerful support to people who may lack capacity.