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.