RCPCH responds to CQC report ‘The Monitoring the Mental Health Act in 2022/2023’

The Care and Quality Commission (CQC) has published their annual report which looks at how healthcare providers use the Mental Health Act (MHA) in the treatment of people with mental health needs.
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The report sets out CQC’s activity and findings during 2022/23 from engagement with people who are subject to the Mental Health Act 1983 as well as a review of services registered to assess, treat and care for people detained using the MHA. The findings of this year’s report show: 

  • Workforce retention and staffing shortages remain one of the greatest challenges for the mental health sector, affecting the quality of care and the safety of both patients and staff.
  • A record high of 496,897 children and young people were waiting to access or undergoing mental health treatment in November 2023. 
  • According to the latest statistics from NHS England, this number increased by almost 20,000 by January of this year. 
  • This high demand and a lack of specialist beds means that children and young people with mental health needs continue to be cared for in inappropriate environments, such as acute or adult wards, which do not fully meet the requirements of the MHA Code of Practice.
  • CQC are concerned that the care children and young people receive on adult wards and children’s general wards is compromised by the fact that these wards are not designed for children and young people who have mental health needs.
  • A lack of designated inpatient beds for children and young people has also led to problems with inappropriate ward layouts. They are concerned that inappropriate ward environments, combined with workforce pressures, are leading to the use of inappropriate restraint and seclusion for children and young people.

RCPCH VP for Policy, Dr Mike McKean, said:

It’s widely known that children’s mental health services are in a state of crisis, but the findings of this report still make for a distressing read with nearly half a million children waiting for care. The CQC rightly points out that workforce retention and staffing are one of the greatest challenges in tackling this problem. Underinvestment in children’s mental health is a longstanding concern, but the mental health needs of our children are also changing and not for the better.

We’re also deeply concerned that children and young people with acute mental health needs are being cared for in unsafe and inappropriate settings due to a lack of safe alternatives. However, the question must be asked as to why so many young people are reaching a crisis point and ending up on these unsuitable wards? 

To properly support the children’s mental health system, we must first ensure that community mental health services are strengthened so fewer children and young people reach crisis, and to develop more appropriate hospital environments for those who do need hospital care. We also need to take a holistic approach to promoting good well-being in our children and young people and addressing the social determinants of mental illness by eliminating child poverty, improving housing conditions and access to green spaces, and improving children’s physical health.