Mental health updates: culture of care and death rates under the Mental Health Act

April has been a busy month for mental health announcements.

New culture of care guidance

NHS England has published their new Culture of Care Standards for Mental Health Inpatient Services including those with a learning disability and autistic people. The co-produced guidance sets out the culture of care that everyone, including people who use services, families, carers and staff want to experience in mental health inpatients settings, and support providers to realise this.

The standards apply to all NHS-funded mental health inpatient services for:

• people with a learning disability and autism
• specialised mental health inpatient services such as:
  • mother and baby units
  • secure services
  • children and young people’s mental health inpatient services

They start by saying “Being in hospital is a form of restriction in and of itself, and it is our moral and legislative duty to provide the least restrictive experience possible within inpatient settings with a clear focus on balancing the right to liberty with therapeutic benefit.”

This leads on to a set of 12 core commitments, each with a set of associated standards:

1. Lived experience
2. Safety
3. Relationships
4. Staff support
5. Equality (which includes the Patient Carer Race Equality Framework discussed in one of the sessions at NHS Confederation’s Mental Health Network Annual Conference last week)
6. Avoiding harm
7. Needs led
8. Choice
9. Environment
10. Things to do
11. Therapeutic support
12. Transparency

The culture of care standards for each of these components are set out in the guidance, together an explanation of what these standards mean in practice.

In addition, the standards are aligned to three key approaches to support the ambition for equality focused inpatient care:

• Trauma informed
• Autism informed
• Culturally competent care

High death rates in prisons under the Mental Health Act

Statistical analysis of recorded deaths in custody between 2017 and 2021 reveal that people in state detention are at a significantly increased risk of death compared to the general population.

Analysis by the Independent Advisory Panel on Deaths in Custody shows that prisons continue to have the highest number of deaths, with an average of 322 deaths per year between 2017 and 2021. However, they go on to say that, when rates are considered, the mortality rate of individuals detained under the Mental Health Act is three times higher than prisons and the highest across all places of custody. Further, while numbers of deaths in police custody remain low, they note that its rate of death is in fact comparable to those two settings, if the approximate length of time spent in detention is taken into account.

They are concerned that a lack of timely and high-quality data limits learning to prevent further deaths in secure health settings and therefore welcome the recommendations arising out of the rapid review into mental health inpatient safety to improve data collection and publication commissioned by the Department of Health and Social Care.

The panel go further and highlight that, unlike deaths in prison, police custody, and immigration detention which are subject to independent scrutiny, deaths of patients detained in secure settings are investigated by the same trust responsible for their care. They observe that, two decades since the Joint Committee on Human Rights called for an independent investigative body, there remains a troubling inconsistency with how the deaths of some of society’s most vulnerable people are examined. They therefore state that an independent investigative body is needed to urgently address this gap and help better understand why so many people are dying in mental health settings.

This is an area of priority focus for them as they look to make recommendations to government and senior health leaders over the coming year.