Mental Health Act Code of Practice 2015: An evaluation of how the Code is being used

This report looks at how well the Mental Health Act (MHA) Code of Practice is being used across mental health services since it was updated in 2015.

Overview

Following a request from the Department of Health and Social Care, we have worked with stakeholders to look at how well the Code is being used across mental health services since it was updated in 2015.

We looked for the useful things and the barriers that services have found when they use the guidance. We also looked at what impact these things have had on people’s experience of detention, care and treatment.

What we did

We worked with stakeholders to identify three key areas that would provide a good insight into how providers are using the Code. The questions we sought to answer were:

1. Have the revised guiding principles had an impact in practice?
2. Have providers taken action to improve the way they are empowering and involving patients in their care?
3. Did the new guidance in the Code have an impact on the way local services work together when people need urgent admission to a mental health bed?

We looked at data from our annual programme of work with patients and providers. This included our visits to services and interviews with patients.

We also used information from:

• Qualitative sampling of over 400 issues raised during MHA monitoring visits about the use of the guiding principles between July 2012 to March 2018
• A literature review by the Collaborating Centre for Values-based Practice in Health and Social Care in Oxford
• Engagement with people with past or current lived experience
• A workshop with commissioners, providers, police, social workers and local authority staff
• A provider-level engagement webinar with professionals working with the current Code
• Engagement with expert stakeholders from our MHA External Advisory group

Findings have been corroborated and, in some cases, supplemented with expert input from stakeholders involved in the review.

What we found

The Code is still not being used as it was intended to be, with variation in providers’ understanding of the Code and how it should be applied.

• Providers lacked understanding about how to promote, apply and report on the guiding principles in the Code
• Providers did not support staff well enough to enable them to have meaningful and productive conversations with patients
• Local areas, including commissioners, local authorities, police and providers, should work together better to make sure that people receive the right care

Recommendations

Based on our findings, we recommend, as part of their response to the independent review of the MHA, the Department of Health and Social Care 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
• Promoting the use of the guiding principles to improve practice and enable meaningful engagement with families and carers
• Making sure that the Code gives clear and consistent guidance on providers’ governance arrangements
• Improving the usability of and access to the Code, taking into account the way the Code is intended to be used in practical situations between patients and their care team