A new report from the social services inspectorate (SSI) reports a worrying lack of information surrounding compulsory mental health admissions, a lack of interpreting services and a lack of alternatives to hospital admission for black people.
The report, Detained: SSI Inspection of Compulsory Mental Health Admissions, found that management supervision of services and staff varied considerably from one local authority to another. Case recording was often poor, links between local authority mental health and children's services were tenuous, and social care input to written plans was underdeveloped, it said.
Published after the inspection of 10 local authorities, the report reveals a mixed picture of the effectiveness of assessment processes and social care services for people detained in psychiatric hospitals.
It found that approved social workers (ASWs) were highly valued and joint working between agencies was generally good. However, inspectors highlighted major areas of concern, including:
• the over-representation of people from minority ethnic groups in mental health assessments
• users' negative experiences of hospital treatment
• shortages of professional staff, including ASWs, sharing similar racial and cultural backgrounds as patients
• patchy equal opportunities practices
• poor information and recording systems, in some places
• unambitious social care input to care plans, in some areas
• inappropriate hospital admission for black people, where alternatives could have been provided
• problems in contacting doctors with specialist knowledge of mental illness.
Concerns were also raised about the use of ASWs. "Most councils had sufficient numbers of ASWs and some paid a premium, in the form of additional increments of pay, to retain experienced staff," says the report. "However, staffing figures were misleading because they included ASWs who had very limited operational involvement, because they were managers or worked in settings where statutory activity was low - learning disability services or services for older people."
Denise Platt, chief inspector of the SSI, said: "This report will help councillors and senior officers review how decisions are made about compulsory admissions under the Mental Health Act and whether an appropriate range of services is currently provided. It will enable them, in some cases, through the provision of good quality mental health services, to avoid the need for compulsory admission by finding alternatives to hospitalisation."
Carers of people with mental health problems were generally not included in discussions about care planning, the inspectors found.
A spokesperson for the Carers National Association said professionals often used "the excuse of confidentiality not to involve the carer".
The report comes as the recent mental health white paper proposes diluting the social work role in mental health sections. Currently, all decisions to "section" people under the Mental Health Act 1983 must involve an ASW as well as two doctors. The white paper says the ASW role in compulsory detention could be undertaken by "another approved mental health professional".
The Association of Directors of Social Services is pushing for ASWs to continue to have a statutory role in sectioning assessments. David Joannides, chairman of the ADSS mental health strategy group and Dorset director, said the shortage of appropriately experienced ASWs was countrywide. The authority of Rochdale, for example, - one of the 10 inspected - is raising the grade of ASWs to deal with a local shortfall.
"Given the shortage in some areas, it's not surprising that we are also finding there's a lack of ASWs with the knowledge and experience to deal with black and ethnic minority communities," he said. "That's something that local authorities are having to give much more regard to.
"The lack of children's services is one that we have all got to work hard at remedying, in particular the assessment of integrated services between health and social care. There's a real risk we could take our eye off the ball of the increased importance between mental health and children's services."
The campaigning charity Mind welcomed the report's focus on poor service provision for minority ethnic communities. "They are often the victims of assessments [which aren't really followed] through with appropriate care and treatment," said policy director Melba Wilson. "We need to have multi-disciplinary assessments that take into account every aspect of a mental health service user's life, and shouldn't be rushed."
Proper assessments were often not taking place because of a lack of time and resources, she said.
Inspections took place in Barking and Dagenham, Bolton, Cambridgeshire, Derby, Hackney, Nottingham, Rochdale, Southwark, Walsall, and Warwickshire.
• Detained: SSI Inspection of Compulsory Mental Health Admissions is available from the NHS responseline on 0541 555 455 or from DH Publications, PO Box 777 London SE1 6XH
