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C&I-based research on detention rates to aid MHA debate

Alice and colleagues
Research carried out at C&I analysing compulsory admissions under the Mental Health Act (MHA) could be an important addition to the current debate on how to reduce detention rates across England.
The Government is currently considering new legislation to reform the MHA, following last year’s report of an independent review of the 1983 act.  A focus of the review was addressing the rising rate of compulsory admissions to a psychiatric ward, ethnic inequalities in detention rates and need for modernisation of detention processes.
Now an academic paper, published in the British Journal of Social Work, and based on analysis of C&I MHA assessments has indicated potential factors that might influence whether a service user is detained under the MHA. To read an abstract of the research click here.
The study was carried out by Alice Wickersham, when a Masters student in Clinical Mental Health Science at UCL and on an honorary contract at C&I.
She was supervised by Shilpa Nairi, while an Approved Mental Health Professional (AMHP) Training Manager and now C&I Crisis Team Operational Services Manager, with overall academic supervision provided by Dr Brynmor Lloyd-Evans, Senior Lecturer in the Division of Psychiatry, UCL. The picture above shows (l-r): Shilpa Nairi, Alice Wickersham and Dr Brynmor Lloyd-Evans.
The research, based on 150 MHA assessments between September 2016 and February 2017, found that higher perceived risks increased the likelihood of detention, and the presence of a practitioner from an involved community team at the MHA assessment was associated with lower risk of detention. Qualitative feedback from MHA assessors indicated that likelihood of detention might be influenced by:
• All three assessors required not being available together
• Having high detention thresholds, and a referrer or team who knows the service user being present at time of assessment
• AMHPs not having time or capacity to withhold from completing a detention application rather than trying alternatives
• Arranging assessments as quickly as possible, particularly when the police are not required
• Inappropriate use of the MHA just to allow compulsory community treatment, or when Deprivation of Liberty Safeguards would be appropriate
• Assessors having as much background on the service user as possible, or a family member available, to further inform decision-making
• Wider working with service users in the community to intervene early, involving crisis and home treatment teams
• Lack of availability of beds
Dr Lloyd-Evans said: “Alice’s paper is very timely given the recent review of the Mental Health Act and the clear need nationally to reduce the rate of detentions in England, which are amongst the highest in Europe.
“The comments and feedback from assessors during her research indicate areas where specific focus is needed in current practice and future research, to help minimise use of detention, without compromising the care and safety of service users.”

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