As Private Providers Take Over Mental Health Detentions Increase By a Third in Five Years
Byline Times reveals a startling rise in the number of people detained under the Mental Health Act, just as the number of mental health beds owned by private healthcare providers increases
The number of people detained under the Mental Health Act has increased by nearly a third over five years, according to analysis of NHS data by Byline Times.
On average, just over 16,000 people per month were detained under the Act between April 2021 and August 2021, compared with just over 12,000 people per month over the same period in 2016. The figures quoted start at the end of the second full lockdown.
“We cannot and should not become immune to the fact that the number of people detained under the Mental Health Act continues to rise,” Alexa Knight, Associate Director for Policy and Practice, Rethink Mental Illness, told Byline Times. “Every statistic represents a person whose life has been put on hold due to mental illness, and any increase underlines how people severely affected by mental illness have been acutely impacted by the pandemic.”
Alongside the increase, there has been a 14% fall in the number of mental health beds from 2014/15 to 2018/19. Reducing the number of mental health beds has formed part of strategic commitment to support people in the community. However, reductions in community care services mean that people are sometimes failing to get the help they need to avoid crisis situations and hospital admissions. This can in turn lead to individuals being detained.
While bed numbers have fallen overall, the proportion of mental health beds owned by private healthcare companies has continued to rise. It is estimated 30% of mental health hospital capacity is now in the private sector – with 98% of private facilities’ earnings coming from the health service. In some regions, the rates are even higher. For example, in Bristol, North Somerset and Gloucestershire, 95% of mental healthcare beds are owned by private providers, and three-fifths are owned by US companies.
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The reduced number of beds may also explain why a concerning number of people detained by the Mental Health Act continue to be held ‘out of area’. In August 2021, 50 patients in England were hospitalised more than 300km from their homes. Of 690 out of area placements in England this summer, 615 were considered “inappropriate”, meaning that patients are sent ‘out of area’ because no bed is available for them locally, which can delay their recovery.
“It is hugely concerning that the number of Out of Area Placements is going up despite the Government target to eliminate the practice,” Knight explained. “Out of Area Placements can be hugely damaging, sending people miles from home for life-saving treatment, cutting them off from community support and ultimately delaying recovery.”
“The increase in these placements comes from a combination of factors, including the impact of the pandemic, the strain on social care and with investment into community mental health services at the start of its planned transformation,” Knight added. “Without adequate funding for social care, significant pressure will continue to be placed on NHS emergency and inpatient services, and progress towards key Government targets such as this will stall.”
Tragically, between June 2018 and March 2019, there were at least seven deaths of people who were assessed as requiring admission, but for whom no mental health bed was available.
Although the number of people detained under the Mental Health Act decreased during March and April 2020 due to the start of the pandemic, there was a sharp increase at the end of the first lockdown period in May of that year.
In its State of Care Report 2019/2020, the Care Quality Commission expressed concern that there would have been “unmet need” for mental healthcare during the lockdown, which “may increase the risk of coercive pathways into mental health care, including detention under the Mental Health Act.”
Coercive measures have a disproportionate impact on black and minority ethnic patients, who are more likely to be detained than their white peers. In 2019/20 there are 321.7 detentions of black and minority ethnic individuals per 100,000 population – over four times more than of white patients.
People from deprived communities are also more likely to be detained under the Mental Health Act than those from wealthier areas.
Deaths of people detained under the Mental Health Act were higher in 2020 than in 2019, in part due to people dying from the Coronavirus. Between 1 March and 1 May 2020, 112 people had died while sectioned under the Mental Health Act, of which 56 patients had died from suspected or confirmed Covid-19. This was double the number of deaths compared to the same period in 2019.
Alongside Byline Times’ analysis, new data from the charity Women in Prison has found that prisons continue to be used as a “place of safety” to detain people in a mental health crisis, due to a shortage of mental health services in the community. Senior managers at one women’s prison counted 24 such incidents in the previous 12 months.
“Women who are severely unwell are being locked away simply because there aren’t enough beds in mental health facilities,” said Dr Kate Paradine, chief executive of Women in Prison. “Prison is a dead-end that will never be able to meet people’s mental health needs.”
New Structures, Private Interests
Although the Government’s new Health and Social Care Bill has very little to say about mental health – plans to reform the Mental Health Act are due in a separate bill – it will still have profound implications on mental health care.
This is in part because the bill aims to restructure the NHS by replacing Clinical Commissioning Groups (CCGs) with Integrated Care Boards (ICBs). These boards will be trusted to decide how much money is spent on mental health care, what services are funded, and who provides them.
While integrated care boards could result in more joined-up support for mental health patients, they have been criticised for opening up private sector interests into the NHS. The new structure provides a greater chance for representatives from private companies to influence decision-making on mental health provision.
The timing has also been criticised, with the British Medical Association Council passing a resolution calling for MPs to reject the bill, arguing it is “not the right time” to bring in widespread reforms as the NHS deals with the Covid-19 pandemic.
The plan to move decision-making from local CCGs to the larger ICBs could also result in local communities being further away from where power lies in the healthcare system. With nothing in the bill to ensure mental health is given equal precedence with physical health in integrated care systems, there is a risk mental health will be marginalised.
Further, while the bill demands ICBs tackle health inequalities, there is little to show how they will be held to account for this. With mental health detention increasing, and disproportionately impacting black and minority ethnic people, as well as patients in deprived areas, the bill could fail to deliver on the ongoing mental health crisis.