A Brief Statistical Analysis of Outcomes of my Assessments under the Mental Health Act
A reader of this blog (hi, La-reve) recently asked how often in my experience admission to hospital was deemed necessary, and of those, how many resulted in formal detention under the Mental Health Act.
I thought this was an interesting question, so I had a trawl through my records. (Throughout my professional career I have kept meticulous records of assessments and outcomes. This is not [just] because I am obsessive-compulsive, but because AMHP’s have to be able to provide evidence of active practice in order to gain reapproval every 5 years.)
The total number of MHA assessments I have undertaken during my career so far that have resulted in either: no admission; informal admission; Sec.2; Sec.3; or Sec.4, is approaching 600. From these figures I have extracted the following statistics:
No admission: 35.8%
Informal admission: 15.6%
From this you will see that over a third of assessments did not result in an admission at all. Just under half of the assessments (48.6%) resulted in detention under Sections 2, 3 or 4.
There are a number of reasons why a formal assessment under the MHA may not result in an admission.
• The request may have been inappropriate or misguided.
• Detention under Sec.136 (when a police officer removes someone from a public place who appears to be mentally disordered) nearly always triggers a statutory duty for an AMHP and a doctor to assess under the MHA. However, many of these assessments do not result in a hospital admission. This is often because the person may have been under the influence of drugs or alcohol at the time of their initial detention, or because the detaining police officer misinterpreted the person’s behaviour (police have little formal training in mental disorder).
• An alternative to admission has been identified. This may be that the patient agrees to take medication, or that the Home Treatment team takes them on, or it is identified that a crisis is resolved, or an admission to a care home or respite has been arranged as an alternative.
• Increasingly I am getting requests for assessments under the MHA for older people with dementia who lack mental capacity who do not actually need admission to hospital but do need to be removed from a risky environment. In those cases, the powers under the Mental Capacity Act can, and should, be used.
There are of course quite a few people who find themselves being assessed on multiple occasions. I have written about some of them. There are several reasons for this.
• Some people with severe and enduring mental illness such as bipolar affective disorder or schizophrenia may have little insight into their illness and therefore can be prone to discontinuing medication and withdrawing from mental health services. This can then lead to an acute relapse. These people may require repeated admissions under Sections of the MHA.
• Some people, especially those with borderline or emotionally unstable personality disorders, may from time to time display alarming or disturbing behaviour that others may identify as “illness” and which may lead to formal assessments. Behaviours may include impulsive overdoses, self harming behaviour such as cutting or burning themselves, or making threats to harm themselves. However, it is generally recognised that admission to hospital for these people rarely achieves anything, and alternative strategies are usually preferable. I know that in my CMHT we try and work with people with personality disorder to reduce their risk behaviours as a response to stress or distress by helping them to devise alternative coping strategies.
The relationship you may have with an individual patient may also influence outcomes.
• It is more likely that someone with a history of mental health problems who is assessed by an AMHP and doctors who do not know the patient will be detained under the MHA, especially if the assessment is occurring outside normal working hours. Having worked in the past in an out of hours emergency social work service, I know that professionals are often less inclined to take risks when assessing in the middle of the night; they are also less likely to have access to information that may help them with their decision making, and may also have less access to support services and alternatives.
• If I know a person and have worked with them over a period of time (and possibly been in a situation in the past with them where I have had to undertake a formal assessment), it is sometimes possible to use the trust the patient may have to persuade them to take medication or to accept an informal admission.