Mental Health Care Monitoring – The Lancet Psychiatry

Societies can be judged on how well they care for those most at risk, especially those who are least able to express themselves, such as people with mental disorders. Vulnerable groups have been particularly affected by the COVID-19 pandemic. The death rate from COVID-19 among adults with learning disabilities in the UK was 3.6 times the rate for the general population. However, there are some examples to celebrate, such as a national suicide prevention strategy in India, greater awareness of mental health issues, and various anti-stigma campaigns around the world.
In December 2021, the The Care Quality Commission has published a progress report on the use of restraint, segregation and isolation for people with mental illness, people with autism and people with learning disabilities in England. This report assesses what has been done in the 2 years since the publication of Out of sight – who cares? The initial report concluded that people with multiple needs often did not receive the support they needed to lead fulfilling lives and were too often subjected to harmful restrictive practices. The number of people in long-term segregation or prolonged segregation in child and adolescent mental health services, services for people with learning disabilities or adults with autism and reduced security and rehabilitation services has increased since 2018 . Out of sight made 17 recommendations to support system change, which were welcomed by the Secretary of State for Health and Welfare and several have been incorporated into an action plan. One of the recommendations was “to carry out an independent and thorough review of the care provided and the discharge plan of each person placed in isolation in a service for children and adolescents or in a service for people with learning disabilities and / or autism. Unfortunately, the progress report describes how a thorough review of care and treatment found that for most people little had changed to improve their situation. Baroness Hollins and an oversight committee recommended seven areas for immediate action, which have been adopted by the UK government’s national strategy for children, young people and adults with autism, together with the recommendations of Out of sight. Additional support is provided by the Lancet committee on the future of autism care and clinical research, which calls for a comprehensive model of autism care and treatment that emphasizes personalized and stepwise approaches to care.

People detained under mental health legislation are particularly at risk of segregation and isolation. The pandemic has made their situation worse due to additional restrictions placed on those hospitalized due to containment and infection control measures, reduced access to advocacy services and disruption of discharge plans. The COVID-19 pandemic has also exacerbated existing health inequalities: for example, in the UK it has had a greater impact on people from black communities, who are more likely, in certain contexts, to be subject to isolation or segregation than the general population. population.

The Care Quality Commission will continue to monitor whether strategies and promises can be translated into improved care, even as health services continue to deal with the ongoing effects of the COVID-19 pandemic. The Commission also assesses its own culture. It convened an expert advisory group made up of people with lived experience of a learning disability, people with autism and people with mental health issues, as well as national bodies that represent these services, providers, commissioners and other charities. Staff now say they are more confident in their ability to identify a closed culture and use regulatory measures to prevent closed cultures in wards.

There is more good news. The Commission Home for good The report featured eight people, some with autism, some with a learning disability, who had been hospitalized and are now thriving in community services across England. Characteristics of successful community support included person-centred care, appropriate and tailored housing and environments, and family involvement. It sounds deceptively simple, but the COVID-19 pandemic has compounded several challenges, such as fewer in-person visits with families and healthcare professionals, finding the right staff with the right skills, and the availability community placements.

Mental health services around the world need investment more than ever. They also need careful advocacy and monitoring to identify what is going well and provide guidance where performance is suboptimal. We commend the Care Quality Commission for its work on mental health care and encourage the formation of similar independent national regulatory bodies in countries where they do not yet exist.

About Antoine L. Cassell

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