The HSSIB says there are no legal powers to lawfully prevent vulnerable individuals from leaving emergency departments while awaiting assessment or admission, placing them at risk of harm and creating extremely challenging conditions for healthcare staff.
Nichola Crust, senior safety investigator at HSSIB said: ‘People experiencing a mental health crisis are often at their most vulnerable when they arrive at the emergency department. Our report has highlighted that the unclear legal powers don't just create operational complications for care. They can have a devastating impact on patients, leaving them exposed to uncertainty, emotional distress and an increased risk of harm at a time when being as safe as possible is paramount.'
The report says staff and organisations are sometimes forced to choose ‘the least harmful way to break the law' in order to try to keep people safe.
In one example, the HSSIB saw a patient who ‘was desperate to end their life' locked in a single room with only a toilet for over four days.
The investigation identified prevention of future deaths reports referencing coroners' concerns about the legal gap and deaths associated with patients who attend ED in mental health crisis and are able to leave.
Around 3% of all ED attendances are related to mental health, however, people experiencing mental health problems are twice as likely as other patients to remain in EDs for more than 12 hours. For those who require admission to a mental health hospital, an application under the Mental Health Act 1983 cannot be completed until an inpatient bed has been identified, which can sometimes take days.
The report highlights prolonged stays can worsen patients' distress and create challenges in maintaining a safe environment for patients, staff and other people using the department.
It calls on the DHSC to urgently review the current legal framework and address legislative gaps affecting the care of people in mental health crisis in emergency departments. In addition, it asks the CQC to work with stakeholders to produce a national position statement on existing legal powers and expectations for staff supporting people in mental health crisis in emergency departments who are not detained under a formal legal framework.
A DHSC spokesperson said: ‘It's clear patients experiencing mental health crises have not been getting the care they deserve, which is why we have reformed the Mental Health Act to make sure they receive appropriate treatment and are treated with dignity.
‘We also know greater clarity may be needed for health professionals in emergency departments treating these patients and we will explore this as part of our forthcoming consultation on police powers. We're also investing an additional £473m in mental health infrastructure by 2030 to modernise facilities, expand neighbourhood mental health services and increase crisis care capacity.'
Other DHSC measures include investing up to £120m in increasing the number of mental health emergency departments to 85, full national coverage of 24/7 liaison mental health teams in general acute hospitals as well as high fidelity crisis teams in a community and developing new core standards of care for community mental health services.
A CQC spokesperson said: ‘These are important findings and we fully support calls for improvements in the care of patients with mental health needs in an acute setting. We are currently considering the report in full, and the recommendation made for CQC to determine our further action in response.'
