Mental Health Act 1983 monitoring visit Provider: Nominated Individual: Region: Location name: Location address: Ward(s) visited: Ward type(s): Type of visit: Sheffield Children's NHS Foundation Trust Simon Morritt North Becton Centre for Children and Young People Sevenaires Road, Beighton, Sheffield, South Yorkshire. S20 1NZ Emerald Lodge Child and adolescent service (CAMHS) Unannounced Visit date: 11 June 2015 Visit reference: 34143 Date of issue: 08 July 2015 Date Provider Action Statement to be returned to CQC: 28 July 2015 What is a Mental Health Act monitoring visit? By law, the Care Quality Commission (CQC) is required to monitor the use of the Mental Health Act 1983 (MHA) to provide a safeguard for individual patients whose rights are restricted under the Act. We do this by looking across the whole patient pathway experience from admission to discharge whether patients have their treatment in the community under a supervised treatment order or are detained in hospital. Mental Health Act Reviewers do this on behalf of CQC, by interviewing detained patients or those who have their rights restricted under the Act and discussing their experience. They also talk to relatives, carers, staff, advocates and managers, and they review records and documents. 1
This report sets out the findings from a visit to monitor the use of the Mental Health Act at the location named above. It is not a public report, but you may use it as the basis for an action statement, to set out how you will make any improvements needed to ensure compliance with the Act and its Code of Practice. You should involve patients as appropriate in developing and monitoring the actions that you will take and, in particular, you should inform patients of what you are doing to address any findings that we have raised in light of their experience of being detained. This report and how you act on any identified areas for improvement will feed directly into our public reporting on the use of the Act and to our monitoring of your compliance with the Health and Social Care Act 2008. However, even though we do not publish this report, it would not be exempt under the Freedom of Information Act 2000 and may be made available upon request. Our monitoring framework We looked at the following parts of our monitoring framework for the MHA: Domain 1 Assessment and application for detention Purpose, respect, participation and least restriction Patients admitted from the community (civil powers) Patients subject to criminal proceedings Patients detained when already in hospital People detained using police powers Domain 2 Detention in hospital Purpose, respect, participation and least restriction Admission to the ward Tribunals and hearings Leave of absence Transfers Control and security Consent to treatment General healthcare Domain 3 Supervised community treatment and discharge from detention Purpose, respect, participation and least restriction Discharge from hospital, CTO conditions and info about rights Consent to treatment Review, recall to hospital and discharge 2
Findings and areas for your action statement Overall findings Introduction: Emerald Lodge is a 9 bedded, mixed gender child and adolescent unit for ten to 14 year olds. It is located in The Becton Centre, a modern single storey building housing four wards and a school for the child and adolescent mental health service (CAMHS) in Sheffield. There were 7 patients on the ward on the day of the visit, one of whom was detained under section 3 of the Mental Health Act (MHA) 1983. We were shown round the unit to view the facilities. The unit was spacious. All patient rooms were single with on-suite shower and toilet facilities. Bathing facilities were available for patients that preferred a bath We were shown the dining area, where patients ate together and a large lounge area with ample seating, an organ, table football and a variety of board games. The unit also had a separate female only lounge. The unit also had a newly installed seclusion room which we were informed had never been used. Patients had access to fresh air in the pleasant outside garden area which was in use by patients and staff during the visit. At the time of the visit six nursing staff were on duty two of whom were registered nurses and four were healthcare assistants. The unit manager was also available during the day. How we completed this review: This was an unannounced visit and we thank staff for their hospitality and assistance during the day. We were shown around the unit to view the facilities and we met with staff members and with one patient who asked to see us and was accompanied by a member of staff. We reviewed a sample of clinical records, care plans, assessments and Mental Health Act documentation. We fed back to the Unit Manager at the end of the day. What people told us: We were told by staff that the trust receives support from the local mental health provider in respect of their use of the Mental Health Act and that since our last visit staff had received further training provided by them. 3
We were not able to include patient comments in this report without breaching the patient s anonymity. Past actions identified: On our last visit we identified several issues, on this visit we were able to confirm that all had been fully addressed as stated in the provider action plan. These included: Copies of section 17 authorisation were not given to the patient or to the relative That the risk assessment used on the ward lacks detail. A process of searching patient s belongings that does not comply with the Code of Practice An application for a consultation by the second opinion appointed doctor (SOAD) was left so late that treatment had to be authorised under section 62 of the Mental Health Act. Domain areas Purpose, respect, participation and least restriction: We saw that patients and their parents/carers were actively encouraged to participate in the care planning process and the review of their care. This was evidenced in the documentation examined. We saw that the risk assessments introduced since our previous visit were reviewed and updated regularly. We observed staff interacting with patients during the course of the visit. All interactions observed treated patients with respect and dignity and there was evidence of good relationships with patients. Admission to the ward: We found that all the documentation associated with detention under the Mental Health Act was in order and an approved mental health professional (AMHP) report was filed in the notes as were copies of detention papers. We found forms for the recording of rights under section 132 MHA had been fully completed and that rights are repeated on a regular basis. Tribunals and hearings: We saw records of an appeal to the First Tier Tribunal. The reports were timely and complete. The doctor s report was prepared by a CAMHS specialist doctor and the patient had support from an independent mental health advocate (IMHA) and had legal representation at the hearing 4
Leave of absence: Completed forms were available to cover periods of leave under section 17 MHA and were signed by the responsible clinician. They also indicated who have received copies of these forms. We saw that all expired leave forms were clearly struck through once they had expired. Transfers: This domain was not reviewed on this inspection. Control and security: We were informed that all staff received an initial three day training in the use of restraint from an external organisation, with an annual one day refresher. Since our previous visit a seclusion room had been developed. We observed that the room met current requirements but had no clock within view for patients to observe the time. We were informed by staff that they had never had to place a patient in seclusion. We checked the seclusion policy and paperwork and found it did not meet current requirements in relation to independent multi-disciplinary team (MDT) reviews. We were shown the search policy and paperwork which had been developed since our last visit and saw evidence in the patient file that the recording of any searches was fully documented. Consent to treatment: Capacity to consent to treatment was found to be assessed and recorded in the record examined. We saw evidence that referral for an assessment by a SOAD, at the end of the three month period following the start of medication for the treatment of their mental health condition, was submitted to give adequate time to enable the T3 form to be in place to negate the need for section 62 to be needed. We checked the T3 authorisation attached to the medicine card and noted that all medication for mental disorder was appropriately authorised. General healthcare: We found documented evidence of physical health checks on admission in all records. 5
Section 120B of the Act allows CQC to require providers to produce a statement of the actions that they will take as a result of a monitoring visit. Your action statement should include the areas set out below, and reach us by the date specified on page 1 of this report. Domain 2 Control and security CoP Ref: Chapter 26 We found: The seclusion policy and paperwork did not meet current requirements in relation to independent MDT reviews and requires updating to the new Code of Practice 2015. Your action statement should address: How the trust will ensure that the seclusion policy and paperwork meets the requirements of the Mental Health Act (MHA) Code of Practice (CoP) 26.141 which states An independent MDT review should be promptly undertaken where a patient has either been secluded for eight hours consecutively or for 12 hours intermittently during a 48-hour period. Domain 2 Control and security CoP Ref: Chapter 26 We found: The new seclusion room had no clock visible from within the room to enable patients in seclusion to see the time. Your action statement should address: How the trust will ensure that this issue is addressed as required by the MHA CoP 26.109 During our visit, no patients raised specific issues regarding their care, treatment and human rights. 6
Information for the reader Document purpose Author Audience Copyright Mental Health Act monitoring visit report Care Quality Commission Providers Copyright (2013) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Contact details for the Care Quality Commission Website: www.cqc.org.uk Telephone: 03000 616161 Email: Postal address: enquiries@cqc.org.uk Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA 7