Workforce shortages (which were already affecting many providers prior to the crisis) may present a further operational challenge over coming weeks but the MHA must continue to be used to detain and treat people in a timely way, where this is necessary.
Consideration must be given to the possible impact on access to section 12 doctors, AMHPs and independent mental health advocacy (IMHA), possible reduction in staff with specialist learning disabilities/autism training, difficulties in accessing mental health tribunals and increases in community treatment order recalls to hospital and subsequent assessments.
The guidance suggests mitigation actions for these challenges, such as:
- deploying additional administrative resource;
- collaborative working between NHS providers and local authorities;
- use of appropriate digital technology;
- enhanced communication with patients and families;
- advanced planning for MHA work; and
- utilising dedicated senior operational resource to co-ordinate demand and capacity.
Restraint and restrictive practices
In these unprecedented times, there may be a justifiable need for restrictive practice in order to maintain both patient and staff safety, for example, where patients refuse to isolate. However, providers must, at every opportunity, use the least restrictive methods possible in line with the MHA and MCA Codes of Practice. Decisions to increase forms of restrictive practice resulting from the impact of COVID-19 should always be documented. Any use of restriction must be proportionate to the risks involved and, if required, a referral should be made to the provider’s ethics committee.
The guidance makes clear that MHA powers must not be used to enforce treatment or isolation for any reason unrelated to the management of a person’s mental health, such as detaining inpatients whose refusal to be tested/isolated is unrelated to their mental disorder.
Every decision to use restraint must continue to take into account the need to respect an individual’s liberty and autonomy. Restrictions should continue to be used only if they are necessary to prevent harm to the person in a proportionate manner and stopped at the earliest opportunity.
Providers should not impose blanket restrictions if they can be avoided. If they are necessary and proportionate due to COVID-19 providers should regularly review and document why they are necessary.
Managing patients with COVID-19
Isolating patients in a mental health setting may be challenging and providers should determine the use of the appropriate legal framework when doing so on a case-by-case basis. NHSE/I are intending to showcase legal and best practice frameworks.
Refresher physical health training for staff is recommended.
Mechanical restraints should not be used solely for infection prevention control purposes.
It is recommended that all inpatient settings should cohort all patients in specific categories even though this may breach each provider’s same sex accommodation guidelines.
To mitigate against any additional risk or distress to patients, the guidance recommends that providers assess the implications for each individual person and communicate transparently and effectively with them, their families and advocates.
Escorting patients detained under the MHA, including those on Restriction Orders (sections 41 and 49 MHA) to and from acute general hospitals
Where this transfer is related to the treatment of COVID-19, it is important that patient, staff and public safety is considered as part of the individual risk assessment, but this must be balanced with the risks in relation to infection control for all those involved.
All transfers must be planned in conjunction with the acute hospital’s safeguarding policies.