Regulator calls for a system-wide approach to improve mental health care

CQC’s annual report on the use of the Mental Health Act (MHA) was published on 29 January 2026, and looks at how providers are caring for patients, and whether patient’s rights are being protected.

The report is based on 635 MHA monitoring visits which involve speaking to 3,642 patients and 717 family members or carers.

As might be expected it covers:

• Rising demand and pressures on the system
• Staffing pressures and impact on care
• Environment
• Quality and safety of care
• Inequalities

In the foreword by Chris Dzikiti, Interim Chief Inspector of Mental Health, it states, “we continue to see examples where people feel their rights were poorly explained” and “Everyone has a role to play in reducing the use of restrictive practices”.

The summary (at pages 7-10) contains many key statistics including:

• Demand has continued to rise with 453,930 new referrals to secondary mental health every month.
• Between 2023/24 and 2024/25 they have seen a 17% increase in the use of Community Treatment Orders (CTOs).
• 9% of roles in mental health trusts were unfilled in March 2025.
• The number of children and young people awaiting first contact following a referral to NHS mental health services increased by 20%.

We would particularly draw readers attention to the following key areas of the report.

Amended MHA

• CQC will work with DHSC to revise the Code of Practice in 2026.
• The Act is likely to be implemented over a 10-year period, and they will develop their processes in parallel, so that this enables them to monitor the new provisions in accordance with their statutory roles.
• The Act has notable implications for their Second Opinion Appointed Doctor (SOAD) service. They anticipate a significant increase in demand because the reforms reduce the length of time a detained patient can be treated without their consent before a second opinion is required.
• The need for them to provide a SOAD within urgent timescales creates complexities and they are exploring how they can cater for these changes and the anticipated rise in demand for the SOAD service. Page 71 sets out the current demand – in 2024/25 they received 15,999 requests for a SOAD – the highest number since 2019/20.
• They will continue to work with DHSC to address the challenges created by the national shortage of consultant psychiatrists, who make up their SOAD service, and current funding arrangements.
• The scope and range of their monitoring activities will need to broaden to encompass new legislative provisions.

Place of safety

• They are continuing to find evidence of the time limit under section 135 and section 136 for admitting a patient to a health-based place of safety (24 hours) being breached because of delays in accessing an inpatient bed.

Discharge

CQC remind readers how they highlighted in last year’s report the new statutory guidance on working together to ensure effective discharge planning. Despite this, they are still seeing that challenges around collaboration and funding continue to affect people.

Systems

They heard from providers that:

• Information can get lost in transition and that there are too many handover points
• A lack of shared computer systems to store and access information across services added to difficulties in communication and contributed to working in a silo
• Too many IT systems in places that do not speak to each other

Quality and safety

• They saw instances where care plans lacked detail and did not consider patient’s individual needs.
• Some patients reported that although they were given copies of their care plans, they had not been involved in reviewing them.
• CQC’s human rights approach to regulation states that people who use health and care services need to be empowered to understand their rights and services that respect human rights are fundamental to good outcomes for people. However, communication about people’s legal rights varies across services
• There is an alarming paragraph at page 46 entitled “De facto detention”. It states our MHA reviewers expressed their concerns that too many people, especially those on wards for older people, were deprived of their liberty without clear legal authorisation. They explained that this can happen when a person is kept in hospital while not being formally detained under the MHA or having a Deprivation of Liberty Safeguards authorisation in place to provide an alternative authority to keep them detained. As discussed in our State of Care report, applications to authorise the deprivation of a person’s liberty have increased significantly over the last decade, often resulting in lengthy delays. MHA reviewers said that this practice has become so common it is “almost normalised”. Where patients are deprived of their liberty without a legal authorisation in place, they have no legal framework to use to appeal the deprivation of their liberty or de-facto detention. They also have no right to support from an Independent Mental Health Advocate to help them understand their rights, or to support them in raising concerns about their situation.

Technology

• To reduce restrictive interventions, we have seen services using technology to keep people safe, while giving people who are detained some control over their lives.
• In our last MHA monitoring report, we acknowledged that periodic observation by staff during the night, while often necessary, can disturb patients’ sleep and be experienced as severely intrusive. We noted that some services have adopted digital contactless patient monitoring technologies in part to lessen this disturbance. Such systems have had a controversial reception from some service user groups, and in 2025 CQC published guidance on our expectations in relation to practice around these.

Regulatory activity

• Themes from concerns raised with providers in monitoring visits included Consent to Treatment (11%), MHA paperwork (7%), and other legislation (2%).
• A total of eight complaints and concerns were formally investigated and included a failure to involve a Nearest Relative and a failure to adhere to the Trust’s Duty of Candour policy.
• Recommendations made included strengthening governance structures around audit and safeguarding data, introducing new risk assessment and management plans, and providing workshops on the MCA and consent.

So, lots to digest as always.

This is going to be a busy year!

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