Mental health patients in crisis put at risk by 'legal grey areas', investigation finds
There are currently no powers for A&E staff to prevent patients in crisis from leaving while awaiting assessment or admission
Patients are being placed in “inhumane” conditions because of legal ambiguities surrounding care for patients in crisis, an investigation has found.
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The Health Services Safety Investigations Body (HSSIB) said that when a patient in a mental health crisis was being cared for in A&E, there were no powers for staff to prevent them from leaving while they were waiting for assessment or admission.
This was forcing doctors to choose the “least harmful way to break the law”, the HSSIB said.
One consultant psychiatrist told HSSIB the “dilemma is stark” as they faced deciding whether to hold the person unlawfully, breaching human rights, or letting them go.
Inspectors from the health safety watchdog saw a patient who had been locked in a single room, with only a toilet, for more than four days.
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“It was not safe for staff to be in the room with them and it was not safe for the door to be unlocked as the patient kept attempting to leave and was desperate to end their life,” a new interim HSSIB report said.
“Staff described that the patient was not receiving any therapeutic intervention and it felt ‘cruel’ and ‘inhumane’ for them to be waiting so long for a bed when they were so mentally unwell.”
Nichola Crust, senior safety investigator at HSSIB, said: “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.
“Without clear legal frameworks, staff repeatedly told us that they are placed in an impossible position when trying to keep people safe.”
The Royal College of Emergency Medicine said gaps in the law and service provision can mean patients in a mental health crisis can face “prolonged stays in emergency departments – often lasting many days and in rare cases weeks”.
College president Dr Ian Higginson said: “The consequences of these gaps have been underscored by several coroners following tragic cases in which patients have left the emergency department after seeking help and have subsequently come to harm.”
The HSSIB called on the Government to act to prevent staff from working in a “legal grey area”.
Mark Winstanley, chief executive of the charity Rethink Mental Illness, said: “This report sets out appalling examples of unsafe care that people have experienced during a mental health crisis, alongside the impossible situations hard-working staff face on a daily basis.
“The basic expectation that we will be kept safe, and treated with dignity if we’re unwell and vulnerable, is routinely not being met.”
A Department of Health and Social Care 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 £473 million in mental health infrastructure by 2030 to modernise facilities, expand neighbourhood mental health services and increase crisis care capacity.”