Mental Health Act 2025 — Written evidence submitted by the Care Quality Commission (CQC) (MHB27)

Mental Health Bill [HL] (10th June 2025)

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Session 2024-25

Mental Health Bill [HL]

Written evidence submitted by the Care Quality Commission

to the Public Bill Committee on the Mental Health Bill (MHB27)

About CQC

The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England. Our purpose is to make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage these services to improve.

[1]

Appointment of Dr Arun Chopra

Dr Arun Chopra has joined as our first ever Chief Inspector for Mental Health in May 2025.

[2]

Dr Chopra leads both on our role in inspecting mental health services (under the Health and Social Care Act) and monitoring the Mental Health Act (MHA). Dr Arun Chopra’s role will help to shape our regulation of the mental health sector and support the delivery of better care as we continue our return to being the strong effective regulator people need and deserve. His role will also carefully explore how to strengthen our focus on MHA compliance in the regulatory assessment of providers and how to ensure we have the appropriate resources and processes so that we can effectively monitor providers’ compliance with all aspects of the MHA, including the reforms when they are enacted.

As part of the accountability process after the Bill becomes law, the Parliamentary Under Secretary of State made a commitment in Parliament to review our (CQC) effectiveness in delivering our Mental Health Act functions. Specifically, this will involve plans to report on our monitoring functions under the Act. This review is to feature in the first of the Government’s annual reports on implementation of the Bill.

[3]

Dr Chopra will work closely with the government on this review and in the delivery of these reforms.

CQC’s Mental Health Act role

We have specific duties and powers under the Mental Health Act (MHA) 1983

[4]

to protect and safeguard the interests of people whose rights are restricted under the Act. Specifically, we have statutory duties under the MHA to:

·

Monitor how services and organisations exercise their powers and discharge their duties when patients are detained in hospital or are subject to community treatment orders or guardianship

·

Visit and interview people who are detained in hospital under the MHA, and

·

Require providers to take action to respond to concerns identified in our MHA monitoring

It is important to note that these MHA duties were transferred from the Mental Health Act Commission to CQC when it was formed and are different powers and duties to those we use to regulate the health and social care sector under the Health and Social Care Act (HSCA) 2008.

Under the HSCA, all health and adult social care providers that are carrying out a regulated activity, including those providing mental health care and treatment, must be registered with CQC.

[5]

We have powers under the HSCA to assess the quality of care and treatment provided and if necessary, to take enforcement action to ensure people are kept safe and receive treatment in accordance with statutory regulations. Assessment of care provided by mental health providers is likely to involve some consideration of how a service discharges its duties under the Mental Health Act. This may be partly informed by information gained through our MHA duties, specifically our monitoring and complaint activities.

CQC also has a duty to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) in England. We monitor DoLS when we assess care homes and hospitals, and we report annually on our findings through our State of Care report

[6]

.

Our duties under the MHA also mean we:

·

Have a discretionary duty to investigate complaints relevant to the MHA and this may involve assessing whether the provider followed their own complaints process appropriately

·

Deliver the second opinion appointed doctor (SOAD) service

[7]

and

·

Publish an annual report to Parliament on the activities carried out relating to our MHA duties

CQC is also one of the 21 statutory bodies which make up the UK’s National Preventive Mechanism (NPM). As a designated NPM body, our powers to inspect, monitor and visit places of detention are formally recognised as part of the UK's efforts to prevent torture and ill-treatment.

[8]

Our MHA colleagues

·

The CQC MHA monitoring team includes MHA reviewers who have in-depth knowledge of the MHA and Code of Practice; and significant experience in talking with detained patients.

·

Our SOAD team includes experienced Consultant Psychiatrists who deliver the statutory second opinions on treatment, required under the Act.

Below we outline key areas of interest to us in the Bill. We would welcome clarity from Government on how they plan to monitor progress on all of the below themes as the Bill progresses into legislation and into the implementation stage.

Our

Second Opinion Appointed Doctor (SOAD) Service

We are responsible for providing the SOAD service and receive over 15,000 requests for second opinions each year. This is an important safeguard for people who are detained under the MHA, which provides an independent medical opinion on the appropriateness and lawfulness of certain treatments given to patients who do not or cannot consent.

[9]

There are many positive proposals in the Mental Health Bill regarding the SOAD service.

[10]

The reforms will:

·

Increase safeguards for people who are detained under the MHA and aim to address many of the issues we have raised in successive Monitoring the Mental Health Act reports.

·

The Bill proposes reducing the length of time that people who are detained can be treated without their consent before a second opinion is required. The length of time would reduce from 3 to 2 months for patients who lack capacity. This will mean there are additional expectations of the SOAD service. These proposals will increase the numbers of second opinions required and will reduce the timeframes for delivering some second opinions.

·

The Bill

will

increase protections for patients undergoing urgent electroconvulsive therapy (ECT) procedures, including by requiring a SOAD to certify the treatment before it is administered where the patient is refusing treatment or makes an advance decision. We support this proposal and will revise and review our SOAD service processes to establish how we can deliver an urgent SOAD service when required.

·

Estimated figures on the number of urgent ECT treatments are in the range of several hundred annually. As we do not have current comparable volumes to rely upon, we urge the committee not to rely heavily on this figure.

·

We support the intentions of the Bill to ensure that ECT is only given where necessary and appropriate if it is to be given without consent. However, harm can also occur where ECT is not readily available to patients who would benefit from, and consent to it. Provision of ECT clinics is not uniform across mental health services and some patients must travel long distances for treatment or may not be offered treatment at all, given local provision.

·

The Bill initially allowed the use of remote technology for urgent ECT second opinions only. We maintained that this should be extended for all second opinions, where appropriate or necessary. This has been accepted and a government amendment will seek to address this.

Our duties under the MHA are funded by grant in aid (GIA) from DHSC, and additional funding is essential for us to deliver the future second opinion service, in order to meet the predicted approximate 76% rise in second opinion requests and more generally our statutory duties. This is also essential for maintaining a fee rate for second opinions which will need to keep pace with market comparators and inflation rises.

It was recognised by the Department of Health and Social Care (DHSC) in their impact assessment for the Mental Health Bill that the policy interventions in the Bill will bring additional costs. We are having ongoing conversation with DHSC and are keen to receive assurance that the necessary additional GIA will be provided by DHSC. Without this additional guaranteed funding, which DHSC is yet to confirm is available, it will not be possible to deliver the proposals within the legislation. Furthermore, ongoing challenges with workforce availability means that additional funding alone will not be enough to address the issues facing the SOAD service. For example, there is a national shortage of Consultant Psychiatrists, from which our potential SOAD pool is drawn and therefore the government’s wider plan needs to address lack of psychiatrists. Over the last 2 years we have increased the fee paid to SOADs and carried out targeted recruitment to increase the number of SOADs. However, we are still struggling to recruit enough and have significant shortfalls in the numbers needed to deliver our current second opinion duties.

[11]

We are keen to also understand the government’s wider plans to address these workforce challenges.

People with a learning disability and autistic people

Previously, we have raised concerns about autistic people and people with a learning disability staying in hospital for prolonged periods when this does not meet their needs.

[12]

We know that in almost every case, the principal cause is the lack of a practical alternative in the form of community support.

We welcome the ambition to change this situation, which is reflected in the proposals of the Mental Health Bill to exclude learning disability or autism from the scope of civil detention for treatment under the MHA. This means that having a learning disability or being autistic alone cannot be a reason to detain a person for longer than 28 days. However legislation alone will not bring the changes needed. Without suitable community-based alternatives there is still a risk that people may be detained unsuitable hospital placements under alternative legal powers such as the Deprivation of Liberty Safeguards (DoLS) or its eventual replacement, Liberty Protection Safeguards. For the same reason, autistic people and people with a learning disability could also become increasingly vulnerable to being drawn into criminal justice measures, such as detention under the criminal justice powers of the MHA, or imprisonment. It is therefore essential to ensure that improved community support is in place throughout the country before reforms are implemented.

[13]

In 2023, DHSC asked us to take a lead on Independent Care (Education) and Treatment Reviews (IC(E)TRs) for 2 years. We will be reporting on this work programme in Spring 2026. The focus of our IC(E)TR programme is reviewing people’s care and encouraging providers and commissioners to overcome the barriers to support people to move out of long-term segregation into more suitable environments where they can flourish.

[14]

IC(E)TRs are Grant in Aid funded, with funding to end this year. Continuation of additional funding would be required to progress this programme beyond 2025.

We have seen positive examples among IC(E)TRs so far:

·

2 people have been successfully discharged from long-term segregation in a high-secure setting.

·

A young person was successfully moved to more appropriate adult services in a single-person accommodation that better meets their needs.

·

2 people have been discharged into bespoke community placements.

·

Of the 56 IC(E)TRs completed, 16 (29%) people have left long-term segregation, either working towards this from the ward or directly moving to the community.

·

We have also seen the numbers of people in long-term segregation reduce from 97 in February 2024 to 81 in April 2025, showing that challenging justifications for keeping people in long-term segregation has a significant impact on the lives of those detained.

Patient voice and involvement

The Bill as amended in the House of Lords adds, among other things, a duty under Clause 35 for mental health patients to be offered a consultation with an independent mental health advocate to review their experiences of hospital treatment, within 30 days of their discharge.

[15]

Below are key actions we take as part of our role to listen to and involve patients:

·

We visit and interview people currently detained in hospital under the MHA and review whether the Act and the Code of Practice are being complied with.

·

Through our MHA Monitoring visits, we have conversations with thousands of patients, carers and staff every year.

·

When we visit mental health inpatient units, we introduce ourselves to all patients on the ward and speak with detained patients in private to hear about their experiences and enable them to raise concerns or issues directly with us. We include patients’ concerns and issues in our visit reports and require action from providers on the concerns raised.

·

MHA visit reports include our review of the use of the Act and the MHA Code of Practice at the location or ward visited. All concerns raised result in action required from providers; and providers are required to respond to us with a record of the action they have taken or plan to take. Requests for action are often the result of themes or individual feedback gleaned from patient interviews. If providers do not respond, we can escalate such issues and may take regulatory action where necessary.

·

Our monitoring feeds into our Monitoring the Mental Health Act report which is published online and explores key themes from our conversations with patients

·

We will ensure any changes introduced by the Bill are reflected in our approach to monitoring the MHA, involving Experts by Experience and advocacy groups where possible. This will allow us to check whether the key aims of the reforms – including enhancing patients’ rights and safeguards and giving them a meaningful voice in their care and treatment– are being met.

Supervised Discharge

·

We welcome plans in the Bill to introduce a power of supervised discharge, aimed at closing a legal gap preventing discharge of some restricted patients.

·

These patients are a subset of patients discharged to the community under supervision conditions, where hospital inpatient treatment is no longer providing a therapeutic benefit.

·

This type of discharge should not become a default discharge route for restricted patients and should be used only when strictly necessary.

·

The extent of CQC’s role in this over and above our existing MHA statutory function is yet to be determined and discussions are ongoing with DHSC and the Ministry of Justice on this matter.

·

CQC is the National Preventive Mechanism against Torture and Ill Treatment (NPM) in relation to deprivation of liberty in health and social care in England. As such there should be a mechanism for us to be informed of where Supervised Discharge takes place, and rights of access to establishments and records for visiting and monitoring. Although the numbers of patients involved should be very small, there are resourcing implications and potential questions over legal powers to enable us to carry out our NPM duties.

Patient

and

Care

Race Equality Framework

·

The UK’s Mental Health Bill includes provisions aimed at addressing racial inequalities in mental health care.

[16]

·

We have reported over many years the worse outcomes for people from racialized communities who are detained under the Mental Health Act, for example in our Mental Health Act monitoring reports

[17]

·

We are fully supportive of the Patient and Care Race Equality Framework, launched in October 2023, as a policy response to this and are working on incorporating PCREF into both our Health and Social Care Act and Mental Health Act work.

[18]

[19]

·

We welcome the Government’s commitment to monitor and evaluate the impact of their reforms and focus on racial inequalities under the Act.

[20]

·

Our early work in monitoring the Mental Health Act carried out between January and March 2025 suggests that ward level awareness of PCREF is still low, with only 23 of 103 wards having heard of PCREF, only 8 of 103 having had training around PCREF implementation and only 50 of 103 having had any training on racial inequalities and implementing solutions to these inequalities.

We would welcome consideration of the best approach to accelerating progress on race equality within the Bill, including how the Bill aligns with the aims and approaches of PCREF as a policy response. This should include consideration of whether PCREF should be put on a more statutory footing, as well as other potential statutory levers.

6 June 2025

[1]

Our purpose and role- CQC

[2]

Dr Arun Chopra appointed as CQC’s first Chief Inspector of Mental Health- 20 March 2025- CQC

[3]

LegislationMental Health Bill – House of Lords Report stage (Day 2)- UK Parliament

[4]

Mental Health Act (MHA) 1983

[5]

How we regulate mental health services- CQC

[6]

State of Care 2024- CQC

[7]

What to expect when you speak with Second Opinion Appointed Doctor (SOAD)- CQC

[8]

National Preventive Mechanism bodies- National Preventive Mechanism

[9]

What to expect when you speak with Second Opinion Appointed Doctor (SOAD)- CQC

[10]

The Mental Health Bill- UK Parliament

[11]

Monitoring the Mental Health Act 2023/24- CQC

[12]

Monitoring the Mental Health Act 2022/23- CQC

[13]

Monitoring the Mental Health Act 2023/24- CQC

[14]

CQC’s Independent Care (Education) and Treatment Reviews - Making a difference- Medium blog-CQC

[15]

The Mental Health Bill (as amended at Report stage)- UK Parliament

[16]

Better care for mental health patients under major reforms- DHSC

[17]

Monitoring the Mental Health Act in 2023/24 - CQC

[18]

Patient and carer race equality framework (PCREF)Our interim approach - CQC

[19]

Tackling inequalities in health and care - the NHS Patient and Carer Race Equality Framework by Care Quality Commission - Medium

[20]

DebateMental Health Bill [HL] - 2nd Apr 2025 - Baroness Merron extracts- UK Parliament

Prepared 10th June 2025

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