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While we found evidence of early and active community interventions, we found some people who were admitted in crisis situations that could have been anticipated or prevented.
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For most people, we were pleased to see good attention to the principles of giving information and encouraging participation. We found good examples of negotiation and attention to the views of individuals and carers.
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In the vast majority of cases, we found that care and treatment was appropriate to people's needs and that a good range of options were considered.
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In most cases, we found that care plans were being updated and were responsive to change in the person's condition.
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We found cases where there were no clear decisions made about the grounds for a compulsory treatment order until very late in the 28 day period. This leads to late applications to the Mental Health Tribunal but also leaves the individual, relatives and ward staff in a state of uncertainty.
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About a third of people detained on short term detention certificates have a nominated named person. We had some concerns about the suitability of some "default" named persons, recording of named person information and people being pressured into choosing a named person when they did not want one.
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There was very good evidence of advocacy provision although there was some evidence that access was more limited for people with dementia and acquired brain injury.
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Doctors did not always follow correct procedure for medical treatment. They did not always notify us of urgent treatment or have proper documentation for people who were already subject to compulsory treatment in the community before detention. We also found poor compliance with part 5 of the Adults with Incapacity Act for treatment for physical health problems.
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In nearly half of cases, we were not satisfied that people had been told of their right to appeal to the Mental Health Tribunal. They may have been given this information on admission, but had either not understood it or retained it.
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We found good medical reviews during the first week of people's detention. After the first week, we did not think that doctors reviewed people often enough, especially to look at whether the grounds for detention were still met.
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Nursing contact was usually documented well, but it was not always possible to find out how often the named nurse saw the person. People seldom saw their mental health officers after admission.
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We had other concerns, about quality of documentation, blanket use of searches and taking samples to test for drugs or alcohol, and the use of statements such as "detainable if wishes to leave" for informal patients.
