It was good to meet most of you on the telephone call hosted by Claire  Murdoch on 28 April 2020. I am aware that your services have been under significant stress during the Covid-19 pandemic and that staffing pressures have been a particular issue for some of you. I am also aware that a number of innovative approaches have been implemented in mental health services over this period and we have received positive feedback about the impact that these have had of the provision of services to patients. 

Context  

As I explained during the call, we have had concerns about the impact of the lockdown on the human rights of detained patients and we are keen to ensure that we have insight into how patients have experienced the lockdown. I am also aware that a number of organisations have developed tools to help staff with decision making around human rights during this period of restriction. 

The underlying principles we would expect organisations to adhere to are: least restrictive, necessary and proportional actions. We have started a series of Mental Health Act review visits which we have been holding virtually starting in the North of England. These involve interviews with ward-based staff and with service users on the ward. Our initial feedback is that staff and patients are finding this a useful way to discuss the situation on the ward, and we will be continuing these for at least the next few months. In addition, we shall soon be starting Mental Health Act Review site visits to services we consider to be high-risk. 

Rise in deaths of detained patients 

I also wanted to raise that we have seen an increase in notifications of deaths of detained patients. I have included the latest data that we have from our notifications of deaths of detained patients: 

In the period 1st March to 1st May 2020, we were notified of 106 deaths of people subject to MHA as reported by mental health providers. This included 54 deaths that providers indicated were confirmed or suspected Covid-19 related. This doubling of death notifications is due to Covid-19 related deaths and while this mirrors a rise in notifications from other sectors and includes deaths from confirmed or suspected COVID-19, it is obviously of concern.   

We will continue to review this data in order to understand what factors might be driving this and if any additional action might be required to safeguard people. If we identify any significant clusters of deaths, we will be contacting you separately to seek further information on why these deaths have occurred. 

We have also recently updated the notification form used to tell us about deaths of patients’ subject to the MHA, to make it easier to identify patients who are known or suspected to have died from COVID-19 related illnesses. I would ask that you continue to use this form to notify us promptly of all deaths of detained patients. 

As you can see there is a significant increase in deaths, which underlines the fact that infection control has never been more critical. We want to ensure you are taking all measures necessary to be able to manage cases of Covid-19 in your services, including having enough supplies of PPE and adequate training and staffing. 

I would draw your attention to new guidance on infection control issued by NHE/I. There is also a useful assurance tool accompanying the guidance, which I hope you will consider using. I welcome Claire’s update that they will also be sending out a guide to the use of PPE in mental health settings that describes visually what equipment is required in various clinical situations. My colleagues will be in touch with you in near future to explore any issues you may have had implementing the new guidance. 

I would also like to thank you and your colleagues more generally for the work you are doing to keep patients safe during this difficult period, and for your cooperation with my team during this very difficult time. I look forward to continuing to work with you to ensure that patients receive high quality care. As always, please do not hesitate to contact me should you wish to discuss this letter further.