Exploring pathways to compulsory detention in psychiatric hospital and ways to prevent repeat detentions; Service user perspectives

Purpose: This study, co-produced by a team of academics, lived experience researchers and clinicians, explores the views and experiences of people who have been compulsorily detained in hospital under the Mental Health Act (1983) (MHA) in England, to understand how and why, from their perspective, compulsory detentions occur, and what might help prevent them. Methods: Semi-structured qualitative interviews were conducted with 20 people (55% male, 40% Black/Black British, 30% White British) who had been compulsory detained in hospital within the past 5 years. Lived experience researchers with relevant personal experience carried out interviews via telephone or videoconference, and participated in analysis of data via a template approach. Results: We derived three over-arching themes from interviews. The first theme was individual factors increasing or reducing likelihood of being detained and it encompassed factors related to peoples own lives and attitudes, including life stressors, not taking medication, the risk individuals may pose to themselves or others, and their attitude to and management of their mental health. The second theme was family and support network which reflects how attitudes and support from family, friends and support network may contribute to compulsory detentions or support people to stay well. The third theme was need for improvement in service responses which identified limitations of services that contribute to detention, including lack of collaborative care and choice, poor quality of professional support, and discriminatory attitudes from staff. Each theme also included potential approaches to addressing these limitations and reducing compulsory detentions. Conclusion: Findings suggest multiple interacting factors may lead to people being detained in hospital under the MHA, and that improvements to services, such as increasing collaborative care and service user-led family involvement, could prevent further detentions.