Mr. John Saunders:

When the commission was established and as the Act dictated, it was given the powers to inspect approved centres. These are residential units that are mostly attached to general hospitals now, where people reside for a period when they are acutely unwell. Those units have replaced the previous large institutions that we all know about. For the first number of years, the commission also inspected those services but they have been closed down since. The Act is very clear that the commission, through its inspectorate, can inspect the approved centres and can put into place changes to improve the quality of service in them. They are commonly called conditions and there are various other steps beyond them. The commission has been doing that since it initiated its inspection process in the early 2000s.

The issue to which I alluded briefly is that since that time, and quite rightly, more and more people are receiving mental healthcare services outside of approved centres. They are going to primary care - to their GP - or to community mental health teams, staffed teams that provide support to people in their local community. I mentioned the community residences, where people live in group homes in the community. As time goes on and in line with A Vision for Change, fewer people statistically and theoretically would use the approved centres while more and more people would receive mental healthcare services outside of them.

The Act allows us to inspect any place where mental health services are provided. However, it does not allow us to regulate or impose changes on those places. We can inspect any community mental health team in the country and if we find issues that need to be changed we can make recommendations. However, we cannot enforce them because the Act, which is now quite old, does not allow us to do so. That is one of the issues around the review of the Mental Health Act. Provisions are needed to allow the commission to regulate all services. In my statement, I said that the vast majority of those now using mental health services are using services that are not regulated in the context of what the commission does. Time and progress have overtaken the original Act.