And the fact that this didn't come as a surprise should be shocking.

The Care Quality Commission published their Mental Health Act Annual report today. It found that 15% of people were not directly involved in their own treatment decisions. The use of detention under the Mental Health Act has increased by 5% in the last year.

This is not great news in a society that generally seemed to me, at least, to be improving in its ability to talk about mental health in a more open and less stigmatising way, helped by the recent disclosures by footballers about their experiences of depression. Yes, I know they were treated badly by some sections of their own community but I don't think any footballer would have dreamed discussing it in the open when I started my nursing career.

What made me sad more than anything else, was that the culture seems to be coming more and more about control and restraint and restrictions than about therapy. I can remember when the decision was taken locally to lock the doors on all the mental health in-patient units.

For me it was a disaster. It seemed to mean that rather than having to need to have therapeutic skills and relationships with the people you were caring for, it meant all that was needed was somebody with a swipe pass. Some of the best interventions I've ever been involved in were when people were determined to leave the ward, sometimes it was a good decision, sometimes less so. But unless there was an immediate and very high risk, people chose for themselves whether being an inpatient was right for them.

There are lots of brilliant nurses and carers out there. There are some fantastic service user groups and advocates. Let's hope this report spurs them on to retake the lead and move back from restriction to therapy.

If you'd like to involve me in a review of your care, culture and practices, please don't hesitate to contact me.

The report is available here.

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