The Care Quality Commission is looking for urgent “levers” to strengthen legal safeguards it fears are failing to protect vulnerable mental health patients.

The regulator is concerned at the number of people being deprived of liberties by commissioners, despite protective safeguards brought in last year.

Undoubtedly people are at risk

CQC commissioner Martin Marshall

It has also launched an “urgent review” after the proportion of patients on controversial community treatment orders who are being denied legal rights reached a new high.

At last week’s board meeting, CQC commissioner Martin Marshall said: “Undoubtedly people are at risk. We absolutely have said we’d come down hard on poor performance in the system and always [put] the patient first but the more I hear about the mental health service the more I see levels of stress.”

The Deprivation of Liberty Safeguards, brought in under a 2007 amendment to the Mental Health Act, were designed to ensure people would retain control over their treatment unless an assessment deemed they were unable to do so.

Department of Health figures in the most recent CQC board papers reveal more than the expected number of assessments are resulting in people losing liberties. By the end of March, a third of the expected assessments will have led to more than half of the expected authorisations.

The report calls for clarity on what should trigger an authorisation, saying some primary care trusts and local authorities are “setting conditions not directly related to the purpose of the deprivation of liberty”.

The CQC can only monitor, not intervene in, matters related to the safeguards.

But interim chair Jo Williams said: “We need to debate further and clarify what our role is and what levers we can pull if we feel there’s inappropriate action.”

A CQC performance report for quarter three also shows only 19 per cent of patients subject to community treatment orders were referred to a doctor for a second opinion within 28 days of being released from hospital, which is the legal timeframe.

The CQC oversees the second opinion service but has been hampered by doctor shortages, as well as unrealistic Department of Health forecasts on the likely numbers of community treatment orders. The DH predicted there would be 450 orders in the first year from when they were introduced in November 2008 but there were more than 4,000.

The CQC has indicated it may try to pull out of providing the service, highlighting in the board papers that it is “in the peculiar position of inspecting its own service provision”.