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No time to wait: why dignity and respect need to be at the heart of the Mental Health Act

Tuesday, 02 April 2019 Alison Cobb

In the first of our expert blog series around the Mental Health Act Review, Alison Cobb, our Specialist Policy Advisor here at Mind talks about the urgent need for dignity and respect to be placed right at the heart of the Mental Health Act.

Dignity and respect go to the heart of questions about the Mental Health Act and how it is used – it's about how you are treated at your most unwell. Are you taken seriously when you say you need support, do mental health professionals respect your wishes; and are you treated with humanity and as a person with fundamental human rights?

We'll look at the Act's powers to detain and treat in future blogs – this one is about how you are treated while you are detained in hospital.

It's hard to believe, listening to people with experience of the Act, that you're hearing about mental health care. People - many from Black and Minority Ethnic communities, some homeless – told us how hospital strips you of your identity and home comforts, and that your mental health is 'treated with a mallet'.

Black patients are overmedicated and seen as more violent; even if you are able to open up to the psychiatrist you aren't understood. We know it's not the same everywhere, but we heard of awful hospital buildings and a lack of facilities and activities that leaves patients with nothing to do with their time. While people gave credit to amazing staff on wards there was talk of an 'us and them' divide, authoritarian attitudes, and intimidation. Forced medication, restraint or being isolated in seclusion are all traumatising. Is that really what we should expect from mental health care?

Whether you are in hospital voluntarily or not, everyone is entitled to be treated with care and courtesy and you should have a therapeutic experience that benefits your recovery and focuses on what is important to you.

What does the Mental Health Act review have to say?

A big emphasis in the review is on giving more weight to people's wishes and preferences, for example in care planning and treatment decisions; something we'll come back to in a future blog.

The review recognises the poor conditions of many wards and recommends an overhaul of the requirements for ward design. It calls for a major investment programme to modernise NHS mental health buildings, for accommodation to be genuinely single sex and for dormitories to be replaced with single rooms so they offer safety, homeliness and dignity for what can be a long stay.

It also states that the social environment of wards should encourage a sense of community and help people stay connected with life outside hospital, and recommends that the independent health and social care regulator, the Care Quality Commission, makes this a yardstick of the quality of wards for when they inspect and rate them. The CQC has started work on this. You should leave hospital better able to manage and thrive in everyday life, not having lost contact with the outside world and with your confidence at rock bottom.

The review calls for an end to unjustified 'blanket' restrictions and behavioural systems that are used to make people comply. Being detained in hospital should not mean that you are threatened with not getting leave if you don't behave in a certain way, or that people are restrained in environments where tensions have been allowed to run very high. We need to treat people with respect.

What would it be like if wards were set up to provide hospitality, where people stayed there as guests? We don't have to speculate. Several of the Promise initiatives on wards in Cambridgeshire and Peterborough NHS Foundation Trust embody a spirit of hospitality: people are being woken up with a cup of tea in bed, closing the day with a tea and toast group at night. Guest or visitor status is explicit in mental health services in Trieste, northern Italy, and a lot of voluntary sector community crisis services, such as the Maytree sanctuary in London, Carlisle Eden Mind's Lighthouse and Leeds Survivor Led Crisis Service. There's no reason why it shouldn't apply in wards too – being welcomed with hospitality could really shift the dynamic.

The law can certainly make a difference, but legal changes alone won't create dignity and respect. And we shouldn't have to wait for legal change - we need better care now.

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About Alison

Alison Cobb is a specialist policy advisor here at Mind. She worked on our crisis care campaign and has been extensively involved in Mind's work on the Mental Health Act Review over the last year.

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