In October 2017 Sir Stephen Wessely was commissioned by the government to chair an independent review of the Mental Health Act ("the Review"). His terms of reference included making recommendations in relation to rising detention rates, the disproportionate impact of the Act on certain communities and the concern that the Act is out of step with a modern mental health system. The Review published its interim report on 1 May 2018.
The interim report describes how the Review is carrying out its work, both in terms of its governance and structure and by setting out how it has called for and received evidence. However, perhaps more interesting is the meat of the interim report which identifies key priority areas likely to be the focus of the full report which will make recommendations to Government in autumn this year.
In line with the Review's terms of reference the rising numbers of detentions under the Act and its disproportionate impact on black and minority ethnic (BAME) communities feature as two of these key topics.
In terms of detention rates the interim review sets out that the Review will, among other things, be considering what interventions could reduce compulsory admission and legislative and non-legislative ways of encouraging or mandating closer inter-agency work between services.
The interim report acknowledges that the variation in outcomes and experiences between ethnic groups is "one of the most significant challenges" the Review faced. A range of explanations for the fact that people from certain BAME communities are at higher risk of detention, come into contact with services through the police, are subject to CTOs and face other poorer outcomes have emerged from studies over the years. The interim report candidly points to the fact that solutions to these problems have been less forthcoming. Mind welcomes the Review's focus on these areas which reflects engagement work that we ourselves are doing. It is to be hoped that the Review makes some positive recommendations in its final report to address these imbalances and ensure that proper account is taken of people's cultural circumstances and needs in mental healthcare.
In addition to this, the interim report has highlighted 16 other key topics which the Review will be looking at in depth. It probably comes as no surprise that reform of the nearest relative provisions in section 26 of the Act are flagged up within the topic "Family and carer involvement". But Mind is also pleased to see that the Review will give consideration to other mechanisms through which the carers, families and friends of people who are detained can be supported to be involved in the care of the person they support.
We are also pleased to see in the interim report that the Review "is not persuaded that CTOs should remain in their current form". The Review heard from people that CTOs are often experienced as coercive and restrictive by the people who are subject to them and we have heard from people who say exactly the same thing. The evidence shows that this is an area with some of the biggest racial disparities in outcomes, with black African and Caribbean men being nine times more likely to be given a CTO than their white peers.
CTOs and the nearest relative provisions are 2 areas in which the interim report recognises that "change is necessary". In other areas the interim report does not express a view but merely highlights issues: - "Should MCA concepts of Powers of Attorney, Advance Decisions to Refuse Treatment, and court-appointed Deputies have a role in care governed by the MHA? Should we join up advocacy services provided by both pieces of legislation, possibly with other health advocates, to produce a unified and accredited service?" It will be interesting to see whether the final report makes definitive recommendations on some of these issues.
The interim report recognises that the Act cannot be looked at in isolation. There are broader issues of lack of respect for people's dignity, deficiencies in practice and procedure, and inpatient wards not providing suitable therapeutic environments which are likely to be issues not with the Act but how it is implemented. These issues are part of the remit of the Review and we will be working hard to ensure that the Review goes towards improving the experiences of people with mental health problems in the health service.
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