The Government has commissioned an independent review of the Mental Health Act. It is due to produce its report and recommendations towards the end of the year, but there will be an interim report, expected in April.
The Mental Health Act sets out when people can be detained and treated in hospital against their will. Being sectioned is one of the most serious things that can happen to somebody experiencing a mental health problem.
The review’s chair, Professor Sir Simon Wessely, and vice chairs, Steven Gilbert, Sir Mark Hedley and Rabbi Baroness Julia Neuberger, have been asked to consider and make recommendations on improving legislation and practice around the Mental Health Act. In particular, they are looking at the rising rates of detention under the Act, the disproportionate number of people from black and minority ethnicities detained under the Act, and different aspects that are out of step with a modern mental health system.
Mind welcomed the review and is involved in a number of ways:
- promoting opportunities for people to input directly to the review
- advising the review through the chief executive Paul Farmer’s participation in the advisory panel
- assisting the review’s analysis and policy development through a senior manager’s membership of the working group.
To develop its own views and recommendations, Mind is listening to people who have been detained under the Act, with an emphasis on perspectives of people from BME communities, and people with problems around drug and alcohol use and/or homelessness as well as mental health problems. This will feed directly into the review as well.
Paul Farmer, Chief Executive of Mind, said:
“A lot has changed in the way we view mental health, and how we treat people who are experiencing a mental health problem, since the Act was written. This review is an important opportunity to fight for legislation and services that are fit for purpose, and support people when they are in crisis.
“We need a thorough look at why we have a Mental Health Act and what we really want from the law. This isn’t just a technical issue - it is about the day to day impact on people of detention, forced treatment and the continuing reality of poor care.
“At Mind, we believe that people who are at their most unwell need choice, control and dignity. The Mental Health Act has very little regard for patients’ wishes and autonomy, and mental health treatment is the only treatment that people can be forced to have against their will even when they have capacity to make their own decisions. We need to think seriously about structural changes to the law to redress this huge imbalance where possible.
“We know that we can’t look at the Act in isolation, without addressing the ongoing failures in mental health services which result in people ending up in crisis. People need to have easy, early access to high quality, culturally appropriate care, and there need to be sufficient, well-trained staff and a crisis care pathway that works smoothly. Any changes to the Mental Health Act need to be delivered alongside the current and future plans to transform mental health services.
“However, the law can help to assure service provision by setting out a purpose and principles for mental health care and creating some kind of enforceable right to services.
“As we develop our thinking further, led by people with lived experience of being detained, we will share this and feed it into the review.”
Mind has also identified improvements that could be made within the current framework, for example:
- giving people more control over treatment decisions, through wishes expressed at the time or in advance
- removing unnecessary restrictions on people when they are in detention
- patient choice over which person acts as ‘nearest relative’ (a family member who can make decisions about your care)
- expanded, adequately resourced and culturally appropriate advocacy provision, with automatic referral
- independent review of medication without consent from day one, or at least earlier than three months
- more frequent automatic tribunals for people who do not have capacity to make a tribunal application
- repealing community treatment orders
- making the Care Act’s delayed discharge rules apply to mental health inpatient services
- giving the tribunal more powers, for example to review treatment or community treatment order conditions, so people can appeal aspects of their treatment as well as detention
- a statutory duty to assess needs for aftercare, leading to a co-produced plan and with a requirement to provide the services in the plan
- creating an enforceable right to services.
If you have been detained under the Mental Health Act, or if you have supported someone else who has been detained, you can share your views with the review team by completing their survey which closes on 6 April. Follow the link to the service user and carer survey on the review's website and choose the survey and format that applies to you.
You can read about the experience of mental health survivor Colin King, who is contributing to Mind’s Mental Health Act work as a member of its steering group.