Straight Talk
Alison Cobb • Specialist Policy Adviser • Mind

The year-long independent Review of the Mental Health Act was published in December. Here, Alison Cobb discusses the priorities.

The Mental Health Act dictates the circumstances under which someone might be detained in hospital for their mental health against their wishes. Although detentions under the Act are specific to hospital settings, many providers will be supporting people who may be affected.

The Prime Minister commissioned the Review of the Mental Health Act to address problems with how the current Act is used; we are seeing rising detentions, racial disparity and concerns about dignity and human rights. The Review highlights the need to restore people’s dignity and proposes changes under four principles that would be in the Act itself, not just the Code of Practice. These are: choice and autonomy, the use of least restriction, therapeutic benefit, and the person as an individual.

The Government has announced a new Mental Health Bill and says it will formally respond to the Review before drafting legislation. However, it has already accepted two recommendations:

  • Choice for people over which friend or relative has a role in decisions about their sectioning and care, replacing the current ‘nearest relative’ role with a ‘nominated person’.
  • Advance choice documents to enable people to set out their wishes about their future care and treatment under the Mental Health Act and to give these legal weight.

Other key changes are also proposed:

Criteria for detention – The Review recommends that the Act should only apply to people who object to being admitted to hospital. People who lack capacity to agree to being admitted, but do not object to it, would be treated under the Mental Capacity Act.

Before sectioning someone, the threshold for the severity of the situation would be increased to, ‘a substantial likelihood of significant harm to the health, safety or welfare of the person, or the safety of any other person, without treatment.’ There would need to be evidence of these risks, in keeping with the aim to have stronger, clearer reasons for detaining someone.

Race equality – One of the main recommendations is to improve how local mental health services respond to the needs of their population’s ethnic and cultural backgrounds. Using an Organisational Competence Framework and Patient and Carer Experience Tool would help to make improvements and support organisations meet their duties under the Equality Act 2010.

Other recommendations include culturally-appropriate advocates, enabling people to follow religious and spiritual practices while in hospital, and encouraging greater representation of African and Caribbean people in mental health professions.

Care in hospital – The Review recommends improving people’s experience while they are detained. It suggests changes to social and physical environments; ending unjustified restrictions; and improving the way complaints are handled. It urges the Care Quality Commission to develop new criteria for monitoring the social environments of wards. Staffing levels would also need to be sufficient for daily one-to-ones with patients.
As far as possible, shared decision-making and planning care collaboratively should be the basis for all care and treatment decisions made under the Act.

Statutory care and treatment plans – A new, legally-required plan would be developed within days of a person being detained, setting out the aims of care and treatment and how the person’s wishes had influenced the plan. This would be developed during the person’s stay and would include planning for when they come out of hospital. It would also be scrutinised by a tribunal whenever it considered an appeal for discharge.

Advocacy – All mental health inpatients, whether detained or in hospital voluntarily, would be entitled to an Independent Mental Health Advocate without having to ask for one.

Second opinions – People who have been sectioned would be able get second opinions on their treatment earlier and make an appeal if they still disagreed with it.

The Review also includes a proposed Statutory Care Plan for people in contact with mental health and/or social care services, changes to the frequency and powers of tribunals, and the need for more accessible and responsive services.

There are also calls to restrict the use of community treatment orders (CTOs) which are meant to reduce the risk of readmission after leaving hospital but are both intrusive and ineffective. Mind wants to see more fundamental shifts in the law and the scrapping of CTOs altogether, but the Review’s recommendations have the potential to make vast improvements to people’s rights and experiences when in crisis.

Mind is calling on Government to accept and implement the recommendations, and for concerted commitment and action to reduce racial inequalities in the use of the Act.

Alison Cobb is a Specialist Policy Adviser at Mind. Email: Twitter: @MindCharity

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