The government has rejected calls from MPs to extend statutory independent advocacy support to all mental health patients in England rather than only those detained under the Mental Health Act.
In a scrutiny report on the Mental Health Act, the house of commons health committee called on the Department of Health (DH) to improve safeguarding of patients who were in hospital voluntarily by giving them the same legal rights to independent mental health advocates (IMHA) as patients detained under the Act.
The health committee said that voluntary patients were often “equally as unwell” as detained patients and pointed out that the Welsh Assembly extended advocacy provision to voluntary patients in Wales in 2012. But the DH’s official response to the committee, laid before parliament last week, said England would not follow the Welsh model.
“The principal distinguishing feature of an IMHA is knowledge of the 1983 [Mental Health] Act, so there is an issue whether IMHA support would be most appropriate for voluntary (informal) patients,” the DH response said.
“We acknowledge that entitlement to an IMHA has been extended to informal patients in Wales but feel that for England, it should remain possible for advocates who are not formally accredited IMHAs to continue to provide their advocacy services.”
The health committee’s report also recommended that IMHA support should become ‘opt out’ rather than ‘opt in’ for patients. In its response, the DH said it would undertake a “full assessment” of the costs, benefits and impacts of moving to ‘opt out’ as such a move would require a change of law.
The health committee’s report also raised concerns over ‘de facto’ detentions – situations where voluntary patients had been told by ward staff that they would be detained under the Mental Health Act if they tried to leave.
In response to this concern, the Department of Health said: “Voluntary inpatients should never be told that if they try to leave hospital they will immediately be detained under the 1983 Act. It is, however, important to ensure that no clinician feels constrained from making correct use of section 5 of the 1983 Act (emergency holding powers) when appropriate. It may be necessary to detain an inpatient under section 5 where they seem likely to pose a risk to themselves or others if they were to leave hospital.”
Other key points from the Department of Health’s response:
- The CQC will gather data on “decision-making at the point of [Mental Health Act] detention” as part of its new inspection model. The health committee heard evidence that patients had been detained ‘unnecessarily’ as the only means of professionals securing a hospital bed.
- The “clinical practice aspects“ of Community Treatment Orders (CTOs) will be reviewed as part of a review of the Mental Health Act Code of Practice in 2014. The committee’s report called for a review of CTOs.
- The DH will consider commissioning research into what is driving the increase in Mental Health Act detentions and any policy changes that could reverse the trend.
Andy McNicoll is Community Care’s community editor