This article was amended at 9.45am on 5 October.
The prime minister has announced an independent review into the Mental Health Act 1983 that will examine rising rates of detention and the disproportionate numbers of black, Asian and minority ethnic (BAME) people detained.
Theresa May announced the review in her speech to the Conservative Party conference, saying it was designed to “tackle the longstanding injustices of discrimination in our mental health system once and for all”.
The review was promised in this summer’s Queen’s Speech, which said it would be the first step towards a new Mental Health Act.
Psychiatrist to chair review
It will be chaired by former president of the Royal College of Psychiatrists Simon Wessely, and is due to report by autumn 2018.
Official figures show that 63,622 people were detained under the act in 2015-16, almost 50% higher than the figure 10 years previously.
The review will examine the causes of this rise and the continued disproportionate use of the act in relation to BAME people.
It will also investigate concerns about safeguards available to people, such as tribunals and second opinions, the use of community treatment orders (CTOs) and the ability of people to determine which family members have a say in their care.
Detention rather than treatment
The terms of reference also state that the review will probe how far the act is used to detain rather than treat, and the time required to take decisions and arrange transfers for people subject to criminal proceedings.
The government said the review’s recommendations should be aimed at improving the treatment and support people receive when experiencing acute mental ill-health.
While the expectation is that it will lead to law reform, the government said that some of the solutions are likely to lie in practice rather than legislation.
Co-production
Ministers will appoint vice-chairs to support Wessely in carrying out the review. The government said that the review should involve past and present service users and carers in all aspects of its work, including through an advisory panel that should have a direct input into the recommendations.
It added that the review’s recommendations should have broad support among service users, carers and professionals.
Reform or replace?
It is not clear at this stage whether the reforms will lead to a wholly new act or a further reform of the 1983 legislation.
Mental health law was last reformed in 2007, though this retained the 1983 act in amended form.
The 2007 reforms introduced CTOs, under which people are discharged from detention in hospital but with conditions placed on them designed to ensure they continue with their treatment, with the possibility of them being recalled to hospital under certain circumstances.
They also introduced entitlement to independent mental health advocacy for detained patients, and changes to professional roles, with the replacement of approved social workers by approved mental health professionals (AMHPs), a position open to nurses, occupational therapists and psychologists as well as social workers.
Reaction
The announcement of the review was welcomed by mental health charities the Centre for Mental Health and Mind, though both stressed that the involvement of people with lived experience would be critical.
Centre for Mental Health chief executive Sarah Hughes backed the appointment of Wessely to lead the review, but added: “We expect the review to be comprehensive. It must look at every aspect of the Act and explore not just the legislation but the context in which it is used. We can only understand why use of the Act has risen every year since it was last reformed in 2007, and why some people are so much more likely than others to be detained, if we examine the way society has changed and services have developed over that time.”
Mind head of policy and campaigns Louise Rubin said: “People who are at their most unwell need choice, control and dignity and legislation needs to support that. We can’t look at the Act in isolation, without also addressing underlying failures in mental health services that see people ending up in crisis.”
Questions raised
But on Twitter, concerns were raised about the review by service users, survivors, professionals and academics.
The writer of the Sectioned blog, who has personal experience of being detained, questioned the choice of a doctor to lead a review into mental health law.
If you want a proper review of #mentalhealth law, put a legal specialist in charge. Why not an AMHP? They’re specialists in applying MH law.
— Mental Health (@Sectioned_) October 4, 2017
Mental health researcher and consultant Dr Sarah Carr, who specialises in service user involvement and co-production, raised concerns about how far service users and survivors would be involved in the review.
💯MHA Review MUST be with people with ‘lived experience’ of being sectioned, not occasionally tearful token mental Big Charity policy wonks https://t.co/56kIBrMOMk
— Dr Sarah Carr (@SchrebersSister) October 4, 2017
Other issues raised included whether law reform would tackle inequalities resulting from institutional racism, and whether any changes would be effective without adequate resourcing for community and inpatient services.
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Very few people are aware that AMHP’s play a key role in terms of the majority of detentions under the MHA 1983/2007. Their involvement in this review needs to be central as they are at the coal face of dealing with rising numbers of referrals for MHA assessments, with less actual resources to respond (including closure of hospitals, closing of wards and increasing demands for beds. All of this is within continuous streams of reorganisation. The latter is informed by austerity and cost cutting leading to operational efficiencies but not necessarily better outcomes for service users and carers. Services and professionals are entwined within a culture of targets, increasing requirements for data recording and less time to actually do qualitative, therapeutic work with the very people we are trying to work alongside to support. We have some of the most advanced legislation in the western world which we should be proud of. However, the legislation and practice does not sit neatly within business dominated models, the latter which has steadily eroded the qualitative impact of the former for quite some time now. I think if this review resolves anything, it should be to redress this imbalance and allow professionals do their job. Some interventions do not fit neatly in to targets and for targets to become the sole rationale for existence under payment by results, is short-term. Finally, I think for independence of review it is always a good thing I feel to have a lawyer lead this process as this is what they are trained to do from everyone’s perspective.
Many of us would have much more confidence in a Lawyer to carry out the review than a Psychiatrist.
The greatest problems in mental health services are caused by the shortages of resources rather than deficiencies in law. If people who wanted access to good quality mental health services were able to get access and get it close to home, the ratios of compulsory detention would be much lower. I fear that this review is a distraction by a government that does not want to deal with what it knows to be the real issue. Dressing it up in the language of justice and concern for minority communities provides an opportunity for “virtue signalling” whilst sidestepping the central problem.
As an AMHP it is my opinion that consultation MUST include AMHPS from all disciplines. We are the frontline staff that have to negotiate many difficulties in the process of assessing a persons mental health. In these times of austerity, the police and ambulance services should also be included. Concentrating on recovery has long been overlooked. I have recently ceased my amhp work due to becoming disillusioned , I am fed up of locking people up, taking away their liberty, continually seeing the same service users coming in and out of the system with no real recovery. ( revolving door patients/ service users) . It is soul destroying
Agree, totally! Although even after many years I still enjoy the role.
In very simple terms, any act or legislation without the right resources and infrastructure will fail, no matter how you adjust it.
The concept of ‘Nearest Relative’ must go!
Patients should be able to choose who they want to be involved in their care if they have capacity to choose and if they do not then an Independant advocate ought to be made available.
Another option could be to allow the AMHP to nominate someone like the ‘RPR’ under DOLS.
There is no AMHP out there who likes the current system to identify the Nearest Relative and most of the public do not understand the process or even care less how we arrive at our decision. They would much rather have someone they can choose.
Perhaps not to have Mental Health Act would be better. Psychiatrists from all over UK make an effort to treat patients in and out of hospitals, go to tribunals for them and continue with all paperwork sections and CTO involve. Despite their effort to keep patients and community safe, they are often accused of using the Act disproportionally as if they were against human rights. It would make a doctor’s life much easier if the Mental Health Act was not there and so that they could just leave disordered people on the streets until Police picks them up.
No-body should have the right to do something to someone else’s body without their permission, unless that person is in a life threatening situation. Drugs are injected into someone against their wishes, drugs that have no scientific evidence as to how they work. A Drug that will kill. Psychosis is often a cycle, people are not given the opportunity to see if they may get better on their own in a supportive environment. Alcohol and illegal drugs are the biggest cause of violence. Psychiatrists who drive are a bigger cause of danger to the general public than someone with psychosis but we don’t ban people driving. Domestic Violence is huge but we don’t ban marriage. The Mental Health Capacity Act must over-ride the Mental Health Act to stop discrimination and human rights’ abuses.