Chair of independent MHA review calls for ‘more therapeutic’ care

Providing “more therapeutic” care for detained mental health patients will be a priority for the independent review of the Mental Health Act (MHA) when it reports this autumn, according to chair Simon Wessely.

Speaking at Community Care Live Manchester this week, Wessely told delegates care for people with severe mental health problems had “gone downhill” in many areas but said the review would help services to “respect people’s choices and dignity” once again.

Last October, Theresa May announced the independent review, saying it would investigate rising rates of detention and examine disproportionate detention rates for black, Asian and minority ethnic (BAME) people and whether certain aspects of the act are out of date.

Yet Wessely said improving the quality of care provided to people who have been detained in mental health hospitals would be a key focus, stating that current environments “could hardly be designed worse” to assist recovery.

“Around a third of people say [being detained] saved their life. But, they go on to ask, why was it such a rotten and awful experience?”

“We feel there are things we can do to increase the respect and dignity of patients that are treated,” he said.

A ‘brutal and toxic’ experience

Respect for the rights of those detained was a point emphasised by the writer of the Sectioned blog, who was detained in a hospital setting in 2011. She described her experience as “brutal and toxic” and said she had since been diagnosed with post-traumatic stress disorder because of her treatment.

The blogger, who also tweets at @Sectioned_, called for a MHA that “focuses on a right to care” and suggested a custody sergeant-type role should be introduced to help enforce the rights of those detained.

“You get an advocate, but an advocate is not enough… I think there is a role for somebody who goes to the ward every day and checks that the sections are legal, checks why this person was restrained and why [the] person was given forced medication… so people can enforce their rights at the time.”

A lack of redress for patients was also flagged by the writer, who highlighted that no business model exists for solicitors to provide advice to patients whose rights have been abused.

The review is due to publish its interim report next week, outlining the review’s “general direction” of thinking.

Interface improvement needed

According to Wessely, the report would look at reforming the nearest relative rules – under which one of the person’s relatives is given special responsibilities to safeguard the person’s rights – dealing with the interface between the MHA and the Deprivation of Liberty Safeguards and reforming, or possibly abandoning community treatment orders.

He continued to say the review needed to “unravel the difficulty with DoLS”, stating that problems with the system of authorising deprivations of liberty was leading to more detentions under the MHA.

“[We need to address] the fact that more people are being detained under the MHA than there should be because it’s an easier system to work [than DoLS].

“We don’t think that’s a very good idea and we need to do something about it,” he added.

Despite the focus on reforming the act in the review, Wessely said that 60-80% of what the review wanted to secure for those with severe mental illness would “not be achieved by changing the legislation”.

Steve Chamberlain, chair of the National Approved Mental Health Professional (AMHPs) Leads Network, echoed Wessely’s calls for an improved interface between the MHA and the DoLS system.

“We don’t know how that’s impacted on the number of people being detained but I have absolutely no doubt that this has a significant impact on people over 65 and people with dementia,’ he said.

Uncertain future for CTOs

Along with Ruth Allen, chief executive of the British Association of Social Workers, Chamberlain said community treatment orders (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 – needed to be scrapped or significantly reformed.

Although the chair insisted he was not sure if the review would recommend that CTOs should be abandoned altogether, he did confirm it would at least propose reforms.

During the discussion, Allen said that it was “tremendously concerning” that detention and admission had become “something people fear” because environments have become less therapeutic. She said this was unacceptable and agreed the review had to be done “in partnership” with service users and families.

“I think it’s hugely important that experience of how mental health law works, and people’s experiences of services is absolutely at the centre of the changes that are made this time.”

Allen also addressed the roles of AMHPs and asked for clarity in how the role functions and how it discharges responsibility of local authorities towards mental health.

She added that a lack of clarity would have a “negative impact on the whole system”.

“The issue for me around the AMHP role is that, it is very much a role which is there to discharge a social approach, a social perspective and a social duty, social care duties of local authorities,” she said.

“Major reductions” to services in the NHS and social care and how they had affected preventative services was also discussed by Allen, who stated acute services like the availability of beds had suffered.

“We really need to look at how the reduction of those preventive services is affecting demand and driving demand.

Although Chamberlain said a lack of resources was not purely about “a lack of beds”, like Allen, he indicated that cuts to services had affected other services like crisis houses and cafes.