A ‘once in a generation’ opportunity to modernise mental health legislation

By Mark Trewin

The interim report from the independent review of the Mental Health Act has been published this week, having been commissioned by the prime minister last October. It is a summary of the work completed so far, the main issues raised and a plan for the next stage.

The review will now begin an in-depth analysis of these themes and how they can shape a new framework for legislation and practice, as we prepare our recommendations and final report by the end of the year.

I have the privilege of being one of the mental health social workers supporting the review. My role is to sit on the working group, which supports the chair and vice chairs in the preparation of the final report. There is also very strong social work and approved mental health professional (AMHP) representation in a second, larger advisory group, within the call for evidence and through the many engagement sessions held so far.

Clear principles and subject areas

Working with the review team has been a fascinating and very positive process. This does feel like a once in a generation opportunity to modernise our mental health legalisation and make it fit for the future.

I have been pleasantly surprised by the amount of agreement over the main areas that need reform, from professionals and service users alike. It does seem there is a real wish to get this right and an understanding of the task ahead.

The terms of reference of the review committed us to work to understand the reason for rising rates of detention, to understand the experience of people from black, Asian and minority ethnic (BAME) communities and to ensure that any future legalisation is compatible with a modern mental health care system.

The review has made few decisions so far on how the future mental health act should look. However, we have established some clear principles and subject areas that will be of interest to AMHPs and mental health social workers. Although the review is only for England and Wales, it has been a good opportunity to learn from progressive legalisation in other countries – starting in Scotland and spreading across the globe.

Greater autonomy for people subject to legislation

One of these overarching principles is that the new act should ensure greater autonomy for people subject to legislation. How this is achieved is for this next stage of our work – but it feels like an important position from which to start the process.

Issues such as access to advocacy and aftercare are part of this approach, as is the principle that people who are affected by the legislation should be fully involved in their care and treatment.

The review has also looked at a number of issues that are currently causing debate and concern in the AMHP and social work community. One is the modernisation of the law in relation to ‘nearest relatives’. The usefulness and efficacy of community treatment orders is another.

We are looking at the evidence base on alternatives to admission, how to avoid detention under the act and the complexity of section 117 aftercare arrangements. The best way to safeguard the rights and mental health of children and young people is also an important aspect of the review. There is a real understanding and appreciation of the complex role of the AMHP in this process, alongside other key professionals, and some reflection on how best to use their expertise in future.

Call for support to help ‘get this right’

Although the main remit of the review is to modernise the legislation, the scale of the task means we must examine how the mental health act overlaps with the Care Act and Mental Capacity Act, and what else is needed for a modern, effective and integrated mental health service.

We will also consider the priorities set out in the Five Year Forward View for Mental Health and potential future funding implications, and explore how to reflect all of this in our recommendations.

The next stage of the review will involve looking at the core issues in detail, and developing the final report for the government. We will need a great deal of help and support to get this right, and there will be more engagement throughout.

I hope AMHPs and social workers will continue to get involved and support the review. Please contact us at MHActreview@dh.gsi.gov.uk to give us your views and help us get it right.

Mark Trewin is the senior manager for mental health at Bradford Council. He is currently seconded to the Department of Health and Social Care to work with the chief social worker for England on her priorities for mental health, social work and social care.