By Mark Trewin
Last week, the independent review of the Mental Health Act (MHA) published its final report. As Professor Sir Simon Wessley, chair of the report, hands a copy of the findings and recommendations over to the prime minister’s office, it is a good time to reflect on how the report has developed and what it means for social work and approved mental health professionals (AMHPs).
The review has been a substantial piece of work, with a large number of people involved in some way. This has ranged from service users and carers, to clinicians, social workers and lawyers – all experts in their own right.
They have gathered feedback and insights and gradually used this to develop and test early recommendations. Backing all of this up was the call for evidence – information from people across the country explaining their personal or professional experience of the MHA.
The terms of reference for the review asked us to understand why rates of detention are rising, why a disproportionate number of people from black, Asian and minority ethnic (BAME) groups are detained and how to reform and modernise mental health services.
Listening closely to patients
Throughout this process, the voices of people who have been detained under the act, has been strong and influential. The experience of being detained and cared for under the MHA has often been described as undignified, frightening and humiliating for many of the people experiencing it – although we have also heard of great examples of innovative services and good practice across the country.
AMHPs and social workers have also had an important role in the review and have been represented in almost every part of the review’s governance. In addition, the AMHP Leads Network advised the review as recommendations were developed. Meanwhile, the Association of Directors of Adult Social Services (ADASS) also helped to review the recommendations and consider how they would affect local authorities.
Although much of the review inevitably concentrates on the service user experience and on strengthening rights and protections for detained people, there are also many developments with implications for AMHPs and community or hospital social work.
Role of the AMHP enhanced
The role of the AMHP is maintained and slightly enhanced within the review, with development related to the proposed updated section 3 assessment process and more robust, community treatment orders. The pressures on AMHPs and doctors undertaking Mental Health Act assessments have also been considered in the review, with recommendations in relation to the availability of section 12 doctors, the timescales for assessment, new regulations around conveyance by ambulance and a renewed emphasis on section 140 agreements to plan for bed availability issues.
AMHPs will also be interested in the recommendations about the use of section 2 and section 3, and the proposed timescales and legal protections within this. The recommendation for a nominated person, instead of a nearest relative, which the government has accepted, will also affect AMHPs. There is a strengthened recommendation that local authorities and clinical commissioning groups (CCGs) should have the ability to have enough AMHPs and section 12 doctors to undertake assessments when needed.
Statutory care planning
Local authorities and CCGs are affected by new recommendations in relation to advocacy, which would require a review of commissioning and funding requirements.
The MHA review has been very clear that care planning needs to move onto a statutory basis and this includes community care plans, inpatient care and treatment plans, as well as specific plans for people with a learning disability or autism and children and young people. To back this up, the review also asks the government to look at a more robust duty for councils and CCGs to work together and jointly fund aftercare and support for vulnerable people with a mental health issue. These reforms will hopefully support frontline social workers and managers.
The review is very aware that amending the MHA is not the only way to improve and develop mental health services. There have been discussions with the team producing the green paper for social care about how that comprehensive consultation about charging, the Care Act and integrated care and support planning can further develop within mental health services. Essentially, our services need to be modernised as well as our legislation.
Linking all areas
In addition, the NHS Long Term Plan should develop a new vision for community mental health services and prevention that needs to be linked to the developments in social care and housing and would be likely to support some of the ambitions of the review.
It is inevitable that projects such as this have to compromise in order to include the views of large numbers of interested and passionate people. On balance, I think the review has been able to achieve its aim of modernising 40-year-old legislation and replacing it with a legal framework based on rights, involvement and dignity.
Mark Trewin is the mental health social work lead for the Department of Health and Social Care and had an advisory role in developing recommendations for the independent review of the Mental Health Act 1983.