The final report of the Independent Review of the Mental Health Act has been published. The Review, chaired by Professor Sir Simon Wesseley, was set up to look at how the legislation in the Mental Health Act 1983 is used and how practice can improve.
The MEAM coalition partners welcomed the Review and requested that special consideration be given to how the powers in the Act are used with regard to people experiencing multiple needs, a majority of whom experience mental ill health. Our submission aimed to highlight the repeated use of s.136 for people under the influence of alcohol or drugs; availability of and referral to appropriate treatment; and the use of appropriate settings.
We are pleased the Review recognises the need for more accessible and responsive mental health crisis services and community-based mental health services that respond to people’s needs. In particular we welcome the focus on:
Patients should not be turned away on the basis of dual diagnosis – The Review draws attention to existing guidance on good practice in this area and states that as a minimum we must seek to ensure that patients are not turned away from mental health services in a psychotic or suicidal crisis because it is perceived by professionals to be substance induced. The reverse is also true- those attending substance misuse services should not be turned away because they have significant mental health problems.
Detention should not be used without appropriate treatment – The Review reiterates that the Mental Health Act has never been about detention in its own right and includes a requirement for treatment. Yet numerous submissions highlighted clear instances where patients are detained but effectively offered no treatment at all. The Review recommends tightening the current criteria so that not only must appropriate treatment be available that cannot be delivered unless the person is detained, but also that the treatment would benefit the patient. This should include consideration as to discharge planning as well as a shift towards treatment in the community wherever possible.
The need for partnership responses towards early intervention and that police cells are not a place of safety for people experiencing mental health crisis – The Review recognises that currently opportunities for early intervention are being missed and increasingly first contact with services is through the police rather than mental health professionals. The Review supports joint working such as the use of vehicles with both the police officer and the healthcare worker aboard. However, recommends that police cells are no longer used as a Place of Safety and that where they do not currently exist, health-based places of safety will need to be commissioned.
It is now important that the Review’s recommendations are taken forward by government as a whole. While we welcome the commitment to introduce legislation on two of the Review’s recommendations, we also believe that many of these issues go beyond legislation, with implications for funding, design and delivery at a local level. Only then can we ensure that all people, including those experiencing multiple disadvantage, receive the appropriate care and support they need, when they ask for it.