Mental health review is an opportunity to do better for people with drug and alcohol problems

Last month the independent review of the Mental Health Act published their interim report. MEAM’s Policy Manager Sam Thomas reflects on the way that people with drug and alcohol problems are treated under the current Mental Health Act and how this requires further attention.

The government made a manifesto pledge last year to review legislation that determines how people with mental health problems are treated. The resulting review of the 1983 Mental Health Act is both welcome and overdue, as mental health charities, clinicians and advocacy groups have long argued the current law isn’t fit for purpose.

The Making Every Adult Matter (MEAM) coalition, formed of Clinks, Homeless Link, Mind and associate member Collective Voice, has been helping people with experience of multiple disadvantage to engage with the review. Mind staff have visited local services to discuss how the Act is affecting people experiencing a range of difficulties that interact with mental health problems.

A particular area we feel needs further attention is the way that people with drug and alcohol problems are treated under the Mental Health Act. Studies suggest that 70% of people in contact with drug services and 86% of people in contact with alcohol services also experienced mental health problems. Often they find it difficult to get the support they need, as different services struggle to agree where responsibility for treatment lies.

In evidence to the review, we’ve made a series of recommendations which we hope the review team will consider as it looks at the Act.

First, section 136 of the Mental Health Act allows police to take someone with a mental health disorder who needs care to a place of safety for clinical assessment. These powers are frequently used to detain people who are under the influence of alcohol or drugs, but evidence (for instance this study) suggests many are released without treatment only to be detained again at a later date. This suggests either that people’s mental health needs aren’t being assessed properly, or that other more appropriate interventions are necessary for people who are intoxicated and in need of care. We’ve asked the review team to ensure that:

  • There is the expertise and capacity available in mental health teams to ensure suitable and effective mental health assessments for people facing multiple needs when they are detained under the Act.
  • Legislation requires cooperation and information sharing between agencies so that individuals can access suitable service pathways regardless of whether a mental health problem is diagnosed, and wherever possible on a voluntary basis.

Second, we highlighted the availability of and referral to appropriate treatment. There is clear evidence – highlighted in recent guidance from Public Health England – that “people  with  co-occurring  conditions  are often unable to  access  the care they  need” and that “it  is  not  uncommon for  mental  health  services  to exclude people  because of  co-occurring  alcohol/drug  use” (Public Health England, 2017).  This guidance and NICE guideline NG51 make clear that coordinated provision is required and that mental health services should take the lead role in providing this.  Our experience in local areas suggests that this is often not the case.  We’ve asked the review team to ensure that:

  • Mental health providers take the lead in providing support for people with co-existing conditions, as outlined in current guidance, and ensure appropriate treatment is available to people who need it whether or not they are formally admitted. Consideration should be given to incorporating rights of access to services in legislation.

Finally, we looked at appropriate settings. We know that the settings in which both assessment, and detention, under the Mental Health Act take place have a significant bearing on outcomes for people experiencing multiple needs. We asked the review team to:

  • Ensure sufficient provision of appropriate settings for assessment under the Act, and of hospital beds for those detained, to avoid the use of prison, police custody or police vehicles. The legislation should clearly state that prison is not an appropriate place of safety.

While the review is focused on the Mental Health Act itself, many of these issues go beyond legislation, and have implications both for the funding, design and operation of mental health and substance misuse services. We hope that the review will be able to examine the evidence and make recommendations so that everyone – including people with drug and alcohol problems – can receive appropriate and effective mental health care.

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