Reforming the Mental Health Act: reflections from the network

June 10, 2021

In 2017 the government requested an independent review of the Mental Health Act 1983, to look at how it’s used and to suggest ways to improve it. The review’s final report found that the Act does not always work as well as it should for patients, their families and their carers. In April this year, government consulted on potential reforms to the Act, including some positive recommendations for changing the law and practices on mental health inpatient treatment; the importance of choice and autonomy; and ensuring patients are treated as individuals.

We are conscious that accessing mental health support is exceptionally difficult for people experiencing multiple disadvantage. For some, inpatient care has been an extremely welcome and necessary experience. However, there are also cases where use of provisions within the current Act has led to confusing, difficult and further traumatizing events for people experiencing multiple disadvantage, and in some cases, use of the Act could have been avoided altogether if there were better access to, and more appropriate, mental health services for this group. In response to the consultation, MEAM spoke with experts with lived experience, strategic leaders and frontline staff to discuss their views on the proposed reforms. Across our network, we heard instances where:

  • The Act was being implemented too frequently, with community mental health support options failing to engage with individuals facing multiple disadvantage;
  • People were repeatedly encountering the police and use of the Mental Health Act for what was deemed to be alarming behaviour at times of crisis, despite continually being declined access to mental health support to address their earlier needs;
  • People were presenting at A&E departments during crisis point, only to be made to wait for such long periods that they would self-discharge, leading to their behaviour spiralling
  • Use of the Act could have been avoided if there was sufficient access to local mental health support services early on.

We therefore believe there are key proposals within the consultation that have the capacity to help create better support for people experiencing multiple disadvantage. In particular:

New guiding principles will drive a more person-centred system

Frontline staff and experts indicated that people experiencing multiple disadvantage risk being detained due to their perceived challenging behaviour. The consultation proposes new principles including a focus on a therapeutic benefit to inpatient support. This could include reforming the criteria so that therapeutic benefit is a requirement for detention, and proposes a higher threshold so someone can only be detained if there is a substantial likelihood of significant harm to the health, safety or welfare of the person, or the safety of any other person. This could go some way to ensuring that the powers of the Act are only used when absolutely necessary, and where there is a tangible, personalised benefit to the individual’s recovery. In cases where a therapeutic benefit from treatment is not being realised, there should be grounds for detention to be reassessed.

It will be mandatory to provide patients with a care and treatment plan within the first week of detention.

Placing this on a statutory footing is particularly positive, as areas across our network report that for some individuals care plans have been neglected or not put in place. Experts by experience felt that patient’s engagement in the first week could be poor due to past experiences, issues of trust and their wellbeing at that point. It is crucial that sufficient time and mechanisms are put in place so that care and treatment plans are based on proper assessments, take full account of individuals’ wishes and needs, and are appropriately reviewed over time with patients.

A new framework for patient consent and refusal of medical treatment will give patients greater control over their care and treatment.

Individuals facing multiple disadvantage often have issues around trust of services. We are aware of individuals refusing treatment after having an adverse reaction to medication but eventually being forced to take them. Experiences like this can be traumatic and enabling individuals to refuse consent (with limitations in some circumstances) is a positive step; giving people greater agency and encouraging staff to consider alternative ways of engaging people in treatment.

Expanding the role of advocates and nominated persons will provide greater safeguards.

Being detained under the Act can be a confusing and complicated process. Proposals to expand the role of Independent Mental Health Advocates is an extremely positive step in increasing representation for patients. The proposal to expand who can be a nominated person under the Act, including support workers that individuals may already have trusting relationships with, could be of particular benefit to individuals facing multiple disadvantage. Advocates must know how to build relationships with people facing multiple disadvantage and have access to relevant training as standard, including around trauma informed care.

The transfer from prison or IRC’s to mental health support will be speedier.

The transfer from prison or immigration removal centres (IRCs) to mental health inpatient settings will now be subject to a 28-day time limit. We were given examples of individuals going through mental health crisis within prisons and yet having to wait extremely long periods before transferring. This exacerbated their mental health issues and made them more vulnerable to self-harm. Providing a time limit will enable a greater degree of certainty for these individuals.

One part of the picture

We are pleased that the consultation recognises the need to update the law around mental health treatment. Some of the proposed changes have the capacity to help mental health services offer better support to people experiencing multiple disadvantage who require inpatient mental health treatment. However, although reform of the Act is welcome, it is only one part of the picture. The clear message from the people we spoke to in MEAM Approach and Fulfilling Lives areas is that use of the Mental Health Act could be avoided in many cases if there was better access to early mental health support interventions, including community based services, and if these services were more responsive to the specific needs and circumstances of people facing multiple disadvantage.

As a coalition, we will continue to focus on this issue, and we hope the outcomes of the current consultation will go some way to ensure that all people, including those experiencing multiple disadvantage, receive the appropriate care and support they need as soon as they need it.