"Our current legislation was written when people with mental health needs were seen as people to be feared rather than helped,” Sir Simon Wessley said upon sharing his independent review's recommendations.
Proposed changes to the Mental Health Act published today could lead to 15-20 percent fewer individuals being detained in hospital against their will – and see more lives saved than currently.
Around 50,000 people experiencing distress and/or disorder were deprived of their liberty for compulsory treatment in 2017.
Sir Simon Wessely, a psychiatrist who has led an independent review of the law, says involuntary detentions should not be increasing year-on-year when rates of severe mental illness have "remained static” throughout his 30-year career.
“Research across the board, not just in mental health, has established beyond doubt that the greater the involvement of patients in decisions about their care and treatment, the better the outcome,” Sir Wessely told reporters as his report was released.
“Increasing dignity reduces the likelihood of unintended adverse outcomes and reduces the risk of subsequent relapse. The recommendations also go some way to overcoming the negative views that exist around inpatient psychiatric treatment.”
Supporting choice and the right to challenge
Individuals experiencing mental health challenges would be given greater rights to challenge detentions – also known as sectioning – through tribunals and then the Court of Protection, under recommendations shared with the government.
The right to challenge would be supported by non-means-tested legal aid.
For the first time, patients would also be given the right to challenge the treatment planned for them. “Tablets rather than injections,” was an example given yesterday, but non-medical therapies could also be requested, through new ‘Advance Choice Documents’, and approved if their clinical benefit had been demonstrated.
“Accepting advance statements [on treatment preferences] would become the default position” Wessely added, in a presentation to 30 assembled journalists at London’s Royal Society of Medicine.
Advance refusals of electro-convulsive therapy would become binding at a clinical level for the first time, and could only be overruled by a judge. This would likely happen “just two or three times a year”, Mark Hedley, a retired High Court judge on the review panel, said yesterday.
- See also: In Our Right Mind - Mental Health Today's year campaigning for a reformed Mental Health Act
- See also: Unfair British care: racial inequality in mental health underlined in EHRC report
Patients would also be able to nominate which relative can make choices for them when too ill to do so independently.
Hospitals would be required to draft demonstrably therapeutic care plans within seven days of first assessment and to record how patient preferences had been reflected. Trust would be obliged to connect patients to advocates under a new opt-out advocacy scheme.
“Our current law rules the lives of around 25,000 people at any one time,” said Sir Wessely. “It was written when people with mental health needs were seen as people to be feared rather than helped.”
Kate King, a writer and former patient, yesterday compared her experiences as a voluntary patient with those she experienced as an in-patient. “It was vastly different as an in-patient. We are treated as though we are ill through lack of will or effort.”
Saving lives while reducing compulsory detentions
The Independent Review Panel have recommended deprivation of liberty should be extended to scenarios when members of the public present at Accident and Emergency wards as suicidal, to ensure they are always assessed for risk to themselves.
Although suicides rates are at their lowest level for 30 years, the review team suggest more lives can be saved through interventions in A+E.
Tacking racial inequality of outcomes
Community Treatment Orders will continue to play a role in responses to mental health challenges, despite acknowledgment from the review team that they are disproportionately applied to people of colour. Their Easter update had suggested CTOs would be scrapped, but instead a target of halving their use has been advocated.
Local authorities would be expected to work to a competency framework to address inequality of outcomes by race, for example, and to show how their services had been shaped by consultation with the range of communities they serve.
‘Behavioural interventions’ to combat implicit bias in decision-making would also be piloted and evaluated.
Learning disability and autism support to be addressed in pre-Christmas announcements
The NHS’s long-term plan, due to land at some point in the fortnight after the crunch Brexit vote on December 11, is expected to provide details for new community provision.
“There are cases when the Mental Health Act has been the only option at a point of crisis,” the report authors write. “Not only has it been the only option, it's been the only option that worked for the patient. We have ultimately been persuaded that the risk of completely removing learning disabilities and autism from the Act is too high, although we think this should be kept under review.”
The government has responded to the independent review by pledging to advance legislation on two of the recommendations in the first instance, through a new Mental Health Bill: those related to advance choice documents and nominated relative.
"I commissioned this review because I am determined to make sure those suffering from mental health issues are treated with dignity and respect, with their liberty and autonomy respected," prime minister Theresa May said.
"By bringing forward this historic legislation – the new mental health bill – we can ensure people are in control of their care, and are receiving the right treatment and support they need."