It is common knowledge in the UK that there is a higher rate of detention in mental health hospitals now than 10 years ago, despite a reduction in the number of inpatient beds and the growth of community services.
We also know that black people are more likely to be detained in hospital against their will. Sadly, this issue is being relegated to a lesser priority as indicated by the Care Quality Commission’s decision to stop collecting the data under the Count Me In Census as they found no change or a worsening of trends, particularly for black and minority ethnic patients.
Then there is the fact that deaths in custody require an inquest while deaths in a hospital setting don’t. What is clear with all these realities is that mental health law is only as effective as the practitioners who implement it, and the quality of governance at the organisations that uphold it.
The Mental Health Legislation Resource for health and social care practitioners, launched today by the Mental Health Providers Forum, sets standards as well as outlines detailed case studies of how to best use the Mental Health Act 2007 to protect and promote good mental health care.
The forum is an umbrella body of more than 50 charities that provide mental health care in the community and is responsible for an £800 million spend on care services. It also promotes the need for improved standards in the implementation and operation of mental care within the requirements of mental health law.
This resource is being launched against a backdrop of a new public health policy and outcomes framework, with arrangements for public health commissioning and provision from local authorities, and the establishment of Public Health England.
In this context the role of the voluntary sector, with its tradition of championing better mental health, irrespective of government policy and priority, is essential. Now that the sector’s role is expanding with the NHS changes, there are new opportunities for even greater influence than ever before.
There are greater opportunities for much safer and more effective models of care, which Public Health England, Health Education England and commissioners will need to respond to.
But there is still much to do. The challenge of preventing inequalities in the care experience and outcomes is being considered at a time of great financial constraint. The decommissioning of services that aim to protect the most vulnerable and those most liable to experience greater inequality of access to effective treatments is one example.
There is also more scope for collaboration between voluntary sector providers and public sector services. This, alongside the transfer of responsibilities for the training of the workforce to Health Education England, places more responsibility on the voluntary sector to step up to the mark and demonstrate at least an equivalent, if not better, quality of service and safety standards.
Of course we can’t all become legal experts overnight, but it is our responsibility to ensure that all practitioners and members of any care team, whether they are directly responsible for using the Act or not, understand its protections.
A continued lack of understanding of mental health legislation has driven me to develop an MSc in Mental Health and Law at Queen Mary, University London. The MSc will be jointly delivered by the Wolfson Institute of Preventive Medicine and the university’s Law Department, and will be open to applications as of January 2013. Shorter courses are already being delivered by the Cultural Consultation Service on homicide and culture until December 2012.
The Cultural Consultation Service will also use the new Mental Health Legislative Resource to set up continuing professional development events to train staff with responsibilities to protect patients. We want to ensure patient safety, while also meeting their rights to humane and effective treatment to maximise their recovery and dignity.
This is no easy task as some 640,000 people are seen for mental health problems in care services on a daily basis. For more than two decades I have championed the need for more flexible, humane and deinstitutionalised forms of care, and pushed for the voluntary sector to have a greater role in addressing racial and ethnic inequalities in care.
I remember cases where patients, who were supported by voluntary sector providers, were released off section and discharged into the community. These decisions needed creativity and trust, and a commitment from all parties as well as the skills and a willingness to take therapeutic risks that offered hope.
Mental health legislation requires people, not just professionals with certificates, to interpret and understand patients and service users experiencing emotional distress.
Voluntary organisations have to display a high level of professional skill and knowledge to effectively tackle inequalities and institutionalised forms of care. If not, no resource will make a difference.
Professor Kamaldeep Bhui is professor of Cultural Psychiatry & Epidemiology, Wolfson Institute of Preventive Medicine and director of the Cultural Consultation Service, which are both based at Queen Mary, University of London. Visit www.culturalconsultation.org.uk
For more information about the new Mental Health Legislation Resource visit www.mhpf.org.uk