Independent Review of the 1983 Mental Health Act

Introduction

The government, through Prime Minister, Hon Theresa May MP, made an announcement concerning an independent review of the 1983 Mental Health Act. Notably, it was chaired by Professor Simon Wessely and of importance, the review had the task of making significant recommendations that were significant for improvements that related to the risen rate of detention rates, racial detention disparities, as well as concerns, which the Act as bent on set up, which was in line with the modern mental system. As such, the review team was asked to put into consideration; legislation and practice.

Based on the aforementioned, the review team thus, produced an interim report, and published it in May 2018. Significant to note, the interim report summarized their present work to date, and purposed to outline various emerging priority sectors. The review highlighted various issues, which related to before and during detention, and also issues that related to a particular group of individuals inclusive of BAME individuals. Moreover, the second stage, as provided in the report probed into further 18 significant topic areas that were also highlighted in the report. The final report was then published in 2018, December. Notably, the final report consists of 154 recommendations, for various members of the Mental Health Network, particularly focusing on the recommendations that are relevant to various service providers.

Precisely, the review purposes to set out a clear case that calls for change. In this regard, it is worth noting that the detention rates in various psychiatric hospitals have increased more than doubly since the year 1983, and in precision, the steepest rises were witnesses during the last decade and in the course of the late 80s and even early 90s. Notably, from the years 2005/2006 to the years 2015/2016, there had been an increase of 40 per cent in the rate of reported numbers of uses of the Mental Health Act, aiming at detaining individuals in hospitals. The review thus, makes it evident that the emerging data, derived from the three years indicate that the trend could be changing. Putting into consideration, the data analysis, which relates to the trends, it is worth noting that it is set out in the report, and this includes various considerations, whereby, societal factors, legal factors and even issues that relate to social provision patterns are noted to be contribution to the rise in the rates of detention.

This policy briefing report, thus purposes to summarize various key points that were expounded on, in the final report of the Independent Review of the Mental Health. As such, it will start by providing a detailed nature of the primary issue, which comprises of the definition of key term, outline of key evidences, and the groups that are most affected by the current policies. Thereafter, the briefing report provides the contextualization of the issue, whereby, many details are expounded upon. Then, it provides the summary of recent trends, followed by the outline of a recent policy, or even campaigns that are witness in this sector. Finally, the policy briefing will provide a conclusive summary, which highlights the main points discusses and raises two key questions or rather, areas that the MP ought to raise with the minister.

Nature of the issue

Definition of terms

The review brings forth the following key concepts, which are majored upon. First is choice and autonomy, which refers to ensuring that the views, as well as choices of service users are respected. Second is least restriction, which is ensuring that the powers of the Act are used in a least restrictive way. Third is therapeutic benefit, which refers to ensuring that patients are supported, with the aim of getting them to feel better, in order for them to be discharged from the stipulated Act and finally is person as an individual, which is ensuring that patients are treated and at the same time, viewed as rounded people. Notably, the four principles are the basis of the 154 stipulated recommendations, which have been set out in the review. Overall, one theme runs through the review, which is ensuring that patient’s voices are heard louder and more distinctly, and considered to be carrying more weight than before.

Outline of key evidence

The first principle is choice and autonomy, whereby, the review makes approximately 30 recommendations that relates to the strengthening of the choice and autonomy principle. In this regard, this principle makes recommendations as follows. The first issue is on making decision, regarding care and treatment, whereby, the review purposes to increase the involvement of service users through enhancing shared decision-making, in planning, as well as treatment decisions as per the Act. The second issue is on family and carer involvement, whereby, the review mandates that service users should be obligated to choose new nominated persons, in place of the current nearest relative role, as stipulates under section 26 of the Mental Health Act. The third issue is on advocacy for patients, whereby, the review recommends on the enhancement and extension of advocacy provision to patients. The fourth issue is on complaints, whereby, the review makes various recommendations related to complaints. The final issue is on deaths in detention, whereby, the review provides significant recommendations that relates to the response that should be given to deaths in detention.

The second principle is least restriction, which provides recommendations on 8 issues. The first issue is tackling of the rising detention rates, whereby, the review provides recommendations whilst stressing that there exists no single driver, enhancing the rise of detention rates. The second issue is criteria for detention, whereby, the review provides recommendations, whilst stressing that great value is derived when patients can be treated as inpatients with their own consent, whilst adhering to the principles bestowed in least restriction, as well as patients’ choices. The third issue is a statutory plan for treatment and care, whereby, recommendations stress that there ought to be statutory plans to be adopted at the point of detention, which evolve in all stages in the process. The fourth issue is the length of detention, whereby, recommendations stress that the code of practice should ensure that detention periods are shortened. The fifth issue is challenging detention, whereby, recommendations stress that there should be a great access, which enables tribunal to have great powers, afforded to it. The sixth issue is either mental Health Act or Mental capacity Act? The seventh issue is community treatment orders, whereby, recommendations focus on various order associated with community treatment. The final issue is coercion and restrictive practices, whereby, recommendations wards ought not to utilize coercive behaviors and restrictions whilst complying with patients, but should implement and monitor other alternatives.

The third principle is therapeutic benefit, having 4 issues. The first issue is care planning, and aftercare, whereby, recommendations acknowledge important issues with system complexity and varied entitlement sets, which service users can have. The second issue is hospital visitors, whereby, recommendations stress that Associate Hospital managers should have the power of discharging service users. The third issue is inpatients social environments, whereby recommendations stress that commissioners and service providers should be obligated to improve wards’ social environments. The final issue is inpatient physical environments, whereby, recommendations stress that physical environment in wards should be improved.

The fourth principle is the persona as an individual, consisting of 7 issues. The first is person-centered care, whereby recommendations purpose to recognize the needs and strengths of patients. The second is recognizing patients’ individualities at the tribunal, whereby, recommendations highlight that training ought to be developed for all specialism panel members. The third is experiences of individuals from the BAME communities, whereby, recommendations tackle racial inequalities to enhance quality of services. The fourth is children and young individuals, whereby, recommendations focus on the legal admission basis, treatment, as well as safeguarding of young children. The fifth is individuals with learning disabilities, as well as autism, whereby recommendations note that health as well as social care commissioners should be obligated to ensure that there is community-based support for individuals with such conditions, to avoid hospital admissions. The sixth is policing/mental health Act, whereby, recommendations stress that individuals facing mental health crisis should be treated with respect and dignity. The final issue is the criminal justice system, whereby, recommendations focus on the criminal justice system whilst relating them to patients.

Groups that are mostly affected by current policies

The review found out that the category of individuals, who are affected by the current policies include individuals, originating from the black and minority ethnic communities, especially for those who are detained, as well as individuals having learning disabilities or even autism. Notably, individuals from BAME communities face many inequalities, whilst considering access, experiences, as well as outcomes of mental health treatment and the care that ought to be given to them. The review makes it clear that these individuals are somewhat disadvantaged.

Contextualization of the issue

It is significant taking into account, the fact that the review was produced, based on extensive engagement, which included the following. First, it included the holding of over 50 significant focus group, and the examination of over 1500 survey responses that were gotten from various service users, as well as carers. Moreover, the review as well, held 7 public workshops that had over 550 attendees, and a series of bespoke roundtables, especially on areas of priority. In this regard, included roundtable, which was at Downing street, aimed at discussing various key priorities for African, as well as Caribbean communities.

The final Mental Health Act, published in December 2018 applies to England and Wales, but the health policy aspects that are explained in the act are the responsibilities of the Welsh government, whilst the justice section of the act poses as the sole obligation of the UK government. In this regard, the recommendations that are provided in the review purposes to cover England, especially for health, but for justice, it covers both England and Wales. The review significantly provides a thoughtful consideration relating to the experiences of various service users. It makes it clear and evident that service users have over the years been disturbed and also saddened, owing to the stories that patients have told. So many individuals are described to be cared for in wards that are below the required standard and it is worth noting that the experiences of the care that they receive have been wanting.

The review makes it clear that there are repeated cases of distressing, as well as experiences, which would otherwise be considered to be unacceptable, especially for individuals from various ethnic minority communities, and particularly black African Caribbean men. These categories of individuals live in fear of what may happen next whilst they are in detention and for how long they may be detained in the hospital and that even if they will get out of the hospital, whether all are widespread in the ethnic minority communities.

It is significant to note that there is an unacceptable overrepresentation of individuals, originating from the black and minority ethnic communities, especially for those who are detained, as well as individuals having learning disabilities or even autism. Evidently, the review makes it clear that these individuals are somewhat disadvantaged, and such, there is significant need for achieving a great and significant focus on various right-based approaches. In this regard, the review provides various recommendations, and one major one is that there ought to be a statement of principles and purposes, which should be fundamental towards the issue and thus, should be articulated in the Mental Health Act opening section. Of significance, the fundamental purposes and principles would provide a basis for the significant actions that need to be undertaken under the act. In this regard, it will aim at setting out various standards against which numerous decisions could be taken into account, thereby, aiding in providing service users with clear expectations, which are significant for their treatment and the care that they receive whilst they are detained in hospitals.

Summary of recent trends

In line with the recommendations provided in the review, it is evident that there are recent trends, which have been adopted, with the intention of meeting the requirements, stipulated in the recommendations. First, there is a trend in better utilization of data, and also leveraging of digital technology, with the intention of supporting efficiency, as well as effectiveness in caring for patients. In this regard, it is evident that an accurate national baseline is easily enhanced for significant use in the mental health services, and this follows a pilot programme that develops a robust methodology. Secondly, there is the adoption of the Mental Health Bill, which purposes to ensure that people are in significant control of their personal care, whilst they receive the appropriate treatment, as well as support that they need. Thirdly, there is a strong focus in hospitals, which aims at improving the experiences of patients, given a specific level of engagement with various stakeholders. Finally, it is evident that the adoption of the recommendations are like a trend as most hospitals have started addressing various unacceptable rates of disparity of detention between various BAME communities.

Campaigns in this area

There are various campaigns in this area, which purpose to ensure that the recommendations are significantly adopted. Firstly, there is need for NHS improvement, as well as NHS England is pushed to focus on funding the establishment of national quality improvement programme, which relates particularly to the Mental Health Act. Secondly, There is a campaign that pushes for the establishment of a Mental Health Act data hub, in order to put together, and at the same time, routinely analyze Mental Health Data across various NHS services, whilst exploring various possibilities for the development of significant linkages across various datasets, local policing and authorities. Thirdly, the review creates a thoughtful consideration regarding the workforce, and the manner in which it can be supported. In this regard, there is campaign to review and address the factors affecting timely availability of section 12. Finally, it is significant to put into consideration that NHS England, as well as NHS improvements are pushed towards considering the implications associated with the evidence that links staff morale, as well as the experiences of patients (detained patients) and thus, take significant action accordingly.

Summary

The final Mental Health Act report consists of 154 recommendations, for various members of the Mental Health Network, particularly focusing on the recommendations that are relevant to various service providers. The review highlights various issues, which relate to before and during detention, and also issues that relate to a particular group of individuals inclusive of BAME individuals. The review provides various recommendations, which have faced significant campaigns for their full adoption and of importance also, is the fact that there are recent trends, which have ensured that the recommendations are being implemented. In this regard, there are two key questions, which the MP ought to raise with the minister, and they include the following:

1. Is it possible to implement the 154 recommendations provided in the review?

2. What other effective actions, aside from the campaigns, can aid in the adoption of the set recommendations?

Bibliography

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