Mental health

Mental Health Act Review

The RCN contributed to the Mental Health Act Review. This page highlights emerging themes and questions raised by mental health nurses.

Catherine Gamble, the RCN's Professional Lead for Mental Health, represented mental health nurses (MHN) on the review. The role was deputised by RCN member Alison Blofield, nurse consultant and approved clinician.

The RCN response to the interim report published in May 2018 was informed by:

  • expert MHN RCN forum members working in acute care, community, court and liaison services 
  • those with experience of being held on sections of the current Mental Health Act
  • nurse consultants, working as Approved Clinician/Responsible Clinician (AC/RC)
  • consultation with the College of Policing, Chief Inspector Michael Brown. 

The following questions were subsequently posed to the review panel:  

Emergency departments

Should section 5 of the Mental Health Act be extended to A&E departments?

  • If so, should the power under 5(4) be RMN/RNLDs only, or all RGNs?
  • Or, should we have just one holding under section 5 for all DRs and relevant nurses?
  • 24hrs instead of 72hrs, in line with s136 MHA?

Police powers in private premises 

Should section 136 be further amended to allow its use in private premises, but subject to additional caveats? 

  • that could include, extra criteria about risk/seriousness
  • inability to explore other options (like s135/street triage)
  • authorised after consultation where practicable: RMN/AMHP/Inspector.

The Mental Review panel convened a bespoke meeting at the RCN headquarters in London, chaired by Mark Trewin, Mental Health Social Work Lead, Department of Health & Social Care. Acute inpatient, Liaison Nurses, MHN forum members and acute care nurse colleagues used the opportunity to: 

  • emphasise the value of extending nursing roles - especially around Approved/Responsible Clinicians
  • highlight a nurse’s lack of holding powers on one hand that is in acute or liaison roles and the underuse of holding powers where they do exist
  • discuss the complexity of the Mental Health Act and MCA legislative processes and highlight the advocacy role mental health nurses play as there is insufficient recognition of this activity
  • outline the challenges of attending Mental Health Act Tribunal appeals - the responsibility of nurses to attend, yet often rostering and/or lack of staffing prevents this
  • highlight the wide and varying examples of the quality of education, the ability to be released for Mental Health Act training and keeping up to date. The Mental Health Act does not emphasise explicitly enough the importance of training and education for all staff especially around Human Rights, MCA and the Mental Health Act
  • challenge Community Treatment Orders (CTOs) implementation and use to shift their clinical focus to strengthening working alliances as increasingly those with lived experience of them report breaches of liberty and having difficulty getting off them. 

The RCN supported the review's strong focus on engaging with service users and carers, but significant change its not just in the hands of the review, it demands a whole systems approach and an attitudinal shift for particularly BAME communities. Mental health nurses form the largest professional group in mental health services, and their expertise in accessing and supporting diverse and hard to reach communities is underutilised.

Further information 

The RCN have published a response to the publication of the report of the Independent Review of the Mental Health Act, written by the RCN's Professional Lead for Mental Health.  

For a summary of the review's work so far into mental health laws, services, best practice and the wider care system, see: Independent review of the Mental Health Act: interim report.

Page last updated - 18/04/2019