arrow_up-blue blog branches consultations events facebook-icon facebook-icon2 factsheet forum-icon forum hands key link location lock mail measure menu_plus news pdf pdf2 phone policies publications related search share subjectguide twitter-icon word youtube-icon

Executive Nurse Network Newsletter

Mental Health Awareness Month

Mental Health Awareness Month

Mental Health Act 1982 Review

Due to rising concerns about the way legislation is implemented, the Prime Minister commissioned a review of the 1983 Mental Health Act in October 2017.  The review, is chaired by Professor Sir Simon Wessely, Regius Professor of Psychiatry at King’s College London and president of the Royal Society of Medicine

The review appraises practice and evidence to formulate recommendations that improve future legislation. The interim report was published on 1 May 2018 Independent review of the Mental Health Act interim report

The report summarises the work so far, acknowledges that the MHA does not work in isolation from the practical and legislative procedures and highlights the review has already identified the need to:

  • address the over-representation of BAME communities particularly those of African-Caribbean and African descent.
  • consider the interface between the MHA and the Mental Capacity Act more widely
  • change Community Treatment Orders
  • nearest relative provision
  • overhaul the overlap between the criminal justice system and mental health needs
  • find solutions to ensure sufficient safeguards to ensure compatibility with the European Convention on Human Rights. Learn from other legislative structures for mental health that currently exist, for example, in Scotland and soon in Northern Ireland.

A widespread consultation process has been undertaken and the authors indicate this process will continue, but post this initial review questions remain.

Does it go far enough? Especially in relation to Mental Health and Mental Capacity Acts implementation.  MHN’s recognise with increasing frustration the complexity of understanding and being involved with implementing these legislative processes. Indeed, 12 years ago Dawson and Szmukler (2006) argued that fusing legislation would reduce unjustified legal discrimination against mentally disordered persons and apply consistent ethical principles across physical and mental medical law.  Yet, significant change by fusing these laws is clearly not being presented as an option in this review.

The review is now proposing Community Treatment Orders will be rewritten – is this really sufficient?  CTOs were introduced into the UK despite unconvincing international evidence for their effectiveness after a series of high-profile cases that involved mentally ill people attacking members of the public.  They were thought to facilitate continuing contact and negotiation with patient, support medication adherence, early identification of relapse, and family involvement in care.   But increasingly those with lived experience of them report breaches of liberty and having difficulty getting off them. Popularly known as "psychiatric Asbos" Burns et al (2014) Oxford Community Treatment Order Evaluation Trial (OCTET) confirmed an absence of any benefit in reducing relapse despite significant curtailment of liberty. Post this evidence community mental health teams were challenged to seriously consider whether they should continue using CTOs or shift their clinical focus to strengthening the working alliance, so why is the review not proposing to go further?

Finally, at this stage as modifications are only being proposed do we have confidence this review will deliver meaningful change for service users – particularly from BAME communities? There is a strong focus on engaging with service users which is really great to see, but the review was presented as a great opportunity to make significant change - let hope this is not being squandered.  

As part of the next phase Catherine Gamble, RCN Professional Mental Health Lead who sits on the Review Group will be

  • submitting findings from survey of RCN and Unite the Unions MHN views and experiences of MHA
  • working with College of Policing Inspector Michael Brown and expert MHN RCN members to outline solutions to address community and liaison psychiatry MHA implementation challenges, for example extending the nurses holding power from inpatient to community settings
  • seeking clarification on the rationale for the CTO continuation

The review will produce a report with recommendations for change in autumn 2018.

References

Burns, T. Molodynski, A (2014) Community treatment orders: background and implications of the OCTET trial.  The Psychiatric Bulletin, Vol 38, Issue 1 pp. 3-5

Dawson J and Szmukler G (2006) Fusion of mental health and incapacity legislation

The British Journal of Psychiatry Volume 188, Issue 6 pp. 504-509

Catherine Gamble
Professional Lead, Mental Health 

Tim Coupland
Consultant, Mental Health