June 22, 2018
I wrote an article in October last year about the terms of reference for a major review into the Mental Health Act (Rights and Risks – The Debate About Mental Health Law Reform). The group undertaking the review have now produced a mid-term report to show the way they are going with proposals.
The report doesn’t really set out any firm actions, more a discussion of the issues they have been looking at with some suggestions about what might be in their proposals when the final document is published at the end of this year. You can view the report here.
The report reminds us of the issues behind a wholescale review of the Act:
- It’s been in the same shape substantially since 1983 – that’s 35 years with some changes in 1995 then 2007. It is definitely in need of modernising.
- Concerns about rising rates of detention, particularly amongst Black and Minority Ethnic groups. You would expect a modern mental health service to show falling rates of detention.
So let’s look at some of the ideas in progress:
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Scrapping Community Treatment Orders: most of the report suggests there won’t be a wholesale tearing up and starting again in mental health law. However the experience of these orders is their use has been much more widespread than first envisaged, and research evidence shows they have not worked in terms of reducing re-admission to hospital (sometimes known as ‘revolving door syndrome’).
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Merging Section 2 and 3: you will be aware that Section 2 of the Act can detain people in hospital for up to 28 days for assessment (and treatment) and Section 3 can detain people for up to 6 months for treatment. The report suggests this distinction is artificial and can cause difficulties for people making decisions about admission to hospital. One single section might allow for the shortest and least restrictive option.
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Updating section 117: this is about offering after-care free of charge to people who have been detained under the Act for treatment. It can provoke arguments about funding responsibilities, and because there are other frameworks in place to plan and co-ordinate people’s care it can often involve duplication of care planning.
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Removing the concept of the nearest relative: your nearest relative might not always be the best placed person to be consulted about your care. The discussion in the report suggests people receiving compulsory treatment will be allowed to nominate who they want to be consulted.
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Taking learning disabilities out of the Act: the review group have heard a number of concerns from learning disability groups about the wide definition of mental disorder in the Act that can include learning disability and autism. The discussion in the report suggests they will look at other ways to support people with learning disability outside of compulsory detention in hospital.
