Although many people with mental health problems are offered help without recourse to mental health legislation, there are times when its use offers support and also a safeguard. The safeguard can be for the person themselves and also for the community. For some people with mental health problems this can involve being formally detained. In the UK in 2016/17, there were 45,864 new detentions recorded. However, this process is undertaken only after medical recommendations and applications are made usually by an Approved Mental Health Professional, who has received extra training and is officially approved to do this role.
Such formal detention is sometimes referred to as being sectioned. The legal framework for the formal care and treatment of people with mental health problems, both in hospitals and in the community, is the Mental Health Act 1983. This Act applies in England and Wales, whereas different legislation applies in Northern Ireland and Scotland. The Act confers powers that do not exist elsewhere in the health and social care field and are usually exercised when people are at their most vulnerable because of a problem with their mental health.
Failed attempts for new legislation
Debates on mental health have not always received equal coverage in the public media and are reflected in conflicting attitudes. One example of this conflict is the initial review of the Mental Health Act 1983 that took place in the first decade of the twentieth century.
Over many years there were attempts by the Government to bring about new mental health legislation to address what was, at the time, concern about the risk posed by people with serious mental disorders living in the community. This concern was fuelled by the anxiety surrounding high-profile cases where people with acute mental health needs committed serious criminal offences, having been either discharged from hospital or not given appropriate and effective supervision in the community.
Among the issues still under consideration are addressing the rising numbers of detentions, decision making and, exploring how the Mental Health Act 1983 works alongside the Mental Capacity Act 2005
However, the idea that this risk was high also attracted fierce criticism and as a result the 1983 Act was amended only, but concern about the use of the Mental Health Act remains and in October 2017, the Government commissioned a second (and this time independent) review of the Mental Health Act 1983. The purpose of the current review is to look at how the Act is used and to understand the reasons for:
• The rising rates in applications for detention;
• The disproportionate numbers of people from black and minority groups detained under the Act; and,
• Processes that are out of step with a modern mental health care system.
In May 2018 the review which was being chaired by Sir Simon Wessely (and a range of experts on the panel), published an interim report outlining the work it has done to date and the proposed next steps. The report acknowledges that while the over-representation of black and minority ethnic groups is neither new nor unrecognised, there does not seem to be a single explanation for this phenomenon other than a reasonable consensus that social reasons may be the biggest impact. This area remains a high priority for the review.
Looking to the future
The report also comments that the increased emphasis being given to the rights of patients as service users, as opposed to the previous predominant focus on issues of safety, is welcome.
A number of activities have taken place since the interim report (which will feed into the final report) is due to be published in the autumn of 2018. Among the issues still under consideration are: addressing the rising numbers of detentions and decision making; exploring how the Mental Health Act works alongside the Mental Capacity Act 2005 (especially concerning deprivation of liberty); examining aspects of care when a person is detained; and, the care planning and support provided on discharge and aftercare.
As highlighted above, issues for particular groups including black and minority ethnicities, are being given priority, as are matters concerning children and young people, and people with learning disabilities and autism. It is not yet known if the review will result in new or amended mental health legislation or what changes may be recommended in relation to the current mental health system as it operates in England and Wales.
Further reading and references
Approved Mental Health Practice - Essential themes for students and practitioners, by Dr Sarah Vicary (Matthews), Philip O'Hare and Jill Hemmington.