Landmark review of the Mental Health Act published

Review calls for greater rights over treatment decisions for mental health patients.

In 2017, the Government commissioned an independent review of the Mental Health Act 1983 to make improvements following rising rates of detention under the Act, racial disparities in detention and concerns that the Act is out of step with a modern mental health care system.

Today’s launch of the final report from the independent review led by Professor Sir Simon Wessely, Regius Professor of Psychiatry at King’s College London has set out recommendations for government on how the Act and associated practice must change to make it fit for a modern society.

Mills & Reeve’s Head of Healthcare and Mental Health, Jill Mason, attended the launch at the Royal Society of Medicine. She heard first-hand the powerful experiences of two service users who had previously been detained under the Mental Health Act. Both shared the realities of life under the Act and their lived experiences which ranged from informal treatment, through many different sections of the Act, as well as across community, inpatient and forensic settings. For both individuals, the importance of ensuring that individuals detained under the Act are “treated with dignity and that their liberty and autonomy is respected as far as possible” is key – and as Professor Wessely said, “detention shouldn’t be the new normal”. He emphasised that they have tried to get the balance between what can’t be balanced – autonomy and protecting the vulnerable. He spoke of depriving people of their liberty but not depriving them of anything else.

So, what are the key changes?

Four principles are outlined in the report that should underpin the reformed Act – an ethos for what the experience of detention should be and a guide to all decisions taken under the Act.

• Choice and autonomy – ensuring service users’ views and choice are respected.
• Least restriction – ensuring the Act’s powers are used in the least restrictive way.
• Therapeutic benefit – ensuring patients are supported to get better, so they can be discharged from the Act.
• People as individuals – ensuring patients are viewed and treated as rounded individuals.

There are 18 different themes in the report.

Sir Mark Hedley, one of the three Vice Chairs from the review team, commented that no Mental Health Act ever made people better but that the Act shapes the culture within which care is provided.

The Secretary of State for Health and Care, Matt Hancock, attended the launch. He explained that he had come along to mark the importance of the report and to put his thanks on record. He described the review report as “thorough” and a “ground breaking piece of work”.

He confirmed that Government is accepting two of the review’s recommendations to modernise the Mental Health Act.

• Those detained under the Act will be allowed to choose a ‘nominated person’ and choose other individuals to receive information about their care – rather than the current automatic ‘nearest relative’. A decision can be made in advance or, where they are able, at the time.
• New statutory ‘Advance Choice Documents’ (ACDs) will be built into routine care planning as part of shared decision making. They will apply to three categories of medical interventions in different ways. They will cover treatment refusals, preferences and who to tell if patients are detained .

The Government will take a careful, deliberative and consultative approach and make sure the Act stands the test of time. They will publish their response to the review’s recommendations next year before drafting new legislation.

Prime Minister Theresa May commenting on the report, said she will bring forward legislation to reform the Act, saying that the disparity in mental health services care was one of the "burning injustices" and is committed to putting it right.