The final report of the Independent Review of the Mental Health Act has been handed to the office of the Prime Minister – just over a year after she appointed Professor Simon Wessely to oversee it. Mark Trewin reveals how its official launch marks the end of a year of intense debate, engagement and research in service to those who need the support of mental health services the most.
The review was undertaken to understand why rates of detention are rising, why a disproportionate number of Black, Asian and minority ethnic (BAME) people are detained and how to reform and modernise mental health services.
I joined the working group of the review in March 2018 as one of many social workers advising or supporting the review.
Social workers and approved mental health professionals (AMHPs) have had a substantial role so far. They have been involved in the working group that oversees the development of the review, the expert advisory group and most of the smaller topic groups that looked in detail at particular themes and developed draft recommendations.
In addition, the AMHP leads group and Association of Directors of Adult Social Services (ADASS) mental health policy group has advised the review on areas that impact on AMHP, social work or Local Government roles.
Being involved in the review has been a fascinating learning experience. It has challenged us all to look at the process of detention, care, treatment and aftercare support from many perspectives – but especially from the viewpoint of people who have directly experienced it.
It was clear from early in the process that, despite receiving many examples of great practice and innovative services, too many people experienced detention under the Mental Health Act as an undignified and traumatic experience. Alternatives to hospital were often unavailable and care, treatment or discharge were not good enough. In short, services were failing people who needed support.
The experience of BAME people has been particularly significant. The frustration of mental health professionals, including AMHPs, doctors and nurses and the complexity of issues that NHS and social work staff must deal with were also major issues.
These experiences have shaped a set of final recommendations based on clear themes. This includes the need to treat people with dignity, to ensure that people are involved in their care and that people who are subject to the MHA should be able to exercise autonomy, choice and control within a system based on human rights.
We have not produced a completely new act, but a substantial redesign and modernisation of the existing legislation. The aim is to reduce coercion to the minimum necessary and tighten the criteria by which professionals must consider and justify their treatment decisions while enhancing the legal protection for people subject to the act.
The review has also tried to create links with the many other mental health developments being undertaken currently – especially the NHS Long Term Plan, the adult social care green paper and the Community Mental Health Framework.
The review has been very aware that legislation alone cannot deliver the changes needed to modernise mental health services. The need to develop community and prevention based services delivered jointly by NHS, Social Care and Public Health services has been clear from the start.
One of the areas we have focused on has been a consideration of the views of frontline AMHPs, NHS staff and police officers from across the country. Based on their feedback, we have made a range of recommendations about the importance of improving joint working across health and social care.
Projects like this are always a compromise between ambition and reality. I hope, at least, we have provided the government with a realistic basis for modernising the outdated mental health act. If we deliver a framework that recognises the humanity, complexity and diversity of our growing population we can deliver better mental health services for all.
Mark Trewin is Mental Health Social Work Lead at the Department of Health and Social Care