Rethink on Mental Health 'Must be Fully Funded'

Peter Russell

December 06, 2018

The charity MIND has welcomed a government rethink on mental health, saying that the previous situation amounted to "appalling" treatment meted out to many patients.

The Department of Health and Social Care promised to introduce updated legislation following a report from the Independent Review of the Mental Health Act 1983.

The British Medical Association (BMA) said change must be underpinned by properly funded resources.

Care is 'Out of Step in the Modern World'

The review looked at a number of key issues, including a rise in the number of detentions under the current law, the disproportionate number of people from black and minority ethnic groups being detained, and processes that were now out of step with a modern mental health care system.

People detained under the Mental Health Act deserved to be treated with respect and dignity and to have their views properly taken into account, the review found.

It said that people with mental health problems were too frequently treated as criminals. While detention might be in the best interests of some, the way the law was implemented was not in keeping with the times, according to the review, chaired by Simon Wessely, a former president of the Royal College of Psychiatrists.

A 'Major Issue' for People from Black and Ethnic Minority Backgrounds

The review also called for an overhaul of the way that people from black and ethnic minorities were treated, after hearing how they were disproportionately given community treatment orders.

"Even amongst that group, black African and Caribbean men are significantly over represented," according to the report.

Complex and "confusing" was how the review characterised the existing law, and said that future principles should enshrine the concepts of:

  • Choice and autonomy – ensuring service users' views and choices were respected

  • Least restriction, so that the powers of the law were used in the least restrictive way

  • Therapeutic benefit, so that as the mental health of patients improves, they could be discharged from care

  • Treating the person as a well-rounded individual

The Government said it accepted two of the review's recommendations to modernise existing legislation.

It said those detained under the Act should be allowed to nominate a person of their choice to be involved in decisions about their care. Currently, they have no say on which relative is contacted. This can lead to distant or unknown relatives being called upon to make important decisions about their care when they are at their most vulnerable.

Also, people should be able to express their preferences for care and treatment and have these listed in statutory 'advance choice' documents.

The Government said it would issue a formal response to the review’s recommendations in the New Year, prior to drawing up new legislation.

It said Theresa May, the Prime Minister, had shown her determination to bring about reform when she said last autumn: "The disparity in our mental health services is one of the burning injustices this country faces that we must put right.

"For decades it has somehow been accepted that if you have a mental illness, you will not receive the same access to treatment as if you have a physical ailment. Well, that is not acceptable."

Staff Shortages

The Care Quality Commission (CQC) said it had raised concerns about unsafe ward environments and over-restrictive, institutionalised care, often made worse by staff shortages.

Dr Paul Lelliott, deputy chief inspector of hospitals, and a lead on mental health issues at the CQC, said: "We will ensure that our inspections of mental health inpatient services properly assess whether wards offer a fit environment for safe and dignified care and that our ratings and judgments accurately reflect what we find. We will also work with providers and national bodies to understand how we can encourage improvement."

Paul Farmer, chief executive of the mental health charity, Mind, said: "It's good to see the review address racial inequalities. We know that black people are disproportionately sectioned, are more likely to be restrained, and are most likely to be put on a Community Treatment Order. These orders have been proven ineffective in reducing hospital readmission. Tightening the rules for imposing them is a small step in the right direction but we are disappointed that the review has not called to scrap them. 

"Likewise, we back the promotion of race equality in mental health services and in the use of the Act but this must come with concrete commitments, including that the NHS builds relationships with local communities."

Dr Andrew Molodynski, from the BMA, said: "As well as a significant legislative overhaul, there is a clear need for investment in mental health to ensure effective patient care, with a focus on treatment rather than security. 

"Meaningful change can only endure if underpinned by properly staffed and fully resourced services."


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