Modernising the Mental Health Act

1 Modernising the Mental Health Act Increasing choice , reducing compulsion Final report of the Independent Review of the Mental Health Act 1983. December 2018. Crown copyright 2018. Published to in pdf format only. This publication is licensed under the terms of the Open Government Licence except where otherwise stated. To view this licence, visit government-licence/version/3. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. 1. Contents FOREWORD - REVIEW CHAIR .. 4. INTRODUCTION AND EXECUTIVE SUMMARY - REVIEW CHAIR AND VICE CHAIRS. 16. LETTER FROM THE REVIEW'S SERVICE USER AND CARER GROUP .. 35. HOW THE REVIEW CARRIED OUT ITS WORK.

2 39. THE CASE FOR CHANGE .. 45. UNDERSTANDING RISING RATES OF DETENTION .. 49. SERVICE USER EXPERIENCE .. 53. STEPS TO TACKLE THE DISPROPORTIONATE NUMBER OF PEOPLE FROM. ETHNIC MINORITY COMMUNITIES DETAINED UNDER THE ACT .. 58. HOW WE ARE MEETING OUR HUMAN RIGHTS 60. Mental CAPACITY AND DECISION MAKING IN THE 63. A NOTE ABOUT LANGUAGE .. 64. NEW Mental Health ACT PURPOSE AND PRINCIPLES .. 65. PRINCIPLE 1 - choice AND 69. MAKING DECISIONS ABOUT CARE AND TREATMENT .. 69. FAMILY AND CARER INVOLVEMENT .. 85. ADVOCACY .. 90. COMPLAINTS .. 95. DEATHS IN DETENTION .. 98. PRINCIPLE 2 - LEAST RESTRICTION .. 103. TACKLING THE RISING RATES OF 103. CRITERIA FOR 109. A STATUTORY CARE AND TREATMENT PLAN.

3 114. LENGTH OF DETENTION .. 117. CHALLENGING DETENTION .. 122. DEPRIVATION OF LIBERTY: MCA OR MHA? .. 126. COMMUNITY TREATMENT ORDERS (CTOs).. 132. COERCION AND RESTRICTIVE PRACTICES WITHIN INPATIENT SETTINGS .. 140. PRINCIPLE 3 - THERAPEUTIC BENEFIT .. 142. CARE PLANNING AND AFTER-CARE .. 142. HOSPITAL VISITORS .. 149. INPATIENT SOCIAL ENVIRONMENTS .. 152. 2. INPATIENT PHYSICAL ENVIRONMENTS .. 154. PRINCIPLE 4 - THE PERSON AS AN INDIVIDUAL .. 158. PERSON CENTRED CARE .. 158. RECOGNITION OF PATIENT INDIVIDUALITY AT THE TRIBUNAL .. 161. THE EXPERIENCES OF PEOPLE FROM ETHNIC MINORITYCOMMUNITIES .. 163. CHILDREN AND YOUNG PEOPLE .. 173. PEOPLE WITH LEARNING DISABILTIES, AUTISM OR BOTH.

4 183. POLICING AND THE MHA .. 191. PATIENTS IN THE CRIMINAL JUSTICE 197. IMMIGRATION 205. VICTIMS .. 207. SYSTEM-WIDE ENABLERS .. 209. DATA .. 209. DIGITAL ENABLERS .. 212. QUALITY IMPROVEMENT AND MONITORING .. 214. STAFFING .. 215. THE APPLICATION OF THIS REVIEW IN WALES .. 220. THE FUTURE DIRECTION OF TRAVEL FUSION OF THE MHA AND MCA .. 222. CONCLUSION .. 228. AFTERWORD - REVIEW CHAIR .. 229. 232. Annex A: Treatment 232. Annex B: Treatment of involuntary placement/treatment and Mental capacity by international and regional human rights bodies .. 241. Annex C: Summaries of commissioned 248. A qualitative exploration of perspectives on the Mental Health Act and people of African and Caribbean descent: summary.

5 290. Annex D: Qualitative analysis of the Service User and Carer Mental Health Act survey .. 296. Our Recommendations .. 297. The Review Team .. 315. Glossary .. 316. Acronyms .. 320. 3. FOREWORD - REVIEW CHAIR. It has been an honour to Chair this Independent Review of the Mental Health Act. But it has been more than that - a great responsibility and a profoundly moving experience. I. have learnt much as the Review progressed, as well as having the opportunity to meet a remarkable range of people. The result is an extraordinary piece of collaboration, across a range of disciplines, putting into the practice the principles of co-production with patients and service users, which some outside observers have described as a model for future independent reports requested by government.

6 But what follows is a single voice - my personal view on the background to the Review and some of the issues that shaped my thinking as the year progressed. Should you wish to hear from me again, I will also sum up what this means and pay tribute to all of those who have made this possible in a brief afterword. For those of you who have opened this document to find out what we have recommended, my first recommendation is to skip this introduction and move straight to the next section. Why do we have Mental Health Acts? On the one hand, the Mental Health Act takes away your liberty and imposes treatment that you don't want. It can be traumatic, frightening and confusing. But on the other it can help restore Health , and even be life-saving.

7 It is an imposition on personal freedom, but it can also help people to become freer from the pain and distress that accompanies the most severe of Mental illnesses. This paradox or tension is nothing new. Society and State have been debating for two centuries or more how to balance an individual's right to autonomy with the desire of a civilised society to protect its most vulnerable. Our cultural and ethical traditions support the concept of autonomy. Allowing everyone to make the decisions that affect their life and accept the consequences of those decisions is a key aspect of respecting the unique value and character of each human person. And in recent years it has become clearer that there is no reason why that should be rescinded simply because an individual is unwell.

8 But our cultural and ethical traditions also support the concept of protecting the vulnerable and those unable to care for themselves. The desire to help a fellow human being in serious distress is one of the more attractive aspects of human nature and societies seek to encourage this by encouraging charitable actions in giving, respecting those in the "helping professions , or giving legal protection to "Good Samaritans". Moreover, most Health professionals (and indeed judges) possess well-developed protective instincts. And most of us, if we see someone about to jump from a bridge, would try to help them step away. 4. Few would like to live in a society in which an individual has precious little autonomy.

9 But nor would we like to live in one that does little or nothing to protect its most vulnerable. And if individuals are ever truly free to choose, which some doubt, they are far less so when they are, in the words of Nikolas Rose, a leading sociologist and critical commentator, in states of anguish, despair or tormented by voices telling them they are worthless and should die 1. These two strands cannot always live together: choices have to be made. This tension often explains the differing perspective of patients (who understandably put a high value on autonomy) and people like me, professionals in the field of Mental Health , who made that choice because they believed, with some justification, that they had something to offer to people in such distress - a "treatment" in the broadest sense of the word, be it physical, social or psychological.

10 I grew up thinking that some temporary intrusion on autonomy is a proportional response to an acute or desperate situation, and that this was often best done in a hospital setting. To quote Nikolas Rose again: sometimes compulsory admission to a place of safety for a short period of respite care, even where conditions are far from ideal, together with the short term, even involuntary, administration of some sedative medication, can be a way of returning an individual in such a state of extreme distress to a condition where they can make thoughtful decisions about their own lives . (Rose, 2019, p175). But it is far from ideal. As Rose continues: Of course all too often the institutions in question do not provide safety, respite and care, and the administration of medication is excessive, prolonged and for the benefit of staff rather than patients2 (Rose, 2019, p222).