Government takes up mental health review recommendations

The government has said it will introduce a new Mental Health Bill focused on modernising and improving mental health care in England.

It follows publication of the Independent Review of the Mental Health Act 1983, which the government commissioned last year.

Two recommendations made in the Modernising the Mental Health Act report have been accepted by the Department of Health and Social Care, which is expected to respond to the remaining 148 recommendations in the new year.

Earlier in the year the Care Quality Commission (CQC) reported that there had been a 40% increase in detentions under the Act in the last decade, warning it could be symptomatic of gaps in provision in the system.

Currently, individuals detained under the Mental Health Act are not given a say over which relative is contacted, but proposals approved by the government will give patients the power to nominate a person of their choice.

Patients will also be able to express their preferences for care and treatment listed in statutory ‘advance choice’ documents, the Department of Health said.

More advanced decision-making for patients underlies several recommendations in the report, which said encouraging patients to make decisions about their care earlier on when they are detained can be used more effectively to identify their preferences when they lose mental capacity.

The 307-page report recommended that the CQC develops new criteria for monitoring inpatient wards, after saying more needs to be done to improve patients’ physical environments and minimise institutionalisation.

According to the report, data collection on the use of restraint in mental health services is ‘inconsistent’ and restraint is a ‘routine occurrence’ on wards. It said users from ethnic minorities, women and girls had been disproportionately affected by its use.

The report called for the removal of ‘coercive behavioural systems and restrictions’ it said can lead to ‘loss of autonomy’ and ‘foster institutionalisation’ –  and said services should look instead to developing alternatives to bringing about patient behavioural compliance.

Last month, the Mental Health Units (Use of Force) Act was passed, putting a requirement on mental health services providing NHS care to publish data on ‘how and when’ they used force on patients.

NHS England and NHS Improvement have also launched programmes to try and reduce restrictive practices across services delivering mental health and learning disability care.

Tim Read, director of UK healthcare advisory, Marwood Group, said: ‘Alongside the independent review of the Mental Health Act, the news that regulators have begun a national improvement pilot programme to reduce the number of times force is used against mental health patients should alert providers to ongoing national concerns about the treatment of people in mental health units.

‘National statistics on the use of force will be published annually, and provider compliance with the Act could form part of CQC’s future inspection activity,’ he said.

Paul Jenkins, chair of the Mental Health Network, added: ‘Restricting someone’s liberty should always be a last resort. Putting this right requires all of us taking steps to ensure we close the gap in terms of inequalities in access and outcomes.

We look forward to working with colleagues on this important issue and await the government’s response in due course.’

Paul Farmer, chief executive of mental health charity Mind, said: ‘[The act’s] outdated legislation has seen thousands of people experience poor, sometimes appalling, treatment, who still live with the consequences to this day.

‘The recommendations to strengthen people’s rights, empower them to question decisions about their care, choose their treatment and involve friends and family have the potential to make a real difference to those who are in an extremely vulnerable situation.

‘The government now needs to take this review forward as soon as possible so that people with mental health problems get the support they need,’ he added.