How the reform to the Mental Health Law must balance the treatment of people with greater autonomy

Around the world, mandatory powers are used to detain and treat people who are perceived to have mental health problems. In the UK, most people who experience these problems voluntarily receive treatment in the community. However, in times of acute mental health crisis, some may be compulsorily detained in the interest of their own health or safety, or for the protection of others.

In England and Wales, decisions about whether or not to detain are normally made by an approved mental health professional and two doctors. These decisions are ethically challenging, because they imply taking autonomy away from the person. They allow themselves to be detained and given drugs against their will.

In the 2022 Queen’s Speech, Boris Johnson reaffirmed his government’s intention to reform the Mental Health Act. “Our mental health laws are outdated,” Johnson said before the speech. “Every person deserves to be treated with dignity, and it is our duty to ensure that the rights and freedoms of the most vulnerable in society are protected and respected.” While many of the measures he announced are laudable, better resources and funding will be required to make them effective.

Boris Johnson in a blue suit photographed behind a lectern outside.
Prime Minister Boris Johnson has recognized how urgently these reforms are needed.
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The way we think about mental health is changing

Changes in mental health law reflect our evolving attitudes toward people with mental health problems. On the one hand, the law allows professionals to treat people against their will and deprive them of their liberty when the conditions of the Mental Health Law are met. On the other hand, it can provide people who use mental health services with rights and protections to ensure they are not detained without good reason and to allow them to receive the treatment they want.

The government’s plans to reform the Mental Health Act were first published in 2021. This followed an independent review commissioned by the government, which recognized the importance of human rights in mental health care. He highlighted the need to restore dignity and allow service users to participate in decisions about their own care.

The subsequent white paper noted widespread concerns about rising detention rates, citing a 40% rise between 2006 and 2016. It acknowledged that black people were much more likely to be detained under the Mental Health Act and discharged under a community treatment order (these orders mean that people must be treated in the community after leaving the hospital, but the doctor in charge of their care can return them to the hospital for treatment if necessary). It also included concerns about the way people with learning disabilities and autism are treated under the Mental Health Act.

The reforms were last introduced in 2007 by the new Labor government. They were driven by the perceived need to manage the risks of violence posed by people with mental illness living in the community and alleviate public concerns about it. The changes gave mental health professionals more control by expanding detention criteria and introducing community treatment orders.

The government aims to raise the admission threshold so that people are only involuntarily detained when strictly necessary. Changes are also established in the admission criteria to limit the use of the legislation for autistic people and people with learning disabilities. And existing guarantees in the Mental Health Law will be strengthened, for example by giving patients the right to formally challenge detention more frequently, through mental health courts.

Other new measures to promote autonomy include providing patients with better support, offering detained people the option of an independent lawyer (a paid professional who can speak on their behalf), and allowing people to choose their own “appointed person.” . This new role replaces the “next of kin” role, as specified in the current version of the law. Currently, a family member is selected from a fixed list and given certain powers to contest detention or request release. This has been criticized for not allowing people to choose who they would like to represent them.

A professional sits with a young man in an office.
It is increasingly understood that human rights and autonomy are crucial to mental health care.
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Reforms will need adequate resources to be effective

Although it is important to rebalance the powers granted to professionals and the rights of people who use mental health services, these presented reforms leave several questions unanswered. The new nominee role, in particular, is welcome. However, our research shows that next of kin feel emotionally unsupported and uncertain about how to use their legal powers to protect their relatives’ rights. Education and support must be provided to nominees for the role to be effective.

Furthermore, the House of Commons Health and Social Care Committee has said that restrictions on the detention of autistic people and people with learning disabilities in hospital will only be successful if they are accompanied by significant improvements in the community support they receive. people can access.

Giving detainees greater rights to mental health courts and defense is laudable in theory. However, you will also need resources. Research indicates that while more and more defense services have been promised, government assessments have highlighted that the provision of defense services varies widely across geographic areas.

Finally, research has shown that people are more likely to be detained when they experience economic deprivation. The proposed reforms do not specifically address this, although they are accompanied by broader system supports and investments, for example in schools, maternity services and for groups most affected by the pandemic. The government’s broader capping policy will also include a new mental health plan.

The government has promised service users more rights. However, these new safeguards will be symbolic, without adequate resources and support on the ground.

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