Friday, January 01, 2021

Supporting people through mental health and capacity legislation

I’ve said before (see eg. previous post) that I’m concerned that the government’s White Paper on reform of the Mental Health Act will not go far enough. This is because it is likely to be based on the review chaired by Simon Wessely. He says in the foreword to the review that “the Mental Health Act takes away your liberty and imposes treatment that you don’t want ... and ... can help restore health, and even be life-saving”. As he also says, this tension is nothing new, but I think the opportunity to have a fundamental rethink about the role of legislation for treatment of mental health problems may have been lost.

Surely the essential aim of mental health and capacity legislation should be to support people with their incapacity/disability, which may well be temporary in the case of mental illness. I actually don't think legislation should primarily be about the removal of liberty and the imposition of treatment. Informal admission should again be seen as the dominant mode of inpatient treatment if this is needed. If detention is necessary, the person's dignity and respect need to be preserved and any decisions made need to take account of their will and preferences. Part of the problem is that we have become trapped in a historic tension between restraint and freedom. We do not immediately need to be jumping to substitute decision making or coercion to support people when they lose or do not have mental capacity. I have always accepted that these measures may be needed, but the legislative framework needs to change so that such interventions are not necessarily seen as a priority. Coercion may be more to do with a failure of treatment than treatment itself.

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