Friday, October 29, 2021

Radical reform of Mental Heath Act

Several of the posts on this blog over the last few years have been on reform of the Mental Health Act in England and Wales, following the independent review chaired by Simon Wessely (see previous post) and the consultation by the UK government on a White paper (see another previous post). Scotland is pursuing its own reforms (see previous post). 

Involuntary mental health treatment must be implemented respecting people’s dignity and their civil and political rights. Complete removal of compulsion, if it can be achieved, will have to be progressively realised, and it should be possible to do this so that it is compliant with the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). Risk in mental health services is not necessarily best managed by increasing coercion (see eg. previous post).

A new Bill is likely to be presented to parliament next year. The government has decided there will not be a draft Bill for pre-legislative scrutiny. This may be unfortunate as there is apparently considerable uncertainty about the development of policy proposals (see my summary of White paper and government's response to consultation). I fear the Bill may not even go as far as the White paper if there is not sufficient discussion. For example, it's not clear to me how family interests will be protected if the Nominated Person replacing the Nearest Relative is not a family member. Nor do I think it is necessarily sensible to extend holding powers to Accident and Emergency departments. I have deliberately chosen examples which may have appeared to be simple and uncontroversial to show that as far as I can see multiple issues still need to be resolved. How learning disability and autism may no longer be considered as mental disorders for treatment (see eg. another previous post) would be an example of a more complex unresolved problem.

Particular issues I have been promoting on this blog include:-

  1. Expanding Mental Health Tribunal powers to decisions about treatment as well as detention (see eg. previous post)
  2. Considering a national advocacy service to include Independent Mental Health Advocates (IMHAs), mental health lawyers and independent experts (see previous post)
  3. Repealing Community Treatment Orders (CTOs) (see eg. previous post)
  4. Abolishing Second Opinion Approved Doctors (SOADs) (see eg. previous post) and
  5. Prohibiting civil detentions (part II cases) to secure facilities (see eg. previous post)

I understand that the government does not want to reopen issues about reform of the Mental Health Act considering the protest caused by what was supposed to have been a root and branch reform of the Act producing a green paper in 1999 that led to the compromise of the 2007 amendments (see eg. letter from my MP at the time). Nonetheless I do think there are fundamental issues about the rights of people with mental health problems that do need proper debate.

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