Tuesday, October 11, 2022

Evidence to the Joint Committee on the draft Mental Health bill

My submission to the Joint Committee on the Draft Mental Health Bill has been published, together with four pages of other submissions. As far as I am concerned, the draft Mental Health bill does not go far enough to reverse the re-institutionalisation of services that has taken place over recent years, particularly reflected in the increase in secure psychiatric provision (see eletter). Those secure services (and other inpatient services) are repeating the worst aspects of the asylums even in the NHS (see last post). There needs to be a refocus on developing community care and inpatient services need to become more open and therapeutic.

As I say in my submission, what's needed in legislative changes are: (1) no further community treatment orders (CTOs) (2) prohibiting civil detentions to secure facilities (3) improving advocacy to create an integrated service of Independent Mental Health Advocates (IMHAs), mental health lawyers and independent experts and (4) extending the role and powers of the Mental Health Tribunal (MHT) to treatment as well as detention decisions (thereby making the role of Second Opinion Approved Doctors (SOADs) redundant). A central feature of these changes would be creating a right to a second opinion for detained patients on both treatment and detention, as is being strengthened elsewhere in the world, such as in Victoria, Australia (see previous post). 

Both the National Survivor User Network (NSUN) (see submission) and Mind and ROTA (see submission) agree with me about CTOs. Dr Gareth Owen, in his submission, summarises the lack of evidence for the effectiveness of CTOs. As he says, the amendments proposed in the draft bill are unlikely to reduce CTOs and make their purpose even less clear.

As NSUN say, the revised legislation has not been sufficiently grounded in a rights-based understanding of mental health (see eg. previous post). NSUN and Mind mention the overlap with Seni's law (see previous post), as I did in my submission. Mind make the helpful suggestion of extending the role of the responsible person in each hospital, created by Seni's law, to oversee the promotion of race equity. As I said in my submission, appointment of a responsible person to reduce detention and coercion in each hospital with wider powers than provided by Seni’s law, and not just for racial issues, who could liaise closely with the MHA monitoring division of the Care Quality Commission (CQC), would help to produce a national focus on improving the rights of people with mental health problems delivered through each hospital.

Voiceability (see submission) helpfully endorse the recommendation of the Law Commission that only the Mental Health Act (MHA) should be used to deprive people of their liberty in psychiatric settings. Making this clear in the bill should deal with the fear expressed by several contributors (eg. submission by Lucy Series) that limiting the scope of detention of people with learning disabilities and/or autism under the MHA will not prevent those same people being detained under the Mental Capacity Act. As Voiceability note, however, there are a few examples where the Court of Protection has helped to secure better outcomes for people with a learning disability and autistic people in long-term detention.

Voiceability has also proposed that a national specialist advocacy service for people with a learning disability and autistic people should be commissioned in mental health settings (see paper). Similarly, I am keen to see consideration given to creating a national advocacy service, not only for people with a learning disability and autism, but also for those with mental illness, rather than relying on piecemeal commissioning arrangements. This would be an integrated service of Independent Mental Health Advocates (IMHAs), mental health lawyers and independent experts.

Voiceability also usefully highlight that the primary focus of the Wessely review and White paper was not on Part III patients. I have argued that no further detentions of Part II patients should be made to secure facilities. This will allow secure services to develop their proper function of being an alternative to prison. There may well need to be a national review of forensic/secure services.

The scrutiny committee starts hearing oral evidence this afternoon (see meeting details).

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