Monday, March 25, 2024

Mental Health Act reform by a failed government

The Government has responded to the Joint Committee on the draft Mental Health Bill (see previous post). Tim Spencer-Lane has summarised in a Linkedin post which recommendations from the Scrutiny Committee were rejected and which were accepted by the government. As I said in a tweet, the response is disappointing but not surprising. As I keep saying, current reforms of the Mental Health Act (MHA) do not go far enough (see previous post). I also think that the opportunity should be taken to reform the Mental Health Tribunal (see another previous post) and formalise the role of a triage AMHP (see yet another previous post).

Failure to follow the recommendation about abolishing community treatment orders (CTOs) for civil patients is the most serious issue. What was fudged by the original review led by Simon Wessely was that mental health legislation is about supporting people with mental health problems (see previous post). Instead the government continues to parrot that review by saying that the MHA "governs the compulsory detention and medical treatment of people with severe mental illness, people with a learning disability and autistic people". It does but it also does, or should do, far more than that. 

Increasing coercion, such as CTOs, is not always the best way to manage risk in mental health services. The over-preoccupation with risk, that led to the introduction of CTOs, has not always produced sensible risk management (see previous post). Even more fundamentally, rights and recovery-orientated services need to be at the centre not the margins of mental health services (see another previous post), whereas the government merely says it will keep a rights-based approach under review (see response to recommendation 2 from the Scrutiny Committee). The government does not seem to be taking seriously that system and service changes are required to reduce coercion in mental health services as recommended by both the World Health Organisation and World Psychiatric Association (see yet another previous post). 

The Scrutiny Committee's recommendation for the creation of a MHA Commissioner, rejected by the government, was also helpful. As I said in a previous post, taking over the function of the Mental Health Act Commission (MHAC) by the Care Quality Commission (CQC) has meant, in my view, that a "specific emphasis on the rights of detained patients has been lost, as CQC has the more general role of regulating health and social care". More independence from CQC and NHS England is required to protect the rights of mentally ill people, as reflected in recent scandals exposed by TV programmes like Panorama (see eg. another previous post). The criteria in mental health legislation that allow coercive treatment are too wide to prevent abuse (see yet another previous post) and this must be remedied.

Not sure if the publication of this government response to the scrutiny committee will be taken forward in this parliament, such as having parliamentary time to discuss it. I think any Labour government will have to ask DHSC to go back to first principles, although there are many proposals, both within current draft legislation and elsewhere, including on this blog, which can be taken forward on this basis (see previous post). 

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