Reforming the Mental Health Act
On 19 December, UK Government published proposals for reforming the 1983 Mental Health Act in the latest White Paper. The Paper combines two different parts of legislation.
- Part 1: The new legal framework
- Part 2: High risk patients
The last Mental Health Act (from 1983) was based on a review of mental health law dating back to the 1950s. Since then, the system of psychiatric care has changed drastically to one where most people requiring mental health services now live in the community as opposed to long-stay psychiatric wards.
What is the Mental Health Act about?
The Mental Health Act has defined when and how someone can be treated, admitted or detained in hospital without their consent. Broadly speaking, the Act is for instances where someone is in danger of seriously harming his or herself or others if they are not treated/detained in hospital.
The Act has been divided into Sections, and these Sections describe different levels of compulsion. For example being 'Sectioned' under Section 2 of the Mental Health Act, would include a short admission into hospital with assessment for up to 28 days. The Hyperguide to the Mental Health Act has a useful review of all the Sections in use.
What are the proposed changes?
Some of the main changes fall under the following headings:
Treatment in the community
In contrast to the 1983 Act, the proposals recommend that people receive treatment under the Mental Health Act in the community. This reflects changes in psychiatric practice in the last two decades, as much treatment has moved out to the community from the hospital ward.
New definition of mental disorder
New legislation would not define categories of illness. So the treatment would guided by patient's need and not dependent on diagnosis. This new definition will move away from treatability as a defining feature of a condition.
People with severe personality disorder have previously been classified as 'untreatable' and were outside the remit of the 1983 Mental Health Act. If the White Paper proposals were adopted, people with personality disorder would also fall under the Mental Health legislation.
New safeguards for vulnerable groups e.g. people with dementia
Those with long-term mental incapacity who may be unable to offer their consent to treatment - for example people with dementia or severe learning difficulties - will also be included under the new Mental Health Act. There may be as many as 44,000 people in the UK who have long-term mental incapacity and they will be subject to different standards than those who actively resist treatment
New commission on mental health (to replace the mental health act commission)
The Commission consisting of users, carers, representatives of the key professional bodies will replace the current Mental Health Act Commission. Their responsibility will be to look after the interests of people who are subject to care and treatment under the act, by making sure the Act is implemented properly.
When will these changes come into effect?
The changes may not ever come into effect. It's very unlikely that changes to the law will happen soon and there is still a great deal of scope for the proposals outlined in the White Paper to be modified.
In the next stage, a bill based on the paper will be brought before Parliament. It would have to be discussed in both the Commons and Lords and both could make amendments before it becomes law.
However, it is unlikely that the bill will come before Parliament at all before the next election. After the election, the new government may announce their intention to bring forward the bill in the Queen's speech (usually given about 2 weeks after the election).
What can you do?
There is still a lot of time to comment on the White Paper. Many professional and user organizations are drafting responses for the Government. Contacting a local mental health organization can be a powerful way of making sure your concerns are heard.
Your local MP is another useful person to contact.
Where can I find out more information about the Mental Health Act?
Department of Health website - a summary and the full White Paper are available on this site as well as the National Service Framework, the Government's standards for care and treatment in mental health.
Royal College of Psychiatrists website
National Schizophrenia Fellowship website
Hyperguide to the Mental Health Act - has some useful information on the powers of sectioning but it's worth noting that it was last updated in 1996.
Szmukler G. (2001) A new mental health (and public protection) act. Risk wins in the balance between providing care and controlling risk. British Medical Journal 322(7277): 2-3 |
