In January, the Government released a White Paper in response to the 2018 review of the Mental Health Act 1983, setting out its recommendations for changes to the Mental Health Act. Today, one of our Experts by Experience Lyndsay shares their experience of the Mental Health Act and how they feel changes to this legislation could impact their lives and others’ living with mental health conditions.
The Government is hosting an online consultation around the proposed reform. You can read the white paper and have your say in the consultation until 11:59pm on 21st April 2021 by clicking here.
My name is Lyndsay, I was diagnosed with Bipolar Affective Disorder in 2012, but I have struggled with mental health for many years before this time. My health has resulted in hospital treatment governed by a section of the Mental Health Act (MHA) 1983, which is undergoing a major review. What follows is reflection on two of the major changes proposed in the government white paper that feel the most relevant to me.
Improving Advance Choice Documents to cover patient’s future care and treatment, and giving these more weighting.
Essentially the Advance Choice Document is a way to define which type of treatment would be appropriate for someone who may not be able to give informed consent at the time of receiving treatment (which might mean they are under a Section of The Mental Health Act). If someone is presenting with issues from chronic depression to psychosis it is reassuring to know that their treatment is led by the helping hand of their wishes pre-hospitalisation.
Following a recent hospitalisation, I have requested advance choices for treatment to be added to my Care Program Approach (CPA). This is initially specific to being treated with a particular medication regimen which I have found assists my sleep and allows me to reset my mood. Without this treatment at the last hospitalisation the consultant thought I’d improved only for this to be a false recovery. There is also scope for further additions to be made. After discharge my Adult Mental Healthcare Team (AMHT) initially struggled to find a way to add this information to my CPA and settled on placing this in the important notes field of the first page of the digital document, it’s possible somewhere more obvious on the patient notes could be found.
The Review of the Mental Health Act (1983) beginning in 2018 has resulted in an intention to improve the use of Advance Choice Documents and make them more important in the new government White Paper. This relies on practitioners (primarily the Consultant Psychiatrist) having access to the CPA at the time of hospitalisation. This should be straightforward to achieve as this is a key document for the staff to make use of, to understand the patients’ health and current treatment.
Cessation of use of the police cells for initial detainment and the use of Police Vehicles.
The use of Police Sections (135 and 136) is a very sensitive issue amongst the Mental Health Community. Nobody wants to feel they are dragged into the criminal justice system when they are ill. The issue isn’t as much that police officers aren’t sensitive to the needs of a person in a mental health crisis, my experience suggests that the vast majority are pleasant and helpful (though a minority are heavy handed). More the significance is that police don’t have the requisite training that Mental Health staff have (Psychiatrists, Nurses and Support Staff).
The worst part of the police involvement in Mental Health detention is the use of police cells. Being unwell often comes with confusion and anxiety. Being taken to a police cell is at the least off-putting, at worst can exacerbate the crisis underway. Police services are often used as an out of hours service for dealing with ill people, as the psychiatric staff who would ordinarily make patient assessments are not available. Police cells are often used where there is no availability in inpatient psychiatric wards. Police vehicles transporting those in mental health relapse are inappropriate also, and the draft bill seeks to end this practice. I wonder which vehicles can be used instead, potentially the ambulance service or private ambulances which all have a cost.
Summary.
Many of the proposed changes to the Mental Health Act are very welcome in my opinion but I am concerned that some will struggle to be actioned because they will require additional revenue streams that successive central governments have failed to present in the past when necessary. I hope I’m wrong because what the White Paper promises, could be a significant sea change in the futures of those living with significant mental health issues.
Oxfordshire Mind, Expert By Experience