Review of Mental Health Act must address excessive detention rates

My Post (4)Theresa May’s speech at the Conservative Party Conference on Wednesday 4 October was one mired by illness, a prankster and a backdrop that fell apart, presenting journalists with countless opportunities for cheap metaphors. But while the gaffs of her mea culpa overshadowed the announcement of new policies, for those that could see past the cringe-induced spectacle there were a number of interesting points.

One of these announcements was how the Government would be carrying out an independent review of the Mental Health Act. Building on her Brexit speech in January, where she vowed to correct the ‘burning injustices’ in modern society, May explained how a particular priority for her was ‘tackling the injustice and stigma associated with mental health’ (May, 2017).

She emphasised her desire for parity between mental and physical health through reiterating the Government’s pledge of increased investment in mental health. Recent announcements of an additional £1.3 billion to transform mental health services by 2021 (Health Education England, (HEE), 2017) were met with mixed reactions from key health bodies. It was said the funding will go towards the creation of 21 000 new posts, including 4600 nurses working in crisis care settings and 1200 nurses and midwives in child and adolescent mental health services (Department of Health, 2017). However, organisations such as the Royal College of Nursing said the Government’s proposals ‘appear not to add up’ (Royal College of Nursing, 2017). Other policies include giving an extra 1 million patients access to mental health services at an earlier stage, round-the-clock services and the integration of mental and physical health services for the first time.

The Mental Health Act
The Mental Health Act was passed in 1983 and is the main piece of legislation that sets out when and how a person can be detained and treated in relation to their mental illness. People detained under the Mental Health Act need urgent treatment for a mental health disorder and are deemed to be at risk of harm to themselves or others. In May’s speech she argued that the three decades old legislation is leading to ‘shortfalls in services and is open to misuse’ (May 2017). While the Mental Health Act was amended in 2007, it is felt by many that a more substantial revision is needed. This amendment was originally a proposed bill, but many felt it was ‘too draconian’ (BBC news, 2007).

The Five Year Forward View for Mental Health called for the Mental Health Act to be revised ‘to ensure stronger protection of people’s autonomy, and greater scrutiny and protection where the views of individuals with mental capacity to make healthcare decisions may be overridden to enforce treatment against their will’ (Mental Health Taskforce, 2016).

Reducing detention rates
Current detention rates under the Mental Health Act are too high. The latest published figures show the number of detentions under the Act are rising annually, increasing by 9% to 63 622 in 2015–2016, compared to 58 399 detentions in 2014–2015 (NHS Digital, 2016). Over the last 10 years they have increased by almost 50%. Of those detentions, a disproportionate number are of people from black and minority ethnic populations — four times as many black people as white people are detained. It is unclear why there are disproportionate detention rates between different communities, but this must be identified to ensure equal access to earlier intervention and crisis care services.

While reviewing the Act will use changes in legislation to help reduce the rates of detention, the difficulty will come in figuring out how the delivery of care must be changed so that detention can be avoided in the first place (Wessely, 2017). Additional focus is needed on the provision of earlier support. By identifying vulnerable people and addressing their mental health needs early, they can receive the support and care they need before detention becomes an unavoidable necessity.

For those that are detained, there needs to be a review of the areas constituting a ‘place of safety’. Police custody is not an appropriate area of safety. Around half the deaths that take place in or following police custody involve detainees with some form of mental health problem (Independent Police Complaints Commission (IPCC), 2017). Although police custody is only used as a last resort, it can exacerbate a person’s mental state, and has the effect of criminalising people who are in need of medical attention (IPCC, 2017).

Undertaking the review
The review will be carried out by Sir Simon Wessely, professor of psychological medicine at the Institute of Psychiatry, King’s College London. He is the former President of the Royal College of Psychiatrists and current President of the Royal Society of Medicine. Wessely will produce an interim report in early 2018 and develop a final report containing detailed recommendations, by autumn 2018.

References

BBC News. Ministers lose Mental Health vote. [Online]. 2007. [Cited on 25 Oct 2017]. Available from: http://news.bbc.co.uk/1/hi/uk_politics/6374547.stm

Department of Health. Thousands of new roles to be created in mental health workforce plan. London: The Stationery Office; 2017 Aug 30 [cited 2017 Oct 18]. Available from https://publichealthmatters.blog.gov.uk/2017/08/30/moving-forward-with-theprevention-of-mental-health-problems/

Health Education England. Stepping forward to 2020/21: The mental health workforce plan for England. Leeds: Health Education England; 2017 [cited 2017 Oct 18]. Available from https://www.hee.nhs.uk/sites/default/files/documents/CCS0717505185-1_FYFV%20Mental%20health%20workforce%20plan%20for%20England_v5%283%29.pdf

Independent Police Complaints Commission. Mental health and police custody [Internet]. Sale: IPCC; 2017 [cited 2017 Oct 19]. Available from https://www.ipcc.gov.uk/page/mental-health-police-custody

May T. Theresa May’s Conservative conference speech, full text [Internet]. London: The Spectator; 2017 Oct 4 [cited 2017 Oct 18]. Available from https://blogs.spectator.co.uk/2017/10/theresa-mays-conservativeconference-speech-full-text/

Mental Health Taskforce. The Five Year Forward View for Mental Health. Leeds: NHS England; 2016

NHS Digital. Inpatients formally detained in hospitals under the Mental Health Act 1983, and patients subject to supervised community treatment. Uses of the Mental Health Act: Annual Statistics, 2015/16. London: Health and Social Care Information Centre; 2016

Royal College of Nursing. RCN responds to Mental Health Workforce Plan. London: RCN; 2017 [cited 2017 Oct 18]. Available from https://tinyurl.com/yavm3ulq

Wessely S. The Prime Minister Has Asked Me To Lead A Review Of The Mental Health Inequality In Britain – Here’s Why. London: The Huffington Post; 2017 Oct 6 [cited 2017 Oct 19]. Available from http://www.huffingtonpost.co.uk/professor-sir-simonwessely/mental-health-act_b_18192476.html

Taken from British Journal of Healthcare Management, published November 2017.

Advertisements

Leading support for those with mental health issues and learning disabilities

Adobe Spark (3)The Chief Nursing Officer has told mental health and learning disability nurses they need to ‘step up and take the lead’ in delivering ambitions set out by NHS England for mental health and learning disability services. Speaking at the NHS Expo in Manchester, Professor Jane Cummings said:

‘Nurses are creative, they’re innovative, they’re leaders, and they can really drive that change that we all want to see.’

Cummings outlined the important leadership role that mental health nurses have in delivering the Five Year Forward View for Mental Health (NHS England, 2016), and that learning disability nurses have in delivering the Learning Disability Transforming Care programme:

‘I think that nurses and midwives should be at the driving edge of change and improvement. I think there is a wealth of knowledge, a wealth of experience. And there’s a huge amount of skill set that nurses can have to really drive the change that everyone wants to see.’

Five Year Forward View for Mental Health

The Five Year Forward View for Mental Health was launched in February 2016 in an attempt to improve mental health outcomes across the health and care system, and includes an additional £1.4 billion of investment in mental health services by 2020/21. The funding will go towards the creation of 21 000 new posts, including 4600 nurses working in crisis care settings and 1200 nurses and midwives in child and adolescent mental health services. Other policies include giving an extra 1 million patients access to mental health services at an earlier stage, round-the-clock services, and the integration of mental and physical health services for the first time.

Cummings said that improvements to mental health services is one of the ‘national priorities’ for NHS England, emphasising how there is a massive amount of work going on around mental health, with a real focus on improving access to services:

‘We are particularly focusing, through the Maternity Transformation Programme, on perinatal health. As part of that we have a big workstream looking at perinatal mental health and supporting women to cope with any problems they get post birth.’

According to Claire Murdoch, National Director for Mental Health, the priorities of the Five Year Forward View for Mental Health are built on a core set of pre-existing services that are transforming and developing to create an ‘absolute, quiet and steady revolution in mental health care.’

Murdoch echoed Cummings by also calling mental health nurses to ‘step forward and step up.’ However, in order to do this she said nurses need to become vocal about their skills, and experts in co-production and working alongside mental health service users in their own care. As part of plans laid out in the Forward View, Murdoch said the NHS will see an additional 1 million extra patients. This will include 70 000 more children and young people, who will have increased access to specialist eating disorder services within the community.

Murdoch explained how further evidence-based interventions, made earlier in the pathway of illness or distress, will ‘fundamentally change the outcomes for people’s lives so that we don’t create unwittingly long-term patients for the future.’ She added that there will be more tier 4 specialist beds for children and young people suffering from serious mental health problems, particularly in London and the south, where occupancy often outstrips demand. Additional improvements in respite care, crisis houses and home treatment teams were also assured.

According to Murdoch, nurses are leading community mental health teams for children and young people. Working alongside psychologists and doctors, she explained that they are playing a key role in the management of conditions such as eating disorders. Community eating disorders services for young people largely did not exist until last year, and Murdoch commended the mental health nurses, who she said were not only leading those teams, but also breaking new ground in having to work alongside families, the young people themselves, and deliver evidence-based care in completely different settings.

One of the greatest concerns Murdoch highlighted was the current pressure on the mental health crisis care pathway. In particular she stressed the need to prevent beds overspilling into the private sector and long waits in accident and emergency (A&E) departments. However, she announced that nurses have led the way in redesigning the care pathway through the ‘development of intensive current treatment teams’ and the ‘establishment  of the psychiatric liaison teams in A&E and acute hospitals more widely.’

She believes nurses will play a ‘fundamental part’ in ‘bringing an end to inappropriate out-of-area placements.’ An example she cited was in Birmingham, where nurses are working alongside the police to dramatically reduce the use of Section 136 of the Mental Health Act, which allows the police to take a person who appears to be suffering from a mental disorder to a place of safety. She said this has enabled better outcomes for people in distress.

Though she raised concerns that large numbers of nurses are leaving the profession and that recruitment will be an additional challenge, she said ‘there has never been a better time to be a mental health nurse.’ However, she urged mental health nurses to be vocal about their skills, whether that is their skill of assessment or complex working in networks of care.

‘We need to become the experts in co-production and working alongside mental health service users in their own care. We need an effort to come up with a care plan that hasn’t been produced at least in partnership, even at times of great crisis. We need to become the experts in that space. Housing, debt, employment, the physical health care, these are the domains of mental health nurses.’

Transforming care for people with learning disabilities

Alongside improvements to mental health services, a national plan to develop community services and close inpatient facilities for people with learning disabilities has meant better care for this patient group. The focus of the Learning Disability Transforming Care programme is on giving people with learning disabilities the opportunity to live in the setting they think is home. It also aims to stop overmedication and improve access to annual health checks.

Vicki Stobbart, a disability nurse and Executive Director of Nursing and Quality for Guildford and Waverley CCG, said that while learning disability nurses may not be as high profile as other areas of nursing, their impact and value in supporting people with learning disabilities should not be underestimated.

‘Learning disability nurses are the only professional group specifically trained to work with people with learning disabilities,’ said Stobbart. ‘This level of preparation, currently provided at degree level, alongside the breadth, competence and knowledge they develop, makes them a unique and critical component on the delivery of comprehensive skills.’

Alongside presentations on the leadership role of mental health and learning disability nurses, Professor Cummings led a panel discussion with healthcare staff and service users on how nurses can play a key role in the care of mental health and learning disability patients. Organised by NHS England, the Health and Care Innovation Expo saw over 5000 delegates learn about developments and innovations taking place across health and social care.

Looking at the progress made since the launch of the Five Year Forward View, it identified a number of key areas of priority, including urgent and emergency care, primary care and general practice, cancer, and mental health.

Taken from British Journal of Mental Health Nursing, published November 2017.