"Being detained is never someone’s life plan, but reforms to the Mental Health Act could help people move forward"

We have been talking about the importance of reforming the Mental Health Act, the law under which someone can be detained in hospital for assessment and/or treatment of their mental health, for several years now.

As the new Mental Health Bill finally enters the House of Commons this week, Ian from Rethink Mental Illness shares his personal and professional lived experience of the Act, how the proposed reforms could make a difference to people’s lives and some of the issues that still need addressing. 

***

Heaven ain’t close in a place like this

I have now been working at Rethink Mental Illness for 10 years, with a focus on making sure that people with lived experience of severe mental illness are at the heart of all of our involvement and co-production programmes. This is a mission that I am passionate about after my own experience of the mental health system. 

I have experienced severe mental illness for most of my adult life, which has led to multiple admissions to hospital and being given multiple different treatments. This includes a catastrophic crisis over 18 years ago, where I was detained under the Mental Health Act. 

When somebody is detained under the Mental Health Act, they are put behind a locked door, with their liberty taken away from them, and still regularly experience things being done ‘to’ them rather than  ‘with’ them. There are over 50,000 detentions under the Mental Health Act each year, so we are talking about significant numbers of people being affected. 

When I reflect on my time in hospital, I am reminded of a lyric from one of my favourite bands: ‘Heaven ain’t close in a place like this’. That is very much the reality for how many people in hospital, experiencing a mental health crisis feel, and why reform is so crucial to support their recovery.

The best legislation is that which enshrines common sense into law

There are so many things that could have improved my experience of being detained under the Mental Health Act, and the new Mental Health Bill includes several changes that have the potential to positively impact people for years to come. Overall, there are more checks and balances for decisions on detaining someone in the first place, for making care and treatment decisions while someone is detained and for discharging someone from hospital. 

The guiding principles included in the Bill lay a clear foundation for doctors and other healthcare staff to make decisions about the treatment and care of patients. These principles are those of choice and autonomy; least restriction; therapeutic benefit; and treating the person as an individual. 

When I was detained all those years ago, I know that my experience would have been completely different if police cells could not be used as a place of safety for people experiencing a crisis, and for others, if there had been a 28-day time limit for people to be transferred from prison to hospital if needed. I would have also really benefited from the new legal right to an Independent Mental Health Advocate and more frequent access to Tribunals, in order to review my detention. 

There is a saying that ‘The best legislation is that which enshrines common sense into law’, and to me many of these changes do exactly that, particularly the ones that place a much greater emphasis on involvement. These include:

• introducing Advance Choice Documents to help people make decisions when they are well about how they want to be treated when they are unwell
• making Care and Treatment Plans for people in hospital a legal right for all
• allowing people to choose their own Nominated Person who can help to make decisions on their behalf. 

Including people in care planning, and giving them choice over their care and treatment, raises the likelihood that they will be more engaged in their care and treatment, leading to better outcomes and experiences. 

Some words of caution

I have been involved in the reform of the Mental Health Act since the Independent Review in 2016, so I am glad that a new Act should finally be enshrined in law this year. However, it is extremely important that decision makers do not consider this the be all and end all when thinking about improving mental health services. 

Workforce shortages across services have been well documented for years, meaning that people who are being detained are being cared for on wards that are short staffed or by staff who are not always adequately trained.

This problem is made even worse by the fact that the 17,000 beds in England and Wales are currently at almost 100% capacity, which in turn means that more and more people are being sent to out-of-area placements, 100s of miles away from their support networks. Lord Darzi’s recent report on the NHS is the latest publication to recognise that hospital estates are simply not fit for purpose, with some conditions being described as ‘crumbling’ and ‘Victorian’. 

Almost 50% of inpatient mental health units are rated by the regulator, the Care Quality Commission, as ‘requires improvement’ or ‘inadequate’ on safe or well led domains. This serves as a stark reminder that any legislative changes we make will need to be supported by significant investment in mental health staff, beds and facilities for them to have a positive impact for the people that need it the most.

Inpatient mental health care does not exist in a vacuum. Rethink Mental Illness have recently been working to highlight the need to tackle ever growing waiting lists. People are currently eight times more likely to wait over 18 months for mental healthcare than physical healthcare, and our research has shown that four in five people waiting for mental healthcare felt that their health deteriorated during this wait. 

The difficulty I had in accessing community services was in part what led to my downward spiral and eventual detention in hospital. Despite their best efforts, my GP saw how unwell I was but was unable to get an appointment with a psychiatrist to assess my mental health. The crisis team couldn’t help as I wasn’t known to them and there was nowhere else for me to go. The consequences of this lack of community support were indeed catastrophic. My experience clearly shows that struggling community services lead to more hospital admissions. 

Being detained in hospital because of mental illness is never a part of someone’s life plan, but I hope that the reforms to the Mental Health Act, especially if they are coupled with improvements to both inpatient units and community mental health services, can help us to move towards detention being a way for people to access the proper care and treatment in a truly supportive environment, allowing them to move forward with their lives.