The Draft Mental Health Bill & you & ME... #AMHPLife

This piece was originally published in the DCC-i June 2022 Newsletter.

So, the government will over the next year or so, draft legislation to reform the Mental Health Act (MHA).
 
What is not to like?
They intend to modernise the MHA & promise to make what is basically 1950’s legislation, fit for the 21st century.  The plan is to give patients suffering from mental health conditions greater control over their treatment & to ensure that they receive the dignity & respect that they deserve.
 
This new legislation is going to address the existing disparities in the use of the MHA for people from ethnic minorities. But it is going to keep CTOs #JustSayingLike.

“In 2020-21, black people were four times more likely than white people to be detained under the Act, and over ten times more likely to be placed on a Community Treatment Order.” 
 
What is that all about then?
What about us #AMHPs?
Are we part of the problem or part of the solution?
 
Can I suggest you read this summary by Mithran Samuel over at Community Care & the responses & make of it what you will.
 
I am also not seeing any plan to do anything about poverty, inequality & substandard housing etc. You know the import stuff & Social Determinants of health & the cost-of-living crisis. They want to make it easier for people with learning disabilities & autism to be discharged from hospital. They are also amending the definition of mental disorder and the hope is, that adults and children with learning disabilities & autism, will not be detained in the first place. I applaud the intended consequences, but I do wonder about the investment in community provision & alternatives to hospitals & about the unintended consequences & about things like S.117.
 
Be careful what you wish for, and it’s not just me,  smarter people than me are wondering about this stuff also, see what the ever-learned and plain speaking Lucy Series has to say about it here.
 
They are proposing to change the criteria needed to detain people so that the MHA is only used when it is strictly necessary. When the person is thought to be a genuine risk to their own safety or that of others & they are introducing the notion of therapeutic benefit. So, adults and children will in theory, only be detained when it is thought to be of therapeutic benefit to them.  A certain contested diagnosis springs to mind & something about having capacity & about taking responsibility.
 
Just think about that for a minute, about what that means in practice. I don’t think sending people/children 100’s of miles away to out of area beds is a therapeutic thing. Plus who gets to decide/assess what genuine or substantial risk is? I suspect that is you & me #AMHPlife & a doctor or two. If you can find a S.12 medic in the dark of the night.
 
I don’t ever speak to any #AMHPs, or indeed doctors, who currently think that they are detaining people/children when it is not strictly necessary. I do speak to #AMHPs & Drs & families who acknowledge that they are detaining people/children because there is no other option or alternative available to safely manage/contain risk.
 
Imagine you or I don’t detain someone, because we don’t think there is avtherapeutic benefit & it all goes wrong. I am not sure that I am looking forward to explaining that particular decision (made without the benefit of hindsight & with limited information & under pressure) in the criminal or coroner’s court.
 
There will be more advocacy for people & the Nearest Relative will become a Nominated Person & they will have greater powers to say no & to be consulted about things like CTOs.
 
Who is funding & providing that advocacy?
What does it look like in the real world?
What if the person doesn’t nominate a person? What if the Nominated Person just says no & no & thrice no & they are not helpful & you think they are unreasonable or unsuitable?
 
Those really ill people in HMPs will be transferred to hospitals within 28 days. *If there is a bed. There will be a new form of supervised community discharge, that will allow us to deprive people of their liberty. But only the really risky ones.
 
Remember the MM & PJ cases tell us, that we cannot use the provisions of the MHA (S.7, S.17A or S.41) to deprive capacious community patients of their liberty, even if they are assessed & thought to be really v risky to self or others. What is that going to look & feel like in the real world?
 
People subject to the provisions of the MHA, will be able to appeal to Tribunals more often & they will be given a statutory care & treatment plan. This plan will be written with them & will set out a clear pathway to their discharge. Some plan that, & of course it will do away with S.117 disputes & funding panels & CHC & CCG squabbles over £s & provide housing with the appropriate level of support & sort benefits & deal with the DWP.
 
It seems that the proposed & much discussed extension of Section 5 holding powers to the Emergency Department (ED), is not going to be a thing. The solution to the problem of adults/children being assessed as requiring admission, but there being no bed/hospital willing to accept the #AMHP application, is I was told, going a be none legislative one.
 
I didn’t quite figure out what that answer meant or might look like in a police custody block, when the PACE clock has ticked & tocked. Other than an ever-increasing number of S.136s & other improvised solutions to system dysfunction. It is at this point that I usually mention S.140 anyone?
 
Did I mention that me & Steve Baker our #CrewCop do joint training for #AMHPs & the girls & boys in blue & the odd Bed Manager?
 
Last year (1920/21) in England there were 53,239 civil detentions under the MHA & something like 1,520 new restricted patients admitted to hospital for treatment. It is not 53,239 people by the way. It probably equates to about c.35,000 people & it doesn’t include people detained on S.136. - complicated this isn’t it?
 
While like many, I really do appreciate the work undertaken by Sir Simon Wessely & his team & the MHA really did need updating & I enjoyed v muchly the odd train trip (consultation event). I can’t help but think (unfortunately, I am old enough & was an ASW in 2007), that it is again a missed opportunity to bring about real change. That the problems are not really rooted in the legislation. That it really is about the other stuff - poverty, inequality & substandard housing. About the lack of investment in the community alternatives & early intervention. If we really want to reduce the numbers of adults and children being detained, then we need to stop calling #AMHPs & we need to stop relying on the MHA as the solution to the problem.
 
We do need to think about risk & perception of risk in a different way & we need to support people & families much better. Otherwise, I fear, that me & others, will simply be writing things like substantial & genuine risk on pink forms & writing that it is of therapeutic benefit & that LD dudes & autistic people will attract another diagnosis. I hope that I am wrong. I fear that I might be right #AMHPlife. 

Tony Deane
Principal Social Worker & #GrumpyAMHP
@asifAMHP

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