Tuesday, June 13, 2017

Rights-based reform of the Mental Health Act

At the recent General Election, the Conservative Party said that it would replace the 1983 Mental Health Act in England and Wales with new laws tackling "unnecessary detention" (see BBC News story). Their manifesto said:-
We will ... reform outdated laws to ensure that those with mental illness are treated fairly and employers fulfill their responsibilities effectively.
The current Mental Health Act does not operate as it should: if you are put on a community treatment order it is very difficult to be discharged; sectioning is too often used to detain rather than treat; families’ information about their loved ones is severely curtailed – parents can be the last to learn that their son or daughter has been sectioned. So we will introduce the first new Mental Health Bill for thirty-five years, putting parity of esteem at the heart of treatment.

Part of the motivation for this change was probably coming from the mental health charities, which formed a Mental Health Policy Group to produce A Manifesto for Better Mental Health. One of these charities, Mind, had a 2017 election manifesto, which had 6 points, of which one was:-
Change outdated and discriminatory legislation like the Mental Health Act and the definition of disability to ensure everyone with mental health problems gets support and respect.

Of course the 1983 Mental Health Act was amended in 2007 to introduce community treatment orders, amongst other changes. There was a several year debate/protest before this amendment and I had a Mental Health Policy website at the time (now essentially defunct). It was the reform of the Mental Health Act then that led to the formation of the Critical Psychiatry Network in 1999. I think changing the Mental Health Act again in the way suggested by the Conservative party is less likely to lead to as much controversy as previously.

If the Conservative Party has enough support to manage to get replacing the current Mental Health Act into a Queen's Speech, the Mental Health Bill needs to take account of the Convention on the Rights of Persons with Disabilities. This is what the UN Special Rapporteur on the right to health has proposed (see previous post) and the rest of this blog uses quotes or amended quotes from his report.

The disability framework should radically reduce medical coercion. It starts from the principle that a disability shall in no case justify a deprivation of liberty. There is shared agreement about the unacceptably high prevalence of human rights violations within mental health settings and that change is necessary. Persons with psychosocial disabilities are generally falsely viewed as dangerous, despite commonly being victims rather than perpetrators of violence.

Change has taken place over recent years to challenge the disability stereotype, as many can live independently when empowered through appropriate legal protection and support. There are limitations to focusing on individual pathology.

Similarly, failure to secure the right to health and other freedoms is a primary driver of coercion and confinement in mental health. Mental health problems and disability are not exactly the same and this does need to be teased out in any new Mental Health Bill. In fact, it is still not clear how non-consensual treatment in mental health should be taken forward following the Convention on the Rights of Persons with Disabilities. This should be a government priority, even for a minority government. It needs to make use of appropriate indicators and benchmarks to monitor progress in respect of reducing medical coercion. The active involvement of mental health professionals in the shift towards rights-compliant mental health services is a crucial element for its success.

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