MHA Review interim report published

[The independent Review of the MHA has published its interim report today (1 May).  Whilst it should be read in full, for those in a real hurry, I reproduce the executive summary below]

This independent review of the Mental Health Act 1983 (MHA) was commissioned by the government in October 2017. Our terms of reference ask us to make recommendations for improvement in relation to rising detention rates, racial disparities in detention, and concerns that the act is out of step with a modern mental health system. We were asked to look at both legislation and practice, with recommendations extending to England in relation to matters that are devolved in Wales (including health), and England and Wales in relation to non-devolved matters (including justice).

This interim report summarises our work so far, and the priority issues that have emerged for further examination. We are just halfway through our work so these are early findings. We remain keen to engage with as many people as possible, and to examine all relevant evidence as we develop recommendations for our final report later this year.

Our ultimate goals have been set by our terms of reference to make recommendations for improvement in relation to rising detention rates, racial disparities in detention, and concerns that the act is out of step with a modern mental health system.

During the course of the review we will explore many opportunities for reform in detail. We have developed a set of more detailed goals to help guide our work. Our hope is that when faced with different options, these goals, we have developed will guide our work and remind us what we are ultimately aiming to achieve.

We have developed these goals by drawing on feedback from our service user and carers’ group, and our advisory panel.

Put simply, our overarching aim is to make the MHA work better for everyone. With that in mind, we will seek to achieve the following:

  • Service users and carers being treated with dignity and respect
  • Greater autonomy for people subject to mental health legislation
  • Greater access to services for those that need them
  • Making the least restrictive option appropriate to a person’s circumstances   the default option
  • Improved service user and carer wellbeing
  • Service users and carers supported to be fully involved in treatment as possible
  • Reduced disparities between groups with protected characteristics
  • Greater focus on rights-based approaches
  • Reduced harm and improved safety for all
  • Professionals better able to deliver their expertise

Our first priority has been to hear directly from people affected by the MHA.

We have now:

Received over 2,000 survey responses from service users and carers

Listened to 320 people at our workshops


Supported over 30 focus groups of service users and carers

Attended over 70 meetings and events

We are clear that improvements cannot be achieved by legislation alone. Whilst legislative change is critical, any changes to the MHA must be underpinned by improvements to mental health services.

The causes of rising detention rates are complex, and we will continue to examine them closely. Our examination of local and national data has found the rise reflects more individuals being detained overall, rather than some people being detained more often. In seeking to address this, we will pay particular attention to whole-system approaches that seek to reduce the need for detention, including health and care services alongside other partners like the police. Multi-agency approaches are also vital in supporting discharge, and we will consider how to improve care planning and the system of aftercare for service users who have been detained.

We have already found that the MHA could be improved to do more to enable a person’s wishes, including via the provision for advance planning, and the reform of rules for involving families and carers, alongside the reform of community treatment orders.

Advocacy is seen as an impactful safeguard by many service users, but provision is currently patchy, standards are variable, and the role of different types of advocates is confusing. We will also be examining opportunities for reform of other safeguards, notably the role of tribunals and managers’ hearings, and requirements for consent.

Experiences of people from black African and Caribbean heritage are particularly poor and they are detained more than any other group. Too often this can result in police becoming involved at times of crisis. The causes of this disparity are complex, but we have heard that services can improve, in particular by taking proper account of people’s cultural circumstances and needs.

We are clear that the MHA must work well for all people affected. We have heard concerns about inappropriate use of the MHA in relation to people with a learning disability or autism, potentially linked to lack of appropriate alternative provision in the community. In relation to children and young people, we will examine issues of parental involvement and decision-making in particular.

We have heard that the interaction between the MHA and the criminal justice system can be improved. Service users are left too long in prisons when they should be in hospital. Decision making about restricted patients is often lengthy. We are pleased to see broad support amongst statutory services to make improvements here.

We want to rescue the notion of the ‘informal patient’ who is not subject to legislation. As well as tackling rising detention rates, we intend to consider what should, and should not, amount to a ‘deprivation of liberty’ at the interface of the MHA and the Mental Capacity Act. This builds on the government’s acknowledgement of the urgent need to reform Deprivation of Liberty Safeguards (DoLS).

We hope to produce recommendations in these areas, and possibly others, which will make the MHA work better for everyone. We are keen for people to get involved in the next stage of our review. We will provide more updates via our webpage, and via email to those who have contacted us.

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