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

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.