This is HSJ’s fortnightly briefing covering quality, performance and finances in the mental health sector

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A good wheeze

Prime minister Theresa May has announced thatformer Royal College of Psychiatrists president Professor Sir Simon Wessely will lead her promised independent review of the Mental Health Act.

In her conference speech on Wednesday, Mrs May returned to her “burning injustices” theme, reiterating that tackling the injustice and stigma associated with mental health is a priority of hers.

The speech will be remembered primarily for Mrs May’s coughing fits, and many in the mental health sector believe a review of the act and Sir Simon’s appointment are a good wheeze. But the act is a fiendishly complicated piece of legislation, which should not be tampered with lightly.

Devil in the details

Mrs May did not spell out very much in her speech, but the Department­ of Health later published the terms of reference for the independent review.

The review will look at how the act is used; how it impacts on service users, families and staff; and make recommendations for improving the legislation. It is expected to produce an interim report early next year, with the final report and recommendations due that autumn.

Concerns flagged up to investigate include:

  • What safeguards are available for patients
  • Whether detention is being used to detain people rather than treat them
  • How effective community treatment orders are
  • What difficulties there are for patients in being discharged.

This is not much more information than Mrs May gave us when she made her pre-election pledge to rip up and replace the “flawed” act in May, and with something so complex the devil will definitely be in the finer details.

The main worry is whether the review will see the light of day if she is replaced as prime minister before it is completed.

The other fear is that any changes to the current legislation will be made to fulfil a political agenda – such as cutting the number of detentions or saving cash – as opposed to improving patient care.

Heart of the matter

Tory leadership squabbles aside, there are few who would envy Sir Simon the task before him.

As Mrs May told the Tory faithful in Manchester this week, the number of detentions is too high and disproportionately affects people from black and minority ethnic backgrounds.

We know the number of people detained under the act rose from 48,600 in 2011-12 to 63,600 in 2015-16, while Downing Street says black people are six times more likely to be detained under the existing act.

But what is not clear is why this is the case, and Sir Simon’s review has some tricky questions to answer, especially when we know the data in the mental health sector can be patch y.

One of the key questions he will have to answer is whether more people are being detained under the act, or are the same people being detained more often?

The obvious feeling is it is a bit of both, but this question cuts to the heart of the issue because each option highlights to a different potential problem in the system.

If more people are being detained full stop, this could suggest problems with people receiving early intervention services or preventative services. But if the same people are being sectioned more often, then this would point to problems with discharge support, rehabilitation and care in the community.