Mental Health Matters: Devil’s in the detail for landmark bill

Last week, the long-awaited draft bill to reform the Mental Health Act was cautiously welcomed by NHS trusts and the wider sector – four long years after Sir Simon Wessely reviewed the antiquated laws.

Many, but not all, of his recommendations feature within the bill. These include: amending the definition of a mental disorder so people can no longer be detained solely because they have a learning disability or are autistic; introducing a statutory care and treatment plan for all patients in detention; and placing a duty on clinicians to consider a person’s feelings and wishes before deciding to treat them under the act.

Alongside the draft bill came confirmation of a £150m investment over the next three years in mental health ambulances, community crisis support and patient safety improvements, all of which Sir Simon recommended.

Other key elements of the bill for healthcare professionals include:

• A requirement for integrated care systems to establish a consent-based register of autistic people and those with a learning disability, who have “risk factors” for detention under the act. It is proposed this register be taken into account during commissioning and market functions;
• Shortening detention periods, from an initial period of six months to three months;
• Allowing patients to choose a “nominated person” to assist with care decisions as opposed to a “nearest relative”, and giving people the option of having an “independent mental health advocate”;
• A new, 28-day time limit for transfers from prison to hospital for acutely ill prisoners; and
• Tightening the definition of “appropriate medical treatment” to reinforce the requirement that such treatment has a reasonable prospect of alleviating or preventing the worsening of the disorder, or manifestation of the disorder (ie there must be a reasonable prospect the treatment’s outcome would have a therapeutic benefit).

There are also four new guiding principles: choice and autonomy, least restriction, therapeutic benefit, and the person as an individual.

Devil’s in the detail

Now the draft bill has been published, it faces a long journey ahead through pre-legislative scrutiny, with first readings anticipated in the coming months.

It is here that professionals from across the whole sector will pore over the details. 

Stakeholders are already dissecting the bill, with Mind CEO Paul Farmer saying government could go further to ensure law is “fair and equitable for all”, particularly around reducing racial inequalities.

The draft bill responds to concerns community treatment orders are used too often by tightening their usage criteria – for instance, they could only be used if there was a risk of “serious harm” to the health and safety of the patient or others. It says consideration must also have been given to the “nature, degree and likelihood of the harm, and how soon it would occur”.

However, Mind wants the government to review the use of such orders, and suggests they are “coercive, don’t reduce admissions, and are disproportionately applied to black people”.

Pre-legislative scrutiny should also allow healthcare leaders to seek clarity on the duties the draft bill places on them.

Mental Health Matters understands trusts are keen to learn about resourcing requirements for implementing major changes, such as statutory care and treatment plans.

Professional bodies are also concerned about staffing. Responding to the draft bill, Royal College of Psychiatrists president Adrian James warned any investment in care “must be underpinned by a robust workforce”, adding an estimated 494 extra psychiatrists would be needed by 2033-34 “to make this plan a reality”. 

NHS Confederation’s mental health network’s chief executive Sean Duggan said implementation will be key and asked for “time and resources” to help make the changes happen.

On announcing the draft bill, health and social care secretary Sajid Javid said the government was “investing more money to ensure NHS patients have tailored services and support, so people in a mental health emergency get the right care at the right time”. 

The government estimates ongoing costs for resourcing the reforms, and upfront training costs for existing staff, will total £436m for healthcare and £46m for the Care Quality Commission.

Department of Health and Social Care said it was investing an additional £2.3bn a year to expand and transform services in England.

Oliver McGowan training ‘ready to go’

As ICSs became statutory on Friday, so did vital training for health and care staff in learning disability and autism, almost six years after the death of a Bristol teenager.

Paralympic hopeful Oliver McGowan, who developed autism, epilepsy and a mild learning disability after contracting meningitis as a baby, was given antipsychotic drugs to control partial seizures – despite his parents’ objections.

He died in November 2016 aged 18, after a swelling detected on his brain left him paralysed.

Two years later, his mother Paula launched a petition asking for doctors and nurses in England to receive mandatory training in learning disability and autism. Since then, she has been working with NHS England and Health Education England to draw up a programme. 

Mrs McGowan, now an OBE, told Mental Health Matters that tier one of Oliver’s training – two hours of online activity, including a 30-minute live webinar – is ready to go. Any CQC-regulated healthcare facility is now required to deliver the training to staff.

While she is delighted that 3 million health and social care staff will now receive the training, Mrs McGowan said she wants medical schools to get on board, too.

“Imagine if [staff] were able to have all of this training and to go into their placements with a real understanding of neurodiversity,” she added. “It would be a huge change in culture.”

HEE’s introduction to the training can be viewed here.