On the 21st April 2021, Fulfilling Lives South East (FLSE) fed into the latest Mental Health Act (MHA) consultation to reform the current mental health laws to make sure that the voice of people with multiple and complex needs (MCN) is being heard. During Mental Health Awareness Week we have taken a moment to consider how mental health legislation has developed over the years and consider what impact these laws have on local practices for people with MCN.

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The MHA has come a long way since it was introduced in 1959, a decade after the NHS was established. There have been multiple reviews over the years and in 1983 the issue of consent was introduced, before the Mental Health Capacity Act was created in 2005. Since then, over a decade later in 2017, the government asked for an independent review of the MHA to be conducted and it concluded that the MHA doesn’t work well for patients or families or carers and 154 recommendations were made. The view was that the existing legislation went too far in removing autonomy and did not protect a person’s ability to make their own decisions in their own care and support.

The 2017 independent review created the basis of its latest national consultation and planned reform which FLSE fed into.

As a project, we welcome the new guiding principles of choice and autonomy, least restriction, therapeutic benefit and the person as an individual. FLSE is very aware that these principles are important but so is a clear definition of the threshold for when a person can and cannot be sectioned. In our experience, people with MCN going through a mental health crisis, having experienced complex trauma and with enduring mental health issues, don’t always meet the threshold. One of our Specialist Workers reflected on these principles with the following experiences:

‘This emphasis on autonomy has been interesting for me as a worker. In my experience, several of my clients have been detained under Section 136 by police whilst having a mental health crisis. They are then brought to hospital for assessment and later discharged based on not being ‘detainable’. Although this complies with the current regulation, some of these individuals have then gone onto cause significant harm to themselves, and sometimes others. These incidents have at times then been criminalised, and a client has been arrested and held in custody, a matter of days after being sectioned by police. Being detained in police custody was due to antisocial and aggressive behaviour, but this behaviour had been preceded by multiple overdoses and attempts to take her life. For those clients I have worked with, who have seemingly less detainable mental health issues like personality disorders and significant trauma, there have been times where not sectioning a person has resulted in them being in the community without appropriate support.’

As a project, we are concerned that the new MHA Reform does not address the government’s commitment to invest into mental health services and that it is left to local authorities to respond to the individuals support needs. This could create geographical mental health care provisions and inequalities. FLSE would call on the national government to set clear guidance for local authorities to avoid postcode lotteries and for national government to commit to funding services that are fit for purpose for people experiencing MCN.

We strongly encourage Advance Choice Documents to be consistently implemented, such as the Wellness Recovery Action Plan, and being able to choose a nominated person is also positive. With

both however, we are keen to see guidelines in place to ensure the patient is not coerced into nominating a specific person and that the patient is in a stable position when completing the Advance Choice Document.

We also welcome automatic referrals to the Mental Health Tribunal as well as more frequent reviews of patients to minimise the length of time a patient is sectioned- as long as there is appropriate community support in place. We would very much like to see a collaborative approach between mental health services and third sector organisations.

The focus on having the patient’s voice being heard and offering more advocacy could open up a more peer-led and expert-by-experience approach. We strongly recommend that any commissioning of new services needs to have coproduction through and through.

In addition, we would like to see separate regulations for prisons and immigration removal centres. We also think that people with learning disabilities and autism have different needs and as such should be looked at separately.

Feedback mechanisms and complaints procedures for patients are unclear and we would like to see dedicated specialist mental health services for people experiencing multiple and complex needs that incorporate trauma informed approaches.

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If you would like to hear more about our work in Mental Health, then please do get in contact with Michaela and Rebecca in the FL team:

Michaela Rossmann, Systems Change Officer: michaela.rossmann@sefulfillinglives.org.uk

Rebecca Rieley, Systems Change Lead: rebecca.rieley@sefulfillinglives.org.uk