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Post-legislative scrutiny of the Mental Health Act 2007

14 August 2013

"Parity of Esteem" not real for mental health patients, say MPs.

More needs to be done to protect the interests of patients who rely on mental health services according to a senior committee of MPs.

Chair's Comments

The Health Committee has undertaken a review of the working 2007 Mental Health Act. Summarizing its findings Committee Chair Stephen Dorrell MP said,

"Mental health legislation is designed to protect extremely vulnerable patients but our review has found that many vital safeguards are not working effectively.

In 2007 the Government legislated changes to the Mental Health legislation and introduced new “Deprivation of Liberty Safeguards” (DOLS) to protect patients who lack mental capacity – typically patients who suffer from dementia or severe learning difficulties.

The provisions for DOLS are not working well. We found that it is commonplace for DOLS to be ignored leaving many people at heightened risk of abuse. DOLS are seen as complicated and difficult to implement, but this is no excuse for the extreme variation in their application across the country. The current approach to these vital safeguards is profoundly depressing and complacent and the Government must immediately instigate a review which details an action plan for improvement."

Accessing treatment

The Health Committee’s inquiry also examined trends in detention and the difficulty mental health patients have in accessing hospital treatment. “Many psychiatric wards are over capacity and there is huge pressure on beds, nevertheless, we were shocked to learn that there is evidence that patients who need hospital treatment are being sectioned unnecessarily in order to access a bed”, Stephen Dorrell said. “This represents a serious violation of patients’ basic rights and it is never acceptable for patients to be subjected to compulsory detention unless it is clinically necessary.

"A clinician who is complicit in this approach has compromised their professional obligations; both the professional regulators and the Government should urgently investigate the prevalence of this practice within the mental health system."

Community Treatment Orders

The 2007 Act contained important provisions which introduced Community Treatment Orders (CTOs). These orders allow for patients to be treated in the community whilst still being subject to recall to hospital if their condition deteriorates. The Health Committee’s report examines whether CTOs have been an effective mechanism for treating patients, Stephen Dorrell said:

"The principle of supervised community treatment is welcome, but they have not worked as the legislation intended. A convincing body of evidence was presented to us questioning whether CTOs prevent readmission to hospital; there is wide variation in the use of CTOs across the country and the availability of this new form of community treatment has not reduced the number of patients detained in hospital.

It is time for Ministers to properly review the effectiveness of CTOs and undertake a detailed analysis to understand when they are clinically appropriate and how they can be improved."

The Committee is also concerned that pressure on hospital beds may be driving increased use of CTOs. Mr Dorrell said “Financial pressures should never distort clinical judgements, but the absence of clear guidelines for clinicians makes this all the more likely. The Royal College of Psychiatrists must lead on developing a consistent approach to CTOs.

Independent Mental Health Advocates

MPs also examined the function of Independent Mental Health Advocates who help patients take advantage of their rights whilst in hospital. “Independent advocates are important in helping patients make best use of the safeguards available to them, but we were concerned to discover that those who need advocacy the most are least likely to be able to access an appropriate service”, says Stephen Dorrell.

"Local authorities are responsible for commissioning a suitable service and Health and Wellbeing Boards should seek firm evidence from them that a high quality advocacy is available for all patients.

Worryingly, we were told that the presence of independent advocates has resulted in some clinical staff retreating from their obligations to help patients understand their rights. The Committee is in no doubt that a patient’s primary advocate should be their clinician and independent advocates, ultimately, provide an important, but supplementary, service."