Written evidence submitted by the South London and Maudsley NHS Foundation Trust (SLaM) (MHB0062)

 

South London and Maudsley NHS Foundation Trust (SLaM) welcomed the long-awaited proposals on the Reform the Mental Health Act and through our  2021 Consultation response we advocated that the scale of these legislative reforms must be substantial to have material impact on addressing the growing use of detention and persistent racial inequalities that exists within the mental health system, particularly for black people.

 

As a large health provider of, and a leader in mental health care, the need for change could not be clearerWe also welcome in general some of the proposed changes to the detention criteria, but are concerned that without adequate resourcing of these, the MHA Reforms will not have the desired impact.  We fully support the vital enabler of investment in integrated community mental health services to prevent and reduce compulsory admission through a range of person-centred and least restrictive community and grass roots neighbourhood alternatives to support and prevention. 

 

Where the use of the Act is required, we agree that it must be to the benefit of the patient and whilst, during our consultation with range of professionals and service users/ carers, there was significant debate on the use of a legislative term, ‘therapeutic benefit’ being potentially legally problematic, we agree that detention under the Mental Health Act should be therapeutic and beneficial, and practiced with dignity and respect, with the ‘whole person’ in mind.  Applying this alongside core legislation such as Article 3 ECHR and existing MHA caselaw where there must be a therapeutic justification for any restraint imposed on a patient.  Our response also support that people subject to part III of the Act should not be excluded from this criterion.

 

Key themes that emerged includes concerns regarding above mentioned funding and resource. Whilst the NHS Long Term Plan and Mental Health transformation investment and spending review provide for significant new funding, it must be matched with an adequate financial settlement for Social Care; our local authority partners are key to the provision of housing, community alternatives, strengths-based support and approved mental health professionals.

 

However, having reviewed the Draft Mental Health Bill SLaM would like to highlight continuing concerns since the publication of the draft bill:

 

 

Cultural Impact:

We welcome the inclusion of a range of actions within the Reforms that demonstrate the government’s commitment to tackling racial inequality.    As a Trust we are one of the development sites for PCREF as well as for culturally appropriate advocacy and welcome the opportunity to work with our local communities and system stakeholders on developing practical frameworks and tools.

As PCREF is a new development, the evidence that it will work on reducing race disparity is lacking, and it is our hope that work undertaken within the sites will assist with growing some evidence.   

 

Whilst this shift to an organisational and structural framework is welcomed and important, it is recognised that on its own it will not reduce racial disparities or sustain the initiatives developed through the Reforms.   It must be met with policy and action to increase funding for mental health services, particularly in the community to address the mental health inequalities.   We are concerned about the inadequate availability of community alternatives to detention, in particular to address needs of diverse and ethnic minority communities and restore trust.

 

 

Impact on the Workforce:

 

Many of the proposed changes are very likely to affect not just the Mental Health Law Team workforce but also the wider clinical and non-clinical staffing groups. Affects will be both procedurally, shifting and changing workflows. Staffing numbers are likely to require attention as needed to cope with the increase in demand.

 

 

Significant resources, both financial and additional staffing, are needed to ensure compliance with the Act. Proposed digital development of MHA practices, whilst welcomed, will have little impact on practices outside of London in other Healthcare settings.

 

The increase in demand and workloads can only be met with increased resources, funds and staffing to ensure governance of the proposed changes in the Act, take place effectively to reduce risks of flawed detention, compliance with treatment provisions and patients access to speedy hearings.

 

Learning Disability and Autism:

 

As an organisation SLaM did not support the reforms of the MHA for people with Learning Disabilities and Autism for the following key reasons we outlined in our Consultation response:

 

 

 

 

We have considered the MH Bill and in summary in line with the forthcoming proposed  changes in the revised MCA Code and the introduction of LPS we believe these are the potential further problematic issues for the LDA population placed under MCA in hospitals:

 

 

We are concerned about the following Human Rights being affected by the proposals in the Bill and we believe these HRA Articles may apply:

 

Article 14: ‘treated less favourably than another person’ or ‘indirect discrimination when a policy is supposedly applying to everyone equally works to the disadvantage of one group. This would cover the issues of:

 

 

Article 5: risk of more patients being placed in the position of the Steven Neary case, and could potentially argue that the MH Bill may produce situations contrary to the case law LB Hillingdon v Steven Neary EWHC 1377 (COP).

 

 

16 September 2022