Written evidence submitted by the National Survivor User Network (NSUN) (MHB0074)
About NSUN
The National Survivor User Network[1] (NSUN) is a membership organisation and a network of community groups and people who have experience of mental distress, ill-health and trauma who come together to create, challenge, and campaign. As a user-led organisation, all of our staff, members and Trustees have lived experience.
We work to redistribute power and resource in mental health. We do this by:
Background
We initially responded to the White Paper in January 2021[3] and responded further in April 2021.[4]
While we welcomed the increased focus in the White Paper on the principles of choice and autonomy; least restriction; therapeutic benefit and the person as an individual, we also observed that these are not the same as a set of rights for the individual subject to the Mental Health Act. This concern, that mental health reform is not and has not been grounded in a rights-based understanding of mental health[5], remains central to our reading of the Draft Bill and its potential impact.
For campaigners, the White Paper and subsequent draft Mental Health Bill may not be what some had hoped for. However, we are aware that small changes in the Act may make a significant difference to the lives of people who are detained[6], their families and friends, and people who live in fear of the Act.
We know that the work of the scrutiny committee is critical in ensuring changes in the Act best serve the people it is intended to protect.
“For anyone in NHS leadership, executive board members, senior managers reading this I want to say to you- please stop locking up survivors and holding us down, please stop diagnosing us with disordered personalities. Please stop hurting us. We are desperately trying to manage the devasting impact of trauma and mental illness. People are dying because of a lack of support and access to care. Listen to specialist charities and grassroots organisations, listen to survivors about what works for us. Work with us to create safe places where we can heal and try to move on with our lives.” Jennifer Reese, Psychiatric Hospital Left Me Suicidal and Homeless – We Need a Human Rights-Based Approach to Mental Health Care[7]
The Draft Mental Health Bill
The Draft Mental Health Bill contains some positive changes that will make a difference to those held under the Act once implemented. Changing nearest relative to nominated person, stopping the use of police and prison cells as places of safety, making advocacy opt-out, and introducing a time limit for the transfer of prisoners and detainees in crisis are all important steps.
However, many of the changes in the bill, for example regarding decisions around treatment, advanced choice, and Community Treatment Orders (CTOs) appear to be more bureaucratic than transformative. Whilst the tightening of detention criteria is certainly welcome, impact assessment and clear resourcing of decision making is needed.
Critically, it is not clear how some proposals will be funded. An investment of £150m has been announced alongside the Draft Bill to support implementation of reforms, primarily for the funding of alternative crisis provision. The additional resourcing necessary to implement change is unclear. The impact of investment will be questionable if it is not sufficient to implement the full suite of reforms and without concurrent investment to address the current staffing crisis, and in modernising the mental health estate.
It can be said that the Bill is lacking in ambition to truly impact the experiences of those who are detained under the Act and reduce the coercion that is an ongoing challenge in the delivery of mental health services. Whilst there is some progress around treatment choice, access to genuine care remains distant for many. It is easy to state: “People should expect parity of esteem between mental health and physical health services” but the reality remains that parity of esteem remains distant, even with the current suite of reforms.
To ensure that the positive changes in the Bill are effective and make a difference, clear strategies for funding, timely implementation, and monitoring and evaluation must go hand in hand with the proposed legislative shifts.
Implementation, evaluation and funding
Racial disparities in use of the Act
“NHS England’s £1.4 billion investment in mental health services includes no specific funding allocations or guidelines to support the mental health of asylum seekers, refugees and other vulnerable migrants with undocumented migrants actively excluded from formal health care settings through the hostile environment” Rose Ziaei, State violence and distress: the false separation between migrant justice and mental health [13]
Reducing coercion: summary
Community Treatment Orders (CTOs)
Supervised community discharge
Treatment choice
Opt-out advocacy
Learning disability and autism
Additions we would like to see to the draft Bill
Conclusion
We invite legislators and others to undertake as deep an examination of the Draft Mental Health Bill as possible, and in particular to scrutinise the proposed changes for unintended consequences. We are keen to challenge the view that any change is better than none. Without detailed scrutiny of the real-world implications of the proposed changes and the input of a broad range of views from those who may be subject to any future powers, we are concerned that unintended consequences may compound the negative effects of the powers of the Mental Health Act for some people, while alleviating harms for others. The implementation timeline for change is long, and in the meantime many will continue to experience coercion in mental health services. If these proposals are to truly make a difference, they must be adequately and sustainably funded and transparently monitored.
16 September 2022
[1] National Survivor User Network https://www.nsun.org.uk/
[2] What do user-led groups need? https://www.nsun.org.uk/news/what-do-user-led-groups-need/
[3] NSUN initial response to the Mental Health Act White Paper 2021 https://www.nsun.org.uk/news/nsun-initial-response-to-the-mental-health-act-white-paper-2021/
[4] Response to the MHA White Paper https://www.nsun.org.uk/news/response-to-the-mha-white-paper/
[5] A Rights-Based Approach to Mental Health Crisis Response https://www.madinamerica.com/2020/07/rights-based-approach-mental-health-crisis-response/
[6] What is it like to be sectioned? https://www.shortlist.com/news/what-is-it-like-to-be-sectioned
[7] Psychiatric Hospital Left Me Suicidal and Homeless – We Need a Human Rights-Based Approach to Mental Health Care https://www.nsun.org.uk/psychiatric-hospital-left-me-suicidal-and-homeless-we-need-a-human-rights-based-approach-to-mental-health-care/
[8] Press release: Better mental health support for people in crisis https://www.gov.uk/government/news/better-mental-health-support-for-people-in-crisis
[9] Mental Health Act Reform – Race and Ethnic Inequalities https://post.parliament.uk/research-briefings/post-pn-0671/
[10] Open letter to Sajid Javid on institutional racism within Mental Health Act reform https://www.nsun.org.uk/news/open-letter-to-sajid-javid-institutional-racism-mha-reform/
[11] Section Zero (indefinite exclusion) https://www.nsun.org.uk/section-zero-indefinite-exclusion/
[12] Magical thinking and moral injury: exclusion culture in psychiatry | BJPsych Bulletin | Cambridge Core
[13] State violence and distress: the false separation between migrant justice and mental health https://www.nsun.org.uk/state-violence-and-distress-the-false-separation-between-migrant-justice-and-mental-health/
[14] JUSTICE FOR SENI The Olaseni Lewis Campaign for Justice and Change: https://www.justiceforseni.com/
[15] No loss of safeguards for people with autism or learning disability taken ‘out’ of the Mental Health Act https://thesmallplaces.wordpress.com/2022/06/24/no-loss-of-safeguards-for-people-with-autism-or-learning-disability-taken-out-of-the-mental-health-act/