Major new investment is needed to improve some of the most “dilapidated” estates in the NHS and provide more community care for the sickest and most vulnerable mental health patients, a new report said.
The independent review of the Mental Health Act 1983 published its findings on Thursday, setting out how to improve care for people detained under the legislation.
Chaired by Professor Sir Simon Wessely, the review said compulsory treatment must be a last resort and more care should be provided in the community before people reach a crisis point and need to be detained.
The report said that providing more care in the community will reduce the number of people needing to be detained, and better inpatient units will help people recover more quickly.
It also proposes a new right for patients to challenge the treatment they are being offered at a tribunal.
The review found that it could be “traumatic” and “damaging” to be detained under the Act and that it was normally used on patients when they are at their most vulnerable.
It added: “We need investment in alternatives to detention, a reinvigoration of our community services focusing on a much broader and swifter offer of alternatives to compulsory treatment.
“And when this is still regrettably necessary, we must acknowledge that the environment in which we look after those detained under the Act is now often anything but therapeutic.
“Sadly, people are often placed in some of the worst estates that the NHS has, just when they need the best.”
It added: “We are calling for a major capital investment in the NHS mental health estate as part of the proposals from the NHS for a multi-year capital plan to support the long-term plan.”
The report does not include an estimate of how much cash is needed to improve mental health units or be invested in new services.
The review said the new capital investment for estates should form part of the next spending review which is due next year.
The review was commissioned by Prime Minister Theresa May following her pre-election pledge to rip up and replace the “flawed” act.
Sir Simon was appointed to chair the review in October 2017 with a remit to investigate the rising detention rate; the disproportionate use of the Act on black, Asian and minority ethnic groups; and what processes were “out of step” with a modern health system.
The number of people detained under the Act rose by about 30% from 48,600 in 2011-12 to 63,600 in 2015-16, according to NHS Digital figures, while black people are four times more likely to be detained under the act.
The review has set out more than 150 recommendations on how to improve the Act, including more investment to improve mental health inpatient units and providing more care in the community.
The authors said the NHS long-term plan was “critical” for implementing its recommendations because it is expected to focus on bolstering crisis and community care.
The plan, due later this month, will set out how the NHS will invest the £20 billion of new funding a year by 2023-24, as promised in the Budget earlier this year.
It added: “It is important to view our recommendations in the context of wider investment in, and reform of, services for people with severe mental illness, learning disability, and autism.
“Compulsory treatment must be a last resort, and the coercion involved places an additional responsibility to ensure the quality of services is high.
“The NHS long-term plan will therefore be critical to our entire report – the two cannot be considered apart.”
Our president @wendyburn has co-signed the Mental Health Policy Group's consensus statement calling for mental health to be underpinned in the NHS long-term plan. The next 10 years must see real #parity of esteem for mental health delivered #NHShttps://t.co/EiHzB5gsq8
— Royal College of Psychiatrists (@rcpsych) December 5, 2018
But Royal College of Psychiatrists president Professor Wendy Burn warned that to reduce detentions under the Act, services need more cash and more staff.
She added: “If the Government is serious about significantly reducing the use of the Mental Health Act, hard-pushed mental health services urgently need further investment and a larger workforce to help people stay well before they reach a crisis point.”
The new report calls for new statutory advance choice documents allowing patients to set out what future care they want or do not want.
It said that while psychiatrists can overrule these choices, they will have a duty to say why they chose to deviate from the patient’s wishes, with patients given the right to challenge decisions on their treatment.
But it proposes that for some treatments – such as electroconvulsive therapy – only a judge could overrule a patient’s choice not to have this treatment.
Sir Simon said the recommendations were not about scrapping the existing Act, but modernising to make it fairer.
He added: “If there’s one important theme from the whole thing, it is to ensure the voice of patients is heard louder and more distinctly and carries more weight than it has in the past.
“Even when deprived of their liberty, patients will still have a say in their treatment with greater and newer protections than they have had before.”
Other recommendations include people being able to choose a nominated person rather than be allocated a “nearest relative” who will have powers to be consulted on proposed detention and on care plans.
The report also calls for every patient detained under the Act to be given a statutory care plan within seven days which includes the wishes and preferences of patients and discharge planning.
It also recommends the creation of an Organisational Competency Framework (OCF) to tackle racial disparity as well as encouraging more black and Asian ethnic people in the workforce.
Shadow mental health minister Barbara Keeley said the Government’s record on treating patients at risk of detention was “woeful”.
She added: “The Prime Minister pledged to tackle the burning injustices of mental ill health but unless it takes urgent action to improve services and take action on the inequities facing ethnic minority communities, it will squander the opportunity to reform the Mental Health Act and this will only serve to fan the flames of this dire injustice.”