Launch of the final Mental Health Act Review report on 6th December

This was quite a small meeting, perhaps because of the sudden change of date for the launch; it would otherwise have clashed with the key parliamentary vote about Brexit due this week.  Nonetheless, there was a mix of professionals and civil servants who had taken part in the Review, representatives from the Review’s Service User and Carer Group and various others, including additional people with lived experience. Simon Wessely, the Review’s Chair, introduced and facilitated the launch. He was joined at the front table by the three Vice Chairs.

The meeting opened with a very moving presentation from Kate King, someone with lived experience who has taken an extensive part in Review groups; Kate spoke about her own and others’ very traumatising experiences under the Mental Health Act, explaining that it was because of such experiences that a Review had been needed so badly. Steve Gilbert, a Vice Chair with lived experience wanted to emphasise, at this point and at the end of the Review, the extent to which people with lived experience and carers had been at the heart of the Review.

Lade Smith, a consultant psychiatrist who had been a deputy chair for the African and Caribbean Review group, talked about work done to obtain views from people with lived experience belonging to black, Asian and other minority ethnic (BAME)  groups and the particularly strong need to improve Mental Health Act experiences for people from black African and Caribbean communities. The group is recommending the use of an Organisational Competence Framework to address such issues.

Mark Hedley, a retired judge and another of the Review’s Vice Chairs, said that, in his view, a Mental Health Act cannot be what makes people better, but that Acts can shape cultures. That was why Simon Wessely, he and the other Vice Chairs are recommending putting principles directly into the Mental Health Act. Sophie Corlett, a Director at Mind, talked about the Review’s recommendation for advance choice documents, about the say that these would give to people who are detained, if they are assessed as having capacity. There was then a presentation about the Review’s community treatment order (CTO) recommendations, the plan to keep CTOs for now because they have benefitted a small number of people. However, the Review recommendation is to make it harder to put people on CTOs and easier for people to get off them.

After this, Simon Wessely invited comments and questions from the audience. There was professional praise for the work of the Review, though one person spoke of the challenge in making sure that progress is made in practice and another expressed disappointment that the Chair and Vice Chairs had, he thought, been rather ‘timid’ in not abolishing CTOs completely. There was some positive carer feedback. However, a spokesperson from the mental illness charity, SANE, was worried that a daughter/son can resent a parent exactly because s/he is ill and might then make an unwise choice of a nominated person.

There was some praise for the Review report from people with lived experience. There were also queries about the effectiveness of recommendations in the report. For example, one person asked whether the recommendations about tackling racism were specific enough and another whether treatment will really become wider than medication. The need to tackle epistemic injustice was emphasised. One strong criticism was that the report recommends ‘half rights’ for people with lived experience, instead of the same rights as anyone else. Someone else expressed strong concern about the report’s medicalisation of mental distress and its continuing recommendation that people with lived experience can be locked up on the basis of projected risk, whereas that is not legal for anyone else. She thought that the report does not go nearly far enough, that what is needed is for the Mental Health Act to be abolished.

At this point the Secretary of State visited the launch meeting briefly. He praised the Review report as ‘thorough, compassionate and thoughtful’. He stated that the government is already agreeing to two of the recommendations: the replacement of the nearest relative system with a nominated person system and the use of advance choice documents to give increased choice to people who are made subject to the Mental Health Act. The government plans to deliberate further about the other recommendations and to decide, too, on the right interaction between them and the Mental Capacity Act.

Steve Gilbert then spoke about his own mental health problems, which had started when he was a teenager. He stressed that people with lived experience can and do play a vital part in society. After this, he closed the meeting with particular acknowledgements of contributions from the Review’s User and Carer Group, of the assistance from civil servants and of the woman who is behind him in his life.