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ss triple helix - Autumn 2021,  Reforming the Mental Health Act  giving a more personalised approach

Reforming the Mental Health Act giving a more personalised approach

Review by Ruth Butlin, a retired medical missionary & member of the Triple Helix committee
The involuntary detention of people with serious mental illness is currently controlled by the Mental Health Act of 1983, as amended in 2007 (MHA 1983/2007). [1] An Independent Review of the Mental Health Act [2] grappled with balancing patient autonomy against the protection of individuals and communities. It also addressed the fear associated with the MHA 1983/2007 in patients' minds. The review panel reported in 2018, but COVID-19 delayed the Government's response, now published as a white paper, [3] a public consultation on which closed in April. [4]

The government is ready to accept most of the recommendations of the Independent Review. In particular, to utilise the framework of four proposed principles, namely Choice and Autonomy, Least Restriction, Therapeutic Benefit and the Person as an Individual. Most of the proposed changes will be in the direction of stricter criteria for detention, more right to appeal against involuntary treatment, more control for detained patients over who can act on their behalf and more support for all patients with mental illness in the form of specialist advocacy services (for voluntary as well as detained patients). There is a marked emphasis on the non-discriminatory application of the legislation, given the evidence that the impact of MHA 1983/2007 has fallen disproportionally on people of Black, Asian, or ethnic minority backgrounds. The new criteria for imposing detention or community treatment orders will require evidence of a higher level of risk to self or others. The duration of detention will be more tightly controlled. Learning disability or autism alone will no longer be justification for detention.

Until now, each detained patient's 'nearest relative' (as defined in the MHA 1983/2007) had certain rights to object to or appeal against detention, as well as a right to be kept informed. This role will be replaced by a Nominated Person (NP), who the patient can choose. Many patients whose family members are not their closest confidantes have welcomed this change.

Under the new Act, neither a police cell nor a prison can be classified as a 'Place of Safety' for a person detained under the MHA. Imprisonment happened all too often to the detriment of the patients concerned. More controversial will be the proposals for Advance Choice documents, which would give patients opportunities to specify their preferences for future management. These would be somewhat similar to Advance Directives, but it is unclear why a different system is needed.

We need to pray for the Government to make the right decisions as they draft this new Mental Health Act, which affects some of our most unfortunate and marginalised citizens.
references (accessed 3/9/2021)
1. The Mental Health Act 2007.

2. Wessely S. Modernising the Mental Health Act: Increasing choice, reducing compulsion. Final report of the Independent Review of the Mental Health Act 1983. December 2018.

3. Reforming the Mental Health Act, Presented to Parliament by the Secretary of State for Health and Social Care and the Lord Chancellor and Secretary of State for Justice, by Command of Her Majesty. January 2021, updated 21 August 2021.

4. Reforming the Mental Health Act (consultation now closed)
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