Mental Health Act Consultation

Thank you to the 449 people who responded to the Mental Health Act Consultation, this is an excellent response that was given in a relatively short time frame. Simon Mudie has joined me in reviewing the responses and a full ACP-UK consultation response report is being written. We hope to work with John Taylor who is leading the BPS response and then to discuss our response with Sir Simon Wessely who is leading the Mental Health Act Review.

Initial themes from the responses so far are:

1. ACP-UK Members want ACP to have a formal role in the discussions about The Mental Health Act.
2. There was strong support for clinical psychologists having greater statutory roles including making the initial assessments under the Mental Health Act in order to permit us to deliver more effectively the psychological care that we offer.
3. Respondents wanted to stress that the Act should; i) promote fundamental human rights and ii) a psychological or psychosocial perspective.
   
4. Many respondents strongly supported the proposal that ‘the Scottish clause’ (or similar) be added to the Act. In Scotland more rights have been given to detained patients and there are are more protections from ill-treatment. But there were caveats. First, there was a strong theme emphasising that risk and need were parallel issues (as in, people need support and occasionally put themselves at risk, as well as losing the ability to exercise autonomy – and, equally, that people who retain the capacity to exercise autonomous judgement occasionally remain at risk or even pose a risk). There were, in particular, concerns that an emphasis on autonomy or capacity should not put individuals or others at greater risk. There were, therefore, several comments that ‘capacity’ as defined by the Mental Capacity Act did not necessarily translate perfectly across to the circumstances of the Mental Health Act. There were comments that people who retain ‘capacity’ can sometimes pose threats to their own or other people’s safety, and there were concerns about highly intelligent and thoughtful people who nevertheless hold beliefs which could lead to significant risk, or are experiencing phenomena such as auditory hallucinations that similarly pose a risk. A solution may be to discuss how an individual’s mental health issues affect their ability to exercise appropriate autonomous judgement, rather than emphasising ‘capacity’.
5. There is a need to address issues of fluctuating capacity / autonomy.
   
6. We need to discuss tricky issues such as suicidal intent in people who appear to be making clear decisions to end their lives – bearing in mind that such decisions often occur when a person is very depressed.