Better care for mental health patients will depend on funding | Letters
I read with interest your editorial on the proposed reforms to the Mental Health Act (6 November). The law serves as a point of balance between the negative duty of the state not to interfere with individual freedom without good reason, and its positive duty to prevent harm to vulnerable people and the wider public. The criteria for detention represent the threshold at which both duties come into effect: detention under the MHA is also a gateway to rights to proactive care and support, both during and after detention. We can debate whether the existing criteria for detention strike the right balance between the positive and negative duties of the state, but at the very least it is the same balance for everyone.
The Bill sets a much higher threshold for detention unless someone has committed a crime, and while this will mean that fewer people will suffer the trauma and humiliation of detention, it will also mean that fewer people will receive the positive support and protection of received by the state. – unless they commit a crime. Even setting aside the as yet unexplored implications of such a perverse incentive for equality, it certainly cannot be less restrictive for the individual, nor more caring for the state, to force people into the criminal justice system to get the help that they need.
Michael Chalmers
Associate director of mental health law, North London NHS foundation to trust
As a social worker, I fully agree that the outcome of the proposed reforms to the Mental Health Act will depend on resources. I am employed by an NHS trust to work with people for three years after they have experienced a first episode of psychosis. If the staff I trust would do everything we already need to do, it would be a fantastic place to receive care. We can’t do that. There are not enough beds, the workload is too high, staff retention is too low, advertised positions often remain unfilled and well-intentioned, but misguided attempts at system reform lead to administrative burdens without improving the quality of care.
Small parts of the system receive higher levels of funding. These teams therefore often provide better care. The workforce has not been better trained, it has simply been adequately resourced.
There is no point in banning the use of police cells as places of safety unless additional assessment suites are offered in hospitals to meet that need. Staff who are rushed cannot build the kinds of relationships with patients that make family involvement or collaborative care planning meaningful. It is one thing to legislate for higher standards, but another thing to secure the resources to meet those standards.
Richard Braham
Ilminster, Somerset
Your editorial is full of the hopes and values we need to provide positive and effective mental health care for people with serious mental illness, as are the amendments in the bill. So it pains me to point out the naivety of these changes being sought at a time when services have deteriorated to such an extent that it takes the horror of the Nottingham attacks to kick-start the process.NHS England Review of the assertive outreach provision 2024) of recognizing the huge gap. If we want to move toward a more humane mental health law, we must first ensure full community benefits for the people whose lives are lived inside and outside psychiatric wards.
Dr. William Hall
NHS Consultant Psychiatrist in Rehabilitation, Bristol
As a parent of adults with serious mental illness, I would like to see easier access to treatment and care. Most people with serious illnesses already have to live an, at best, impoverished life in the ‘community’. I don’t recognize the story that people’s rights are being stripped away by hospital admissions. People’s rights are already being harmed by their lack of access to good, timely treatment and care, if necessary under sect. If the threshold for admission rises even further, I see this only leading to more misery, deaths and criminalization.
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The National Autistic Society has been campaigning for this for many years. The Tories promised to reduce the number of autistic people in psychiatric wards in 2015, when they made up 38% of patients. The last digit is 68% of patients. This is shocking and needs to change. It is so harmful to place people with autism in such wards because patients are prescribed drugs and subjected to coercive measures. As an autistic adult, it’s scary to think that I could be sectioned because of a lack of understanding about my behavior – especially during a meltdown, when I lose control.
Nick Prins
Waterhuizen, Staffordshire