It is very rare that society believes the state should intervene against someone’s will to restrict their rights to liberty and choice for the good of their health. We don’t go to such extremes to stop people smoking or binge-drinking or participating in dangerous sports. But if someone has a serious mental health problem or lacks mental capacity to make decisions for themselves, we accept that the state should step in.
In the case of a serious mental health problem, the law is designed to balance the rights of the individual with the need to protect them from harming themselves or others. Psychiatrists, psychologists, social workers, ‘patients’, families and politicians all agree on one thing – being detained under a section of the Mental Health Act is a last resort and it’s a power that should be used carefully.
Ask anyone who’s ever been ‘sectioned’ and you’ll understand why. It’s a painful, humiliating and dehumanising process. It usually involves an ambulance, the police, doctors and social workers and sometimes it involves officers in riot gear, physical restraint and a brush with the law. It is often experienced by people as violent and criminalising. It can destroy family relationships and set back prospects of recovery by years. Many people I’ve spoken to about their experiences tell me it was the worst day of their life.
For these reasons, we should all be concerned by the latest report by the Care Quality Commission. As part of its crucial role as the health regulator, it tells Parliament and the public how this powerful law is being applied. Today’s report makes for worrying reading.
Use of the Act is up, with many more people now being detained under section. Use of the new Community Treatment Orders, which enable people to be compulsorily treated outside of hospital, now far exceeds original government projections. In some parts of the country, you can only get a hospital bed if you are under section. Access to advocacy – a crucial safeguard to help people express their wishes when detained against their will – is patchy. Use of physical restraint is up. And the numbers of those detained from certain black and minority ethnic communities remains unacceptably high.
So why is this happening? There’s an easy conclusion to draw, especially when we know that services are overstretched – spend less money on mental health care and more people will be detained. If people can’t get help early on, their needs are likely to spiral into a crisis. The last resort becomes the first resort in a cash-strapped system where prevention and early intervention are scarce. Add to that the general rise in demand for mental health services and the challenge is clear to see.
But it doesn’t have to be a disaster. The CQC is for the first time reporting good practice, in places like Lancashire and East London, proving that services can work well. Mind’s crisis care inquiry, Listening to Experience, found examples of excellent practice, with staff treating patients with dignity and respect. Early intervention and crisis teams both have a vital role to play here – if help is available at the right time, sectioning can revert to its rightful place as a last resort.
Mental health is, slowly but surely, working its way up the agenda and into the public consciousness. There’s a good government-led, cross-departmental mental health strategy led by a committed Minister, Norman Lamb, and the new NHS Mandate has set an ambitious target for mental health over the next few years – to achieve equity or a ‘parity of esteem’ with physical health care. The way in which the numbers of people being treated under the Act change will be a powerful litmus test of this.