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Few will argue against the need to rebuild our mental health services after over a decade of poor investment and limited political interest. None, except perhaps some politicians, believe it will be easy.
Last week, the first part of that process reached a crucial stage with the publication of Modernising the Mental Health Act: increasing choice, reducing compulsion. It follows a review led by the immediate past president of the Royal College of Psychiatrists Professor Sir Simon Wessely, and has included the views of scores of patients, carers, lawyers, and experts, including the BMA.
Fairly major restructuring of mental health laws is proposed, with significant shifts in our relationships and interactions with patients. They’re changes which will affect us all, and hopefully for the better.
There are calls for greater weight to be given to patients’ preferences for treatment even when it is compulsory, greater transparency about how compulsion is justified, and steps to address the gross disparities in mental health act use according to ethnicity.
Different outcomes, inevitably worse for those from black minority groups, have no place in a modern health service, and it is to be hoped the review will show teeth as it goes forwards. We (doctors, patients, carers and others) will need a believable and bold blueprint moving forwards.
Crucially it will need to be backed by an equally believable plan from government to support these reforms and provide the better resourced services needed to make words become reality. There has been enough tinkering around the edges. It is time for meaningful and transformational change.
The BMA, on behalf of its members, welcomes the review’s ambition to improve patients’ experience of mental health care. Kate King, a patient who spoke at the review launch described the care she received in detention as ranging from ‘the excellent to the abusive’. We need to have much more of the former and progressively less of the latter, with patient experiences improving steadily year on year.
The Government has pledged to consider the report and its recommendations in detail and has restated its intention to reform mental health laws.
It has already accepted two which should strengthen a person’s say over their care: the creation of legally enforceable ‘advanced choice documents’ and the role of ‘nominated person’, someone a patient can nominate themselves to be informed of and involved in decisions about their care. It will seem odd to many that this is not already the case and indeed it is time for change.
Sir Simon hopes his reforms will help to create mental healthcare which is fairer and which doesn’t rob patients of their voice once sectioned. He rightly recognises that it’s not fair for patients to be detained for weeks or months without treatment as can happen at present. Or that black people are eight times more likely to be put on CTOs (community treatment orders).
‘Mental health and mental illness has come out of the shadows and so should the Mental Health Act,’ he said.
Mental health law is only part of the picture though, albeit an important one. Many people already get excellent treatment from caring and humane practitioners in a system fit for bursting. Improved mental health law, as Sir Simon, acknowledges, will do nothing about that: ‘You can hardly have a modern mental health system without a modern estate,’ he said.
He wants dilapidated wards improved and has placed faith in NHS England’s forthcoming LTP (long-term plan) for improvements. We all want these building works, and have for years. We hope that the mental health review and the LTP will fit together to enhance each other’s potential.
The review group hopes its reforms will halve the number of CTOs and reduce inpatient detentions by 15 per cent. These are conservative aims given the lack of evidence for the former and the 50 per cent rise of the latter in recent years. Surely, we can do more Sir Simon?
If a drug with side effects did not work and was used eight times more frequently in black people I don’t think we would be looking for a 15 percent reduction – it would be out of the formulary. Surely, we should regard legal remedies such as CTOs with the same objectiveness as their pharmaceutical and therapeutic equivalents?
To make real the promise in this review – that of a fairer, less coercive, and more patient centred system – will require the Government to put its money where its mouth is. Our general mental health services strive hard to look after people and usually do so well, but they are progressively deteriorating with increased demand and squeezes on funding.
Billions of pounds of investment and real (not pie in the sky) plans will be needed to allow for proper care for ordinary people like you and I if we get ill.
Funding needs to be fairer and clearer with less of the ridiculous inequalities in commissioning that currently exist. We need a bold vision for how we will staff our services now not in a decade or more.
None of these things is easy. Not one, however, is impossible. The stakes are high. Doctors, nurses, and others deserve to work in a system that allows them to care properly and humanely for patients and their families. To be able to provide long-term care and work on prevention rather than being entirely crisis driven due to shortages as we are now. Those patients and families deserve that too, at the very least. The stakes are high; the chance is there. But will the government take it?
The era of parity of esteem is dead (it never really meant anything). It is time for parity of resource, parity of access, and parity of outcome. Anything less is morally unacceptable.
Andrew Molodynski is the BMA consultants committee mental health lead
Find out more about the BMA’s work on mental health
i dont belivbe simon wese;y cares about human beings whaqt about thjose vile horrible yuppie militants he had his friends denounce in the press after years off those headlines i would have to be deluded that the knighted for abuse knob head would do anything for anyone. Its about Simon and how little he can do for people to get as much attention for himself . A typical nasty knighted psychopath and a toxic man, the sort that do well in cut back tory Britain . All bells ans whistles nothing real under is smug smile .
beware knighted people
i don’t believe Simon wessely cares about human beings what about those vile horrible yuppie militants he had his friends denounce in the press after years off those headlines i would have to be deluded that the knighted for abuse knob head would do anything for anyone. Its about Simon and how little he can do for people to get as much attention for himself . A typical nasty knighted psychopath and a toxic man, the sort that do well in cut back tory Britain . All bells and whistles nothing real under is smug smile .
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I am sure we should not conflate the clear need to fund better mental heealth services with reforming the Mental health act. The latter appears to be driven largely by political correctness and will as usual, end up as a compromise between various warring factions. It is likely the end result will do patients and psychiatrists no favours.
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