I read your editorial on the proposed reforms to the Mental Health Act with interest (6 November). The act serves as the balancing point between the state’s negative duty not to interfere with individual liberty without good reason and its positive duties to prevent harm to vulnerable people and the wider public. The criteria for detention represent the threshold at which both of those duties are triggered: detention under the MHA is also a gateway to rights to proactive care and support both during and after detention. We may argue about whether the existing criteria for detention strike the right balance between the state’s positive and negative duties, but it is at least the same balance for everyone.
The draft bill sets a much higher threshold for detention unless a person has committed a crime, and while this will lead to fewer people suffering the trauma and indignity of being detained, it will also mean fewer people receiving the positive support and protection of the state – that is unless they commit a crime. Even leaving aside the unexplored equalities implications of such a perverse incentive, it can surely be neither less restrictive of the individual nor more caring of the state to force people into the criminal justice system in order to receive the help they need.
Michael Chalmers
Associate director of mental health law, North London NHS foundation trust
• As a social worker, I couldn’t agree more 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 experience a first episode of psychosis. If staff in my trust did everything that we are already supposed to, it would be a fantastic place to receive care. We cannot. There are not enough beds, caseloads are too high, staff retention is too low, advertised posts often remain unoccupied and well-meaning but misguided attempts at system reform create administrative burdens without improving the quality of care.
Small pockets of the system receive higher levels of funding. These teams tend to deliver better quality care as a result. The staff are not more skilled, they simply have been given adequate resources.
There is no point banning the use of police cells as a place of safety unless additional assessment suites are provided in hospital settings to meet that need. Staff who are rushed off their feet cannot build the kind of relationships with patients that make family involvement or collaborative care planning meaningful. It is one thing to legislate for higher standards, another to secure the resources to meet those standards.
Richard Braham
Ilminster, Somerset
• Your editorial is full of the hope and values that we need to offer positive and effective mental health services to people with serious mental illness, as are the amendments in the bill. So it pains me to call out the naivety of these changes being sought at a time when services are so deteriorated that it takes the horror of the Nottingham attacks to begin the process (NHS England’s review of assertive outreach provision 2024) of recognising the vast hole. If we are to move towards a more humane Mental Health Act, we first need to provide full community provision for the people whose lives are lived in and out of psychiatric wards.
Dr William Hall
NHS consultant psychiatrist in rehabilitation, Bristol
• As a parent of adults with severe mental illness, I would like to see easier access to treatment and care. Already, most people with severe illness are left to live, at best, impoverished lives in the “community”. I don’t recognise the narrative of people’s rights being removed by hospital admissions. Already, people’s rights are removed by not having access to good, timely treatment and care, under section if necessary. If the threshold for admission rises even further, I can only see this leading to more misery, deaths and criminalisation.
Name and address supplied
• The National Autistic Society has campaigned on this for many years now. The Tories pledged to reduce the number of autistic people in mental health wards back in 2015 when they made up 38% of patients. The latest figure is 68% of patients. This is shocking and needs to change. Placing people with autism on such wards is so harmful, due to patients being prescribed medications and being subjected to restraint. As an autistic adult, it is frightening to think I could be sectioned for a lack of understanding about my behaviour – especially during a meltdown, when I lose control.
Nick Prince
Waterhouses, Staffordshire
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