The Mental Health Act Review: BASW and social work involvement

An independent review of the Mental Health Act (MHA) in England and Wales was announced in October 2017, tasked with looking at not only the law but practices that impact its use. 

BASW has joined the MHA Review Advisory Panel and is represented by Dr Ruth Allen, CEO. Other BASW members are also on the panel, including Steve Chamberlain and Emad Lilo, as well as the Association of Directors of Adult Social Services' (ADASS) Claire Barcham, representing social work and Approved Mental Health Professionals (AMHP) issues.

The first meeting of the Advisory Panel was held on the 14th November and the meeting heard from a diverse group, including people who have used services, families and carers.

The overall terms of the review include investigating stark problems with:

·         rising rates of detention under the act

·         the disproportionate number of people from black and minority ethnicities detained under the act

·         stakeholder concerns that some processes relating to the act are out of step with a modern mental health system

The review will also cover specific issues of implementation and protection of human rights, including:

·         the balance of safeguards available to patients, such as tribunals, second opinions, and requirements for consent

·         the ability of the detained person to determine which family or carers have a say in their care, and of families to find appropriate information about their loved one

·         that detention may in some cases be used to detain rather than treat

·         questions about the effectiveness of community treatment orders, and the difficulties in getting discharged

·         the time required to take decisions and arrange transfers for patient’s subject to criminal proceedings

All these issues of rights and equalities are of concern to social workers and to those of us who are Approved Mental Health Professionals.

BASW is particularly pleased to hear in the first meeting about the freedom of this review to consider the underlying causes of some of the problems associated with the MHA, and we hope that alongside making recommendation about legal and practice imperative, the review will comment on the impact of discrimination, poverty and exclusion on the mental health of the population.

We hope the review will raise these well-known issues in new and powerful ways.

Presentation on social work issues with the MHA:

At the Advisory Panel's first group meeting, Ruth Allen was invited to present an overview of key issues for social work and social care. In summary, these were presented as:

·         Priority of ensuring that the profile of social work and social care is raised in this review, as it has been invisible in much mental health policy recently, yet the system and people’s support cannot work without it. This is about adult’s mental health, but also about social care across the life span, and the join up of children’s social care and mental health services is very poor and is adding to child mental health unmet demand

·         The expectation that the review takes a human rights and citizenship approach. This includes how to bring together MCA and MHA in a more coherent way, and make our law and practice compliant with the UN Convention on the Rights of Disabled People

·         The review cannot be silent on the wider social determinants of poor mental health, such as poverty, racism and reductions in adult social care. We asked: how do we make better decisions about practice and law if the resources just aren’t there to protect rights and dignity? Can the review speak out about this and its impact on citizens and on staff?

·         Recognition that the experience of service users and families is central and must drive the review in a meaningful way. There is a stated commitment to co-production in this review, yet there is no detail yet on the model and approach for this. We asked: What does that mean in practice and how will it be brought to life?

·         The AMHP role is still 95% undertaken by social workers and we want to see the operational and workforce planning difficulties of AMHPs given strong profile in this review. This is essential if AMHPs are to discharge the very powerful and stringent duties they perform on behalf of society

·         The question was raised: what was lost when the Approved Social Worker role became the AMHP role? Perhaps its wider function in enabling access to social work services beyond the crisis and beyond the individual, and their role as a portal to wider local government responsibilities for citizens has been diluted and we should think about that in this review and think what we need for modern times.

The Advisory Panel group will meet bi-monthly and a first interim report will be written in Spring 2018. BASW welcomes feedback on what issues social workers want raised in this forum, so if you would like to send us your views please email anthony.dhadwal@basw.co.uk