Intended for healthcare professionals

Rapid response to:

Head To Head Maudsley Debate

Has the Mental Health Act had its day?

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5248 (Published 16 November 2017) Cite this as: BMJ 2017;359:j5248

Rapid Response:

Views from the frontline

Views from the Frontline

I cherish the rigour in psychiatry where we can debate issues amongst ourselves and do not have to pretend about our views.

On the frontline, for some time now, the Mental Health Act (MHA) and Mental Capacity Act (MCA) have caused a lot of difficulties. These pieces of legislature are often at odds with each other and those that drafted them do not seem to have given due consideration to each other. Unlike in many comparable jurisdictions, the English Mental Health Legislature appears to be unwieldy and unnecessarily complex. There are definitely grounds to streamline or fuse its processes, as suggested by George Szmukler.1

Another view from the frontline is that detention does save lives but may also do damage, in fewer circumstances. Clinicians are now forced to resort to detention to secure services and/or a bed. That black patients are three times more likely to be compulsorily admitted, may say more about our society than the law itself. We require to properly resource teams to tackle this inequality.

Demand for mental health services, and expectations of delivery, including nuances in expectations, are comparatively higher and more complex in England and Wales. As hard as some may want to push it, mental illnesses are different from physical illnesses and therefore need extra safeguards. While we support streamlining of the law, we believe that liability to compulsory treatment does and has indeed saved lives which is a cardinal responsibility of psychiatry in England & Wales.

Review of use of legislation in Netherlands where mental competence or mental capacity is used as a benchmark for assisted suicide (for example) has suggested that the lives of persons with potentially treatable but severe mental illness may have been legally ended prematurely, due to the limitation in availability and or access to mental health resources and treatment.2, 3 Issues around capacity or competency may be more complex than simply the presence or absence of treatable mental illness.4 Hence resorting to only this, may not solve the challenges we hope to. Whether this would be tolerable or acceptable in English society is up for discussion.

References:
1. Szmukler G, Weich S. Has the Mental Health Act had its day? BMJ. 2017;359.
2. Kim SH, De Vries RG, Peteet JR. Euthanasia and assisted suicide of patients with psychiatric disorders in the netherlands 2011 to 2014. JAMA Psychiatry. 2016;73(4):362-8.
3. Odeyale F, Udo I. Mental Capacity as a Safeguard in Assisted Dying: Clarity is Needed. BMJ 2015;351:h4461. Available from http://www.bmj.com/content/351/bmj.h4461/rr-1 (Published 27 March 2016).
4. Miller DG, Kim SYH. Euthanasia and physician-assisted suicide not meeting due care criteria in the Netherlands: a qualitative review of review committee judgements. BMJ Open. 2017;7(10).

Competing interests: No competing interests

17 November 2017
Ebunoluwa A Patrick
Specialty doctor
Itoro Udo
Moss House Community Mental Health Team c/o Merseycare NHS FoundationTrust
Moss Street, Garston, Liverpool. L19 2NA