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Exclusive: Jeremy Hunt on mental health injustices and more

RESOLUTE: Health Secretary Jeremy Hunt

IT IS now nearly 35 years since the introduction of the 1983 Mental Health Act, a defining piece of legislation that has provided the legal basis for how the state responds to a person experiencing severe mental illness since then.

The 149 sections in the Act have famously inspired the common name for its best known element – ‘sectioning’ – which has become a short-hand for the process and conditions under which an individual could be detained against their wishes.

And, while the Act has been substantively amended twice since its passage – in the late 1990s and again in 2007 – the social consensus it forged, in balancing public safety concerns with the rights of the individual, has remained broadly consistent with the 1983 vision.

Yet, it is a rare piece of legislation that can stand nearly four decades of social change without needing significant and reform – and in the case of the Mental Health Act, it has become increasingly apparent that we need to rethink the way we treat people with acute psychiatric disorders.

DIGNITY AND RESPECT

The Government has already taken some action to ensure more people are treated with dignity and respect if they become seriously unwell. For example, specialist liaison and diversion services have spread across more than two-thirds of the country, meaning use of police cells as a place of safety has decreased by three-fold over the past three years.

Our investment in crisis cafés and other community based provision – supported by a new £15 million Beyond Places of Safety fund which will open for bids later this month – is further strengthening support for vulnerable people before they reach the point where emergency admissions are required.

And, under the Crisis Care Concordat, we have built a new culture of integrated working across health, criminal justice and local government, transforming the support available to those experiencing crisis.

In places like Bradford, the impact of these partnerships has significantly improved the range of 24/7 support available to people – from stronger triage in police stations and the community, to the development of alternative ‘places of safety’ for young people in distress.

180 PEOPLE A DAY SECTIONED

Yet there may still be deeper injustices in our mental health system that call for a more substantive, far-reaching look at legislation and practice.

Firstly, rates of detention are rising – up 47% in a little over a decade, meaning that last year, on average, 180 people a day were detained or ‘sectioned’ under the terms of the Act.

There is also significant over-representation of certain ethnic groups in psychiatric care. Black people are almost four times as likely to be detained as white people – far higher than would be expected by differences in underlying rates of illness within these groups.

At the same time, many campaigners have criticised the balance of safeguards available to patients, and particularly the fact that the legislation gives the patient’s “nearest relative” significant powers over their treatment without giving the patient themselves any say over which relative this is.

And it is unacceptable that some people face unnecessary delays in being transferred from prison to a clinical setting – a situation that compromises both their ongoing treatment as a patient and their essential dignity as an individual experiencing profound illness.

DIRECT EXPERIENCE

So this week I announced that we would begin an independent review of the Mental Health Act to begin the complex task of modernising our mental health legislation for the 21st century.

Chaired by the respected psychiatrist Professor Sir Simon Wessely and supported by a team of vice-chairs representing the BME community and those with direct experience of the mental health system, the review will look at the evidence and draw out ambitious recommendations for how we reconfigure our approach.

Looking back on the history of mental health over the last century or so, it is hard not to feel incomprehension and anger at the inhumanity that was built into the practices and assumptions of the distant past.

Yet we should view this not simply with bemused disgust, but with the self-awareness to recognise that history provides a warning to the present – that today’s realities invariably become tomorrow’s anachronisms.

It is beyond doubt that we need to do more to assert the basic dignity of the individual in a modern, mental health service. This historic review will pave the way for a more compassionate, fair and progressive approach to managing mental illness in the future.

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