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[Project Status - Completed]
PROJECT SUMMARY
In 2017, the United Kingdom government announced an Independent Review of the Mental Health Act for England and Wales. The aim was to understand the rapid rise in detentions, particularly among people from Black, Asian and Minority Ethnic (BAME) groups, to clarify the interface between the Mental Health Act and the Mental Capacity Act (2005), and to review recent developments in human rights. The Mental Health Act Review working group commissioned nine pieces of research which were conducted by the Mental Health Policy Research Unit in 2017/18. MHPRU Deputy Director, Dr. Brynmor Lloyd-Evans, was a member of the MHA Review working group which helped the Review Chair and Vice Chairs agree and draft the Review’s recommendations.
ENGAGEMENT AND EVENTS
- Dissemination event held by the MHPRU to discuss the results of our work.
- A Mental Health Question Time panel discussion about compulsory admissions and the Mental Health Act (MHA) with Dr. Lloyd-Evans, deputy director of the MHPRU.
- Mental Health Question Time: panel discussion arising from our MHA work
- Mental Elf Blog: Involuntary admission for psychiatric care: a review of clinical and social risk factors
- Mental Elf Blog: Mental health service users’ experiences of statutory detentions - lessons for reform
- European Psychiatric Association Presentation:
Publications
Modernising the Mental Health Act – final report from the independent review: A summary of findings from the MHPRU work is included as an appendix to the MHA Review report published in 2018
Reforming the Mental Health Act: The Centre for mental Health published a briefing paper summarising the policy implications of the MHPRU MHA projects
Social and Clinical Correlates of Involuntary Psychiatric Detention: A Systematic Review and Meta-Analysis: A systematic review of 77 studies. Having been detained before, having a diagnosis of psychosis and economic deprivation were associated with detention and may be useful focuses for intervention.
- Patients' Experiences of Assessment and Detention Under Mental Health Legislation: Systematic Review and Qualitative Meta-synthesis: A systematic review and meta-synthesis of of 56 studies confirmed patients’ experience of fear and distress during detention. Where staff were perceived as striving to form caring and collaborative relationships and when clear information was delivered, the negative impact of involuntary care seemed to be reduced. A lack of research with Black and minority ethnic service users was highlighted.
- Crisis-planning Interventions For People with Psychotic Illness or Bipolar Disorder: Systematic Review and Meta-analyses: A systematic review including five studies suggests that joint crisis planning may be an effective model of support which can reduce repeat detentions by up to 25%.
- Compulsory Community Treatment To Reduce Readmission To Hospital and Increase Engagement With Community Care In People With Mental Illness: A Systematic Review and Meta-analyses: A systematic review of 41 studies provides clear evidence that compulsory community treatment is ineffective in reducing hospital admissions or length of inpatient stays.
- Psychosocial Interventions To Reduce Compulsory Psychiatric Admissions: A Rapid Evidence Synthesis: A review of 949 mental health trials of psychosocial interventions found only 19 which evaluated compulsory admissions as an outcome. Crisis planning was an effective means to reduce detentions and Early Intervention in Psychosis teams showed some promise from available trials. No other types of support have a robust evidence base for reducing detentions.
- Patterns of The Use of The Mental Health Act 1983, from 2007-2008 to 2016-2017, in Two Major London Secondary Mental Healthcare Providers: An analysis of anonymised health records from two London Trusts found that rises in the rate of detentions since 2008 reflect more people being detained, not the same people being detained more often. Increased psychiatric morbidity and/or better detection of need for detention in services may contribute to the rise in detentions in England.
- Variations In Patterns of Involuntary Hospitalisation and In Legal Frameworks: An International Comparative Study: A comparative study of detention rates and legal systems in 22 high income countries found that rates of detention in England were about average, but rising faster than nearly all other countries over the last decade. No characteristics of countries’ legal arrangements were associated with detentions. Countries with more inpatient beds tended to have higher detention rates.
- Understanding Increasing Rates of Detention in Psychiatric Hospitals In England: Development and Preliminary Testing of An Explanatory Model: Available evidence was scoped to examine seventeen proposed explanations for the rising rate of detentions in England since 1983. An explanatory model was developed. Evolving case law about mental capacity, increasing psychiatric morbidity and stretched community services may all have contributed to the rise in detentions in England.
- Carers' Experiences of Involuntary Admission Under Mental Health Legislation: Systematic Review and Qualitative Meta-synthesis: A systematic review of 23 studies highlighted the impact of detention on carers’ relationship with their detained relative, and their needs for timely and accessible information, supportive and trusting relationships with mental health professionals, and involvement as partners in care.
A qualitative meta-synthesis of service users’ and carers’ experiences of assessment and involuntary hospital admissions under mental health legislations: a five-year update: A review of 24 studies summarising service user's views on compulsory admissions and assessment