The Mental Health Act

The Mental Health Act was brought into being by parliament, ultimately, to give more protection to all of those involved with mental health, including staff and patients. Mental health has only really been taken seriously in the last few decades, and the Mental Health Act 1983 went a long way to establishing the rights of people suffering from mental disorders.

History and evolution of the Mental Health Act

How did we get to the mental health act we have now? There is evidence from cave drawings that there were mental disorders in the Stone Age, with Witch Doctors treating mental disorders with ‘magic’, however, we will fast forward and look closer to the modern era.

The Madhouses Act 1774

In 1774 The Madhouses Act was brought into effect, which established a group of five commissioners from the Royal College of Physicians that dealt with licenses for premises to hold mentally ill people (Justices of the peace dealt with the rest of England and Wales).  The act also made it a requirement that any person detained in one of the madhouses, must have a signed certificate from a doctor, confirming their mental illness. There were amendments in 1828 and 1832.

The Lunacy Act 1845 and the County Asylums Act 1845

The Lunacy Act 1845 and the County Asylums Act 1845 were the next forward motions in ‘caring’ for people with mental health. These acts ensured that there was an asylum for each county to deal with mentally ill people and it gave them the power to detain people that were not of “sound mind”. The Lunacy Commission was created to oversee the asylums and ultimately check they were running appropriately.

The Lunacy Act 1890

These two acts were later repealed by the Lunacy Act 1890 which made small changes, and the Lunacy Commission were handed more powers and renamed the “Board of Control” in the Mental Deficiency Act 1913. The Board of Control would later be altered in the Mental Health Act 1930 and the National Health Service Act 1946.

The Mental Health Act 1959

The Mental Health Act 1959 was the first parliamentary Act on mental health that started treating the subject more seriously. This was the first legal move to treat mental health issues similarly to physical illness (as close as possible). It also removed promiscuity or other immoral conduct as grounds for detention.

However, although this act was a great first step, there were, unfortunately, grey areas that needed clarifying. There was confusion whether a legal detaining order for a person gave the hospital power to treat them against their will. Also as the 1970’s were in full swing, it was becoming more obvious that a specific legal framework was required regarding medical treatments for mental health, such as psychiatric medication, electro convulsion therapy, and psychotherapy.

The Mental Health Act 1983

The Mental Health Act 1983 was brought in by parliament to try and tackle these legal requirements. It implements controls on treatments for mental disorders, specifically including mood altering drugs, electro convulsion therapy, and surgery, making it clearer what treatment a hospital could give to a detained patient.

It also introduced social workers, who were specially trained in mental health care and also demanded the aftercare (by local health services) of mental health patients who were released from detainment. This Act was amended in 1995, 2001 and finally in 2007.

Why did the Mental Health Act change in 2007?

The Mental Health Act of 1983 was more concentrated on patient rights to seek reviews on their treatment. However, the amendment in 2007 was more focused on the protection of the public and risk management.

Mental Health definition changed

The first significant change was the definition of mental disorder. In 1983 it was defined as four clear areas which were “mental illness, arrested or incomplete development of mind, psychopathic disorder and any other disability or disorder of mind”. The 2007 amendment changed the definition to “any disorder or disability of the mind”. It excluded people with a learning disability unless they had abnormal behavioural tendencies, and also excluded substance addiction.

Wider range of professional roles

The 2007 amendment of the Mental Health act renamed the specific mental health roles and allowed a greater number of professionals from a variety of healthcare backgrounds to be included. Approved Social Workers (AWP) were renamed to Approved Mental Health Professionals (AMHP), allowing, not only social workers but also nurses, occupational therapists, and phycologists, with the relevant experience, to become one.

Responsible Medical Officers (RMO) were renamed to Responsible Clinicians (RC) allowing not only doctors but also social workers, nurses, occupational therapists and phycologists, with the relevant experience, to become one. It is worth noting that to become an RC you first need to become an Approved Clinician.

Ability to pass rights to a selected ‘nearest relative’

In the 1983 Act, the nearest relative of a patient had a lot of rights, including applying for admission to hospital, block admission for treatment, to discharge the patient from compulsory admission and gain information on the patient. However, the 2007 Act allows mental health patients to go to court to nominate someone as their nearest relative if they so wish.

Treatment

The Mental Health Act 2007 made a few significant changes to the treatment of mental health patients. Firstly the 2007 act sets out a clear definition of a medical treatment. The new definition adds “nursing, psychological intervention and specialist mental health habilitation, rehabilitation and care” to medication and other medical treatments. This means that patients can be detained in hospital even if traditional mental health medication is not an option.

However, the 2007 Act also improves the protection of patients who might be detained, by making the test for this procedure more robust. Before the 1983 act, the major test to see if someone should be admitted to a mental health hospital was that treatment would “likely alleviate or prevent deterioration”. However, now a patient that suffers from mental health problems can only be detained under section 3 if there is “an appropriate medical treatment available to that person in that hospital”.

The 2007 act also made a few changes to consent to unusual treatment, but consent to treatment with things such has medication has largely stayed unchanged. This is especially important for Electroconvulsive therapy (ECT), as the act sets out strict guidelines as to when someone should have it. The first scenario a person can get ECT is if they consent to the treatment, but they still have the right to withdraw their consent at any time, if they so wish.

Secondly, if they are unable to give consent for whatever reason, then an independent doctor has to give his second opinion for ECT to go ahead. However, it is complicated by the fact that this second doctor must first consult with two other people which includes a professional involved in the care of the patient.

These Second Opinion Appointed Doctors (SOAD) also are used to safeguard patients who have been on a course of treatment which they haven’t consented to, for over 3 months. They must agree the treatment is appropriate before the patient can continue receiving it.

Supervised Community Treatment (SCT) and Community Treatment Orders (CTOs)

SCT and CTO were important developments in the Mental Health Act as they can help to start giving a patient more of a normal life back. The Supervised Community Treatment allows people to be subject to Community Treatment Orders when living in their own home.

Being at home can reduce the amount of distress patients can go through and is the next rational step in the treatment process, if there is a risk the patient is not going to continue their treatment unsupervised. A patient can only be considered for SCT if they have been detained for treatment in a hospital under a section 3 or 37 and they continue to need treatment but no longer need to be in hospital. There also has to be a believed risk that they will not continue their treatment without supervision.

When can the Mental Health Act be used?

Normally, a patient with mental health problems agrees to be in hospital or volunteers. However, when someone poses a risk to themselves or others, the Mental Health Act can be used to detain (section) them and treat them without needing their consent.

Patients detained under the Mental Health Act are usually in urgent need of treatment, and it protects both the patient and the public from their actions.

In emergencies, police have the power to detain a person in a safe place and to have you assessed by a mental health professional. This can be in a hospital or a police station, and they have the right to keep someone there for up to 72 hours while they are assessed.

In non-emergencies, if a person’s family or professionals involved in their care are worried about their mental health they can ask for an assessment of their mental health under the Mental Health Act process.

The length of time that a patient can be detained for depends on the severity of the mental health problem. Under Section 2 of the Mental Health Act, a patient can be detained for 28 days and under Section 3 of the Mental Health Act, a patient can be detained for 6 months, with further renewals.

Mental health care has come a long way since the time of the ‘witch doctors’, and that is largely thanks to the progressive mental health laws that have been passed in the last few centuries. The Mental Health Act 2007 is hugely important to keeping people safe and went along way to making sure mental health was taken as seriously as physical health.