No Voice, No Choice?

Being detained under the Mental Health Act shouldn’t mean you lose your dignity. We are pleased to announce that our report ‘No Voice, No Choice – Making the Mental Health Act more person centred’ has been published by Rethink Mental Illness. ‘No Voice, No Choice’ has been published ahead of the interim report which is due this week from the government appointed review of the Mental Health Act, as led by Sir Simon Wessely.

The report focuses on how we can make the Mental Health Act more person centred and fit for the future. The research was commissioned by Rethink Mental Illness and undertaken by Adelphi Research UK, with support from Janssen Cilag Ltd.

Take a look at the Executive Summary and Next Steps below from the report or to view the full report click here.

This research has highlighted a number of issues with the Mental Health Act as a result of what we heard from service users, carers, HCPs and other professionals.

Executive Summary

  • Service users who had been detained under the Mental Health Act told us they had minimal involvement in decision making and their choices were largely disregarded.
  • Changes to the Nearest Relative provision within the current legislation would be welcomed to give service users the right to select who they think is suitable and appropriate.
  • Very few service users and carers involved in the research were aware of the option to make and record Advance Decisions regarding their care as part of the Mental Health Act although there was a clear appetite for these.
  • Although Healthcare Professionals (HCPs) said they assess service user capacity to make decisions there appears to be no formal or consistent approach to doing so.
  • There were significant gaps in the information provided to service users and carers regarding their rights whilst detained. Information on treatment options and a lack of consistency in terms of what was received and how it was explained.
  • Time pressures and shortage of staff (nurses in particular) were cited as a key reason for the inconsistency of information provided.
  • Differences in the attitude and approach of HCPs to service users were also reported to have a fundamental impact, both positive and negative, on the quality of care received.
  • Independent Mental Health Advocates (IMHAs) were perceived by both service users and healthcare professionals to be an invaluable resource to guide service users through the system.
  • The research uncovered a feeling that detention under the Mental Health Act takes a standard, ‘one-size-fits-all’ approach with little focus on the service user themselves.
  • Many service users described their experiences as similar to being imprisoned rather than being cared for with a complete loss of any sense of control over their lives.

Next Steps 

Whilst the insights offer a clear foundation on which to build, there is a need to explore the recommendations further and validate what was said in the interviews. The Mental Health Act Review offers an opportunity to ensure that this further research and exploration takes place.

“I think there should be more person centred care, more so than blanket rules…It should be individualised to your care with a say on what you’re allowed to have and not have.”
Service user

The findings from this research will feed into the Independent Review of the Mental Health Act as led by Sir Simon Wessely. The interim report is due later this week and we are keen to see the outcome.

Click here to view the full report.