'The returning normalisation of sectioning and invasive treatment demands new legislation'

The number of applications made by healthcare professionals to detain people in hospitals under the Mental Health Act has risen by 40 percent in the last decade, regulators the Care Quality Commission have revealed.

We should all care about the law governing what happens to us if and when our mental health takes a crash. Any of us could be hospitalised for our mental health at any time. Our mental health is contingent on how safe and secure we feel. Circumstances can change for any of us, at any time.

• See also: In Our Right Mind

Though we can take steps to maintain our mental health, none of us knows what is around the corner or what impact changes to our social circumstances (relationships, work, physical health, discrimination, money, trauma…) will have on our mental equilibrium.

Disorders are not something that happen to ‘other people’. Biological factors play a role, but it’s social and psychological factors that catalyse the onset of diagnosable mental health conditions.

Invasive treatments continue to undermine good crisis care

The Mental Health Act used in England and Wales permits clinicians to make applications for hospital detention and treatment without patient consent. That treatment can include surgery and electroconvulsive therapy.

Section 57 of the law says: ‘Surgery shall not be carried out unless… it is appropriate for the treatment to be given… to prevent the patient from behaving violently.’ Who is to discern what characterises violence rather than distress? This question is regularly voiced by BAME mental health campaigners, who say a paranoid perception of ‘big, black and bad’ still permeates too readily in mental health settings. In the UK, black people are four times more likely to be detained under the mental health act and 17 times more likely to be diagnosed with a serious mental health condition.

The existing Mental Health Act also says: ‘A person shall not be given electroconvulsive therapy unless… it is appropriate… and there has not been an advance notice given’ (by the individual, before they were ill, refusing consent to the therapy, which involves electric shocks permeating through the brain).'

• Join MHT Wales to learn more about crisis care and the mental health act review

The law was written in a different time, when hospitals were still there primarily to protect the public rather than help in-patients recover. However, it would be naïve to assume that such ‘therapy’ is never used by the NHS. In 2012/2013 there were 1,447 patients who received ECT. A year later the number jumped by 32 percent to 1,904. A year later, the NHS stopped publishing the data in a publicly accessible format. This writer recently made a request for current figures. I was directed to a subsidiary who charge £1,000 per application for this data and have asked for an internal review of their decision as it breaches freedom of information law.

NHS sometimes stretched to pragmatism at the expense of patient-centered care

The Care Quality Commission say there is no single reason why applications to use the mental health act to detain people in hospital has jumped forty percent in a decade, but suggest they are “signs of a healthcare system under considerable strain… Detentions under the Act can be influenced by gaps in support and provision in the system. This includes limited hospital bed availability, which means that people cannot easily be admitted as voluntary patients early in the course of their illness.” 

The CQC add: "The broadened definition of a mental disorder in the revised Mental Health Act in 2007 is already understood to have led to increased applications for detention. As well as that, there is greater awareness, for example among the police, of mental disorder and among clinicians who wish to ensure there are legal safeguards in place when caring for people who lack mental capacity."

The Mental Health Act is worded in such a way that it gives clinicians autonomy they don’t want, to do whatever is most pragmatic in the tortuous, under-resourced constructs in which they have to work. In environments of such pragmatism, empathy with the individual – when they most need compassion, when they most need to be treated with dignity and respect – can be lost. Mental health hospitals save lives but detention should to be used as a last resort, not as a substitute for cuts to care in the community or preventative services.

The Government have appointed psychiatrist Professor Sir Simon Wessely to review the Mental Health Act and he concluded the first round of evidence gathering this week. Preliminary proposals are due in the Easter. Professor Wessely has said it represents a once in a generation opportunity to make mental health care ‘more civilised and less coercive’. For peace of mind, let’s hope the chance is taken.