I have had the privilege of being a mental health nurse and of working for the NHS for 38 years, in lots of different roles, including commissioning mental health services. I have always thought that the Mental Health Act (1983) should be in place to help people experiencing mental illness, to help keep them safe and well and also to ensure that other people are kept safe.
As it is not possible or indeed desirable to go through all of the past 38 years, I want to focus on a particular time which had a huge impact on me as a nurse. That time period is the early 1990s, when nationally there was an emphasis on the need for people who had been in mental health hospitals, for many years, to be discharged and supported to live in the ‘community’, as part of their rehabilitation.
Quite a few of my colleagues were genuinely worried that these people, who had lived in hospital for a very long time, would not be able to cope living in the community. Some said that the older patients might die as a result of being moved, and there was quite a lot of staff resistance to this change. They queried whether it was possible for someone on a Section 3 of the Mental Health Act (1983) who had been admitted to hospital for treatment, ongoing assessment and support to be discharged into what would be considered their own home, with 24 hour staff support.
Colleagues were genuinely worried that these people, who had lived in hospital for a very long time, would not be able to cope living in the community
The implications seemed to be, by some, that the service users were not able to make this informed choice or did not have the capacity to do this. At that time, we did not have the framework of the Mental Capacity Act (2005), which now applies to the care and treatment of anyone who is 16 or older in England and Wales, who is unable to make all or some decisions for themselves. The Mental Capacity Act is designed to protect and restore power to those vulnerable people who are deemed to lack capacity.
Some of the service users who were discharged from the large mental health hospitals are still living in the community today, and for years I have thought about how worried colleagues were at the time. Looking back now, though, it seems quite incredible that anyone would have been that concerned.
The implications seemed to be, by some, that the service users were not able to make this informed choice or did not have the capacity to do this
In the same way, is it possible that there are current practices within mental health care which we will look back on in twenty years’ time with amazement, or shame? For instance, I recently reviewed some young people who had been detained under the Mental Health Act. Sometimes clinicians struggled to engage them and so, despite having multiple vulnerabilities and being at risk of harming themselves, the young person was discharged without receiving therapeutic engagement. We are failing some young people by not offering them the therapeutic support they need while they are in hospital; and just as importantly by missing opportunities to intervene earlier to prevent the crisis that leads to their admission. I hope that in the future, we will look back and recognise that we missed opportunities to support vulnerable young people experiencing mental distress.
We are failing some young people by not offering them the therapeutic support they need while they are in hospital
Do we always work to keep the best interests of service users at the centre of all that we do, or are we too worried about what could happen in the future to really focus on the present? Will we now take the opportunity to ‘future proof’ mental health law and the Mental Health Act? Let’s consider the Mental Health Act we want for the next 20 years, so we don’t say… “I can’t believe we used to think and do that in 2018”.