The Wessely Review

Yesterday, Prime Minister Theresa May announced she has asked Professor Sir Simon Wessely to lead a review of the Mental Health Act 1983 and to report back by Autumn 2018 on what a new Mental Health Act may look like.  Sir Simon is a psychiatrist by background, professor of psychological medicine (especially working with our military) at the Institute of Psychiatry and Psychology, King’s College, London and he is the previous President of the Royal College of Psychiatrists. He is now the President of the Royal Society of Medicine, the first psychiatrist to hold that position and you can follow him on Twitter (see image, above) if you want to keep up to date with the MHA review and his cycling holidays! You can also read his own views about this work.

One or two comments on Twitter yesterday about the wisdom of appointing a doctor as the lead of a review of our laws: it hadn’t occurred to me to worry because having known Professor Wessely a few years, it seemed obvious to me one of the first things he’ll probably do is surround himself with the best people he can find to offering necessary perspectives, from mental health and capacity lawyers of various sorts, to patients and their families as well as the professionals of all kinds who operate the Mental Health Act in everyday life.  I hope I’m right!

TERMS OF REFERENCE

The UK Government have set out terms of reference for Sir Simon’s review and by way of some background to all of this, I was reminded of a blog post by Andy Bell, deputy chief executive of the Centre for Mental Health which explains a lot of the current issues and problems as our laws and our public service realities come in to tension and conflict.

Anyone who has read my BLOG before will know there are many pieces on this site which highlight operational problems connected to the police and I already know that Sir Simon has asked to speak to Chief Constable Mark Collins, the NPCC lead on mental health, so I’m guessing that’s the start of a conversation about how the police interface with the MHA in our various circumstances.

This thing will have a different impact in Wales to that in England, because the review relates to England and to those matters not devolved in Wales. The health system and its legislation is devolved in Wales, but not everything in the Mental Health Act relates to the health system: apart from the obvious police powers, all of Part III of the MHA relates to the operation of the courts and criminal justice system and policing and justice matters are not devolved – as if this wasn’t complicated enough!

JUST SOME THOUGHTS

This post will be short: it’s just to set out what’s going on and provide some links if you’re interested in reading them.  But I also want to post some questions, whether you are a police officer a member of the public with whatever perspective on the issues or whether you’re another kind of professional.  Ask yourself, what problems do you encounter with the Act, especially where it relates to the police and what would you want Sir Simon’s review to take account of when forming opinions for recommendations in a year’s time? Please feel free to leave a comment below – don’t do it on Twitter or Facebook, as the comments will inevitably be hard to gather – if they’re all below, they’re in one place and NPCC can then make sure when we’re asked for any opinion, we can represent the views of police officers in our response.  A few of my own thoughts, having had 12hrs to think about this, most of which was spent asleep!

  • The country’s response to mental health crisis in private premises is not safe – the recent inquest in to the death of Michael Thompson showed this again and without wanting to argue for expanded police powers, it’s fair to say that we still risk people attempting to blame police or paramedics for not keeping people safe because they neither have powers to use nor the ability to call on the support of those who do.  This could be addressed in a number of ways and the review should look at them.
  • We have massive problems in securing admission to hospital – whether this is too few beds, too few alternatives or anything else besides, the fact remains that there are thousands of cases a year (based on estimates) of where patients rights are violated or their safety compromised whilst delays in accessing beds thought needed are resolved. This will only become more difficult when timescales for assessment in Places of Safety are reduced in a few weeks. Whether we need a new ‘section 140’, whether we need legislation to compel minimum standards of out of hospital alternatives, etc., is for Sir Simon to resolve but the problem needs grasping, in my view!
  • Greater clarity about invasions of privacy and property for inpatients – the MHA was (essentially) drafted in 1959 and much was taken to be implied. Where we get in to frequent discussions about searching, restriction, seclusion, seizure of property (like mobile phones), do patients need greater clarity about their rights whilst detained?
  • Should we aim to have capacity based mental health legislation? – the MHA allows interference with autonomy even where patients have capacity to take certain decisions. Is it time we moved away from this and had capacity-based legislation? The Mental Capacity Act 2005 (MCA) has been criticised and formally reviewed by the Law Commission with various problems in that part of our ‘mental health’ world, too. Should the pair of Acts be scrapped and modernised?

I’ve actually got a much longer list than this, but that will do just to give some examples.  Mental health campaigner Mark Brown wrote a very interesting opinion piece in the Guardian yesterday, encouraging a bolder, more positive vision and that’s also worth a read. Have a think: leave a comment.  If you don’t, we can’t consider what to say to Sir Simon if / when he comes knocking on the door for a police perspective on the issues and challenges ahead.

Regardless of anything else: this is quite a task ahead and I can only wish Sir Simon the very best of luck with it!  Attempts have been made in the UK to review and replace the Mental Health Act and they failed miserably amidst big debates about what the purpose of our mental health laws should be. The Mental Health Act 2007, which largely just manned and updated our two main legal frameworks (the 1983 MHA; and the 2005 MCA) and that was a compromise after the Mental health Bill 2004 failed to make its way through Parliament. That legislation incidentally, included scope for a s136 type power in private premises, which I note purely as an historical curiosity.

The task is huge and important – very best of luck Simon!


IMG_0053IMG_0052Winner of the President’s Medal from
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.


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5 thoughts on “The Wessely Review

  1. We know too many CCGs use funds intended for MH for other purposes. NHSE must discharge its responsibilities under 2012 HSCA to ensure investment in community MH services; avoiding many crisis admissions. These services neglected although evidence established of effectiveness and UC preferences following implementation of the National Service Framework for Adult MH. Fear review may be another exercise in exploring the long grass. Nevertheless, wish Sir Simon well in this important work and suggest 2 vice chairs to be appointed come from patient and carer constituencies.

    ‘People have been powerless in the face of organised special interests. We will change this’. A Bevan.

  2. I don’t know if this is relevant but hear goes I’m an appropriate adult I see lots of people with mental health issues in police custody – I’ve had many positive experiences in custody where I’ve been included in conversations and assessments with both custody sargents and L&D practioners in relation to safeguarding of individuals held; my point if relevant is due to one presumes lack of funding/resources is the length of time a person is having to wait for a team to arrive to carry out the assessment for example an individual arrested on suspicion of a low level offence where an extension to his PACE had to be sought as he was still waiting for an assessment.
    I regularly read your emails and know that the issue of custody cells being used to safeguard vulnerable individuals whilst waiting for hospital beds and mental health services is sought and I’m sure situations like the one I’ve mentioned are sadly common place but perhaps this is something to mention to Sir Simon.

  3. Cracked MH [health] crisis care pathways and very slow /sticky handovers from police to health are constant barriers to patient care. Current NHS Commissioning funding fails to provide health capability to cope with policing MH crisis demands. How about legally changing MH [Health ] funding ?

  4. I would like to see legislation MHA amended to resolve the legal limbo of person in custody for substantive offence PACE clock expired awaiting bed post MH assessment. If the MHA assessment was complete once decision to section rather than identifying and naming bed as is the case.

  5. is it worth categorising police MH crisis demand issues into two categories… 1) LEGAL DIFFICULTIES; and 2) CARE PATHWAY DIFFICULTIES (where the law/procedure is adequate but health response is inadequate… Insufficient resources etc) ?

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