The Thankless Task

Have you ever been given a piece of work to do or faced some decision in your life where no matter what you do, you’ll be criticised? More than that: the vast majority of people will look at your decision and either criticise or comment that things could have been done differently?!

I’ve spent many hours this year, especially over the Summer, in various meetings associated with the Mental Health Act review. In particular, I was recently in the Advisory Group to the Review, chaired by Professor Sir Simon Wessely, past President of the Royal College of Psychiatrists and Regious Professor of Psychological Medicine at King’s College, London. Whilst there, whilst listening to various people talking about the sensitive and important issues which may feature in the report the Professor must submit to the Prime Minister, two things ocurred to me:

  • Because of my general effort to blog a bit less often during 2018 than I did in 2017, I have managed to say precisely nothing on here about the review – and I should correct that as soon as possible.
  • Far more importantly, it occurred to me: no matter what this bloke recommends, many people, if not most people, are going to criticise him or comment that it could or should have been different.
  • Some will politely and constructively criticise that he perhaps could have gone further in some areas whilst regretting that he didn’t; and others may quite vehemently criticise that he hasn’t been anywhere near radical enough; or hasn’t been inclusive enough; or has listened too much to some vested interests, whilst not to others – you only have to be familiar with the many debates, arguments and amazing fallouts on social media to see how extremely dissatisfied some of us are with our mental health system and the laws within which it must operate. So how you come up with a series of legal recommendations that satisfy everyone in those disparate and dissociated groups, I’ve no idea … but come December 12th, when the final report is published, we’ll see where we are.
  • WHERE ARE WE NOW

  • You may remember, back in April, the Review published its interim report and outlined what it thought the general issues were and the specific areas where more work was required. There were eighteen areas overall and each issues has had a ‘topic group’ working over the Summer on the various issues within that topic. So for example, the police topic group, chaired by the PCC lead on mental health, Matthew Scott from Kent, has been looking at the five specific issues flagged by the Review leaders, as well as considering a few other issues which member of the topic group feel need considering. If you want to refresh your memory on those things, see my previous post from May 2018 on the policing implications of the interim review.

    So, the police have been involved in various other topic groups because there are obvious overlaps with some of the other issues: there is a broader ‘criminal justice’ topic group and another on African-Caribbean mental health. We’ve chipped in briefly at the Advisory Group on some other topics which are not about policing, but which have the occasional overlap – such as the mind-blogging complexity for frontline officers of ‘recalling’ people from a Community Treatment Order. “What’s a community treatment order” you might ask?! If you don’t know – and why would you?! – then you probably don’t know the three different ways in which people can be recalled from them AND the different timescales which apply to the effect that those methods has on the ability of the police, AMHPs or others to re-detain people and take them back hospital. I’ve known mental health professionals of all kinds get this stuff wrong, when they manage patients on these orders as a part of their day-to-day work. How often is the average police officer asked to return someone who has been recalled?! … not often enough to make it reasonable that they have free recall of the methods and timescales, that’s for sure! That’s just one example for you – we’ve asked for that to be looked at.

    So the policing topic group has finished its meetings and reported back to the Review leadership: they now have the heavy duty of working through all of the competing priorities and vested interests at stake in order to decide what to recommend to the Prime Minister. There are still some public meetings in October, whereby those who still have an interest in how this pans out can make their views known but by December 12th, Professor Wessely must make recommendations to the Prime Minister about how the Mental Health Act should be changed.

    MANAGING EXPECTATIONS

    You might remember if you’ve followed the debate at all, that the problems being flagged to necessitate a review were –

    1. Rising rates of detention in hospital, under the MHA –
    2. Disproportionate representation within those figures of those from an African-Caribbean background.

    I’ve learned a lot from being involved in this process, especially the African-Caribbean group chaired by the quite-inspiring force of nature that is Jacqui Dyer MBE. Jacqui was the vice-chair of NHS England’s Five-Year Forward view and is an experienced and impressive campaigner around mental health generally and “the black experience” in particular (that’s the term Jacqui’s uses). It’s obvious that if you just think about the policing stuff; or the African-Caribbean stuff; or the Criminal Justice stuff – what Simon is grappling with are multi-faceted, complex issues with irreconcilable vested interests at stake.

    Some people think the MHA should be totally abolished and not replaced – did you know that some countries don’t have a Mental Health Act or equivalent? … who knew?! Some think it should be totally replaced with a new Act that is predicated exclusively upon ‘capacity’ and people’s decision-making – but did you know that some very vulnerable people with certain mental health conditions that could lead to their death, don’t lose capacity until they are medically beyond hope of recovery – eating disorders was given as an example of this. Some have argued that as the British Government is a signatory to the United Nations Convention on the Rights of Person’s With Disabilities (UN CRPD) and that the review recommendations should be fully compliant with that international treaty and the ‘optional protocol’ that we also adopted.

    So be prepared, no matter what position you come from to find that all of this complex, competing stuff cannot be completely reconciled to the satisfaction of everyone.

    POLITICS AND THE REAL WORLD

    The political reality of this is: no matter what Sir Simon recommends, it means nothing at all in the real world unless the Government adopt it and get it through Parliament, in whole or in part. And we should all bear in mind it will take several years to do that, no matter the detail of the report. Those of us who remember the fate of the Mental Health Bill 2004, which was the initial product of the last review of the Act (The Richardson Review), will remember it was loaded with some controversial stuff insisted upon by the Labour Government and the opposition was such that the whole Bill fell which meant NOTHING got through.

    The interim review report sets out an obvious desire to make a positive difference in a number of areas: whatever your view on the particular changes required, it’s all just been a very interesting talking shop (with nice Royal College of Psychiatrists biscuits!), unless something from this report makes it to the House of Commons for a vote. I hope to see a few things in there which, based on this Summer’s work, seem likely to feature because I’m keen to see that lead to change in the real world – we have been talking about some of the things the Review may help change for far too long. And by ‘far too long’, I don’t mean the review’s timescales – the review has happened at pace. I’m referring to the years and decades for which some problems have existed in the real world because our Mental Health Act 1983 is, ultimately, just the Mental Health Act 1959 with some additions to safeguard rights.

    We, the police service, are policing alongside a highly-deinstitutionalised model of mental health care, rightly replete with demands and concerns about autonomy and human rights, using legislation drafted at a time when those demands and concerns were taken less seriously and when the role of the police was very different. Our model of mental health care is unrecognisable compared to that when the Act was created and our expectations of our police officers has evolved. I use that word advisedly, because evolution doesn’t imply design! Simon’s job in reconciling all of this is quite a thankless task, in a way – that’s just my opinion.

    But his focus on making a positive difference in the real world has remained and I’d close with this observation, which I make willingly: I’ve seen criticism on social media and in email exchanges of how he’s and the Review leadership have approached their duties here and having been in more meetings than I can count since the end of last year, I can honestly say I recognise none of it.

    I wish him the best of luck squaring his circles!

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