Attitudes to mental health and wellbeing are going through a major change. Alongside increased public awareness of mental health issues, there are also significant changes in the way that individuals are cared for.
The recent review of the 1983 Mental Health Act1, with recommendations from Professor Sir Simon Wessely, focuses on the reduction of restrictions and detention. It is estimated that implementation of the recommendations could mean that some 10,000 fewer people will be subject to detention, with a continued move of patients from hospital into the community.
Alongside this is a drive for reduction in restrictive practices. The Mental Health Units (Use of Force) Act2 (implementation date awaited) continues the focus on new national approaches and reduced levels of restraint. There is also a call for more patient autonomy, with reduced use of coercive treatment, more choice for patients, even if they are detained, and patients having a clear voice in these proposed changes.
There will be significant shifts in the mental healthcare landscape, towards a more collaborative approach to patient care, where possible. The recently published NHS Long Term Plan3 promotes technology-based approaches as part of the wider solution to the challenges faced by the sector. Mental health is now leading the way within healthcare, with its uptake of digital healthcare technology, in proactively diagnosing and treating the rising rates of mental illness, particularly when it comes to children and young people.
In support of this, a new cadre of education mental health practitioners4 will be trained to form relationships with schools and colleges, the police and local authorities, as well as Child and Adolescent Mental Health Services (CAMHS), young people and families.
However, there are challenging systemic, financial, legal and societal obstacles to achieving the laudable aims of providing accessible, effective care, with patient choice and autonomy at its heart.
In this report, DAC Beachcroft examines these challenges, alongside experts in mental health who call for better contracting and new models of funding and care to ensure proper integration between health and social services and housing and care providers so people receive appropriate and safe care for mind and body.
These challenges include addressing the fact that inpatient wards are increasingly becoming places for only the most severely ill, who are usually detained under the Mental Health Act. This results in precious little space to admit less acutely unwell patients on a voluntary basis. Whilst every detained patient has the right to access an independent mental health advocate (IMHA), our experts worry that cash-strapped local authority commissioners won't be able to continue to pay for them. They call for more money for local authorities so that patients can be treated in the community.