Mental Health Act White Paper – Dimensions’ key points and message

The Government is currently consulting on reform to the Mental Health Act. The consultation closes on 21 April.

Below, we outline key elements of our thinking in order to help people and organisations shape their own responses. This is a vital piece of legislation and we encourage everyone to contribute.

We will publish our full response in due course.

Our principles

• Community based support is the best model of support for people who have a learning disability and autism.
• Inpatient detention should only be used as a last resort and should be for as short a period as possible.
• The person and their loved ones should be able to access and understand their rights and should be meaningfully and regularly involved in all processes relating to inpatient detention.
• Where it is necessary to use inpatient settings, staff should be skilled and trained in supporting the specific needs of people who have a learning disability and policies should include reasonable adjustments to ensure people are treated fairly and equally.
• The system of mental health detention for people who have a learning disability and autism should have proper oversight, informed by people who have lived experience.

The Issues

• Inpatient detention is too often used to compensate for a lack of appropriate community based support. This includes a lack of preventative and early intervention services, a lack of appropriate housing, and barriers to transitioning care funding between different public authorities.
• Inappropriate use of mental health detention means people are being admitted to hospital without a realistic prospect that the underlying causes of their detention will be addressed or improved. Essentially, the problem is being treated with the wrong set of tools.
• People and their families are not well supported in understanding the processes that surround mental health detention and their rights within the system.
• Once admitted to inpatient care, too many people spend extended periods of time in inpatient settings, without adequate plans or processes to facilitate a move into appropriate community support.
• People’s loved ones are not listened to within the system and this can hinder the development of person centred plans to facilitate their discharge.
• Staff working in inpatient settings with people who have a learning disability and autism often lack the appropriate skills and training to properly support people. This can lead to a deterioration in the person’s wellbeing that makes it even less likely that they will be discharged from hospital care.
• There is an overreliance on chemical interventions to treat people who have a learning disability and autism in mental health settings, where they would be better supported through other interventions developed in community based settings.
• There criteria for detaining people who have a learning disability and autism under the Mental Health Act serve to medicalise approaches to supporting people. There is need for reform to ensure people are only detained when they have a underlying mental health need, but reforms must be accompanied by investment in services that meet people’s needs in the community.

The solutions

• The existing Care and Treatment Review should be carried out every six months for every person who has a learning disability and autism. This should be mandated through statute. Clear guidelines should be given for carrying out a CTR, with a mandatory role for someone who has lived experience and monitoring of progress against a person’s individual plan.
• Mandatory minimum levels of training should be introduced in mental health settings to ensure people who have a learning disability and autism receive care and support from people who can understand them and their specific needs.
• There should be a duty on health and care commissioners to work together to ensure availability of appropriate provision for people who have a learning disability and autism, to reduce the overall use of inpatient settings for people in crisis. This should include an expectation that commissioners work with the local provider market to identify appropriate services that can meet a person’s needs.
• An enhanced review process should be implemented for those who have a learning disability or autism who have been detained for treatment in inpatient settings for 1 year or more. People detained for assessment should also have an enhanced process for reviewing their support in the community.
• The legal framework should ensure that people who have a learning disability and autism are only admitted to inpatient settings when community based interventions are unavailable and they have an underlying mental health need.
• Family members, or other people close to the person and nominated by them, should have enhanced rights, to attend and participate in CTRs, receive relevant information and reports and to visit their loved one in inpatient care.