There is a growing consensus that mental health legislation across the Western world represents crude human-rights violations, as well as acting as an engine room for the often-damaging biomedical approach to human suffering. In the autumn of 2017, the United Kingdom government initiated an ‘Independent Review of the Mental Health Act (1983) that aims to publish its priority recommendations by autumn 2018. In light of this development, how optimistic should we be that the urgently-required radical revision of the discriminatory Mental Health Act (MHA) is imminent?
Taken at face value, the comments of the Prime Minister, Theresa May, in the run up to the review were encouraging. Appropriately, she referred to the ‘burning injustices’ associated with a ‘discriminatory use of a law passed more than three decades ago’, and pledged to ‘rip up the 1983 act’ and replace it with ‘a new law which finally confronts the discrimination and unnecessary detention’ (Savage, 2017). The Queen’s Speech following the Conservative Party’s election victory in June 2017 retained the commitment to ‘reform mental health legislation’. So maybe we are on the cusp of meaningful – perhaps even ground-breaking – change to mental health legislation?
The review is chaired by Professor Simon Wessely – a psychiatrist and former president of the Royal College of Psychiatry – and, predictably, his intention seems to be to steer the range of stakeholders away from anything that might disturb the status quo. In a blog about the review for The Huffington Post, he regurgitates the language of biomedical psychiatry – ‘serious mental illness’, ‘very unwell’ – thereby showing no recognition of the desirability of capacity-based laws (applicable to all and requiring no explicit reference to the dubious construct of ‘mental disorder’) as an alternative to the existing discriminatory legislation. In the same blogpost, Wessely also suggests that changing the legislation may be less important than changing ‘the way we deliver care’ – an ominous sign that he sees the MHA as broadly fit for purpose in its present form.
Reading the terms of reference strengthens my scepticism. In describing the purpose of the review it states: ‘Some of the solutions are likely to lie in practice rather than the legislation itself. The review should consider practice-based solutions wherever possible.’ Clearly, despite the explicit human-rights violations within it, there is an assumption from the outset that the MHA per se requires little revision; instead, the review group should focus on how psychiatric professionals oversee its implementation.
So I await the review’s report later this year (autumn 2018). For those who recognise the fundamental flaws inherent to existing mental health laws, now might be an appropriate time to canvass politicians about the need for radical revision – I’m currently engaged in correspondence with my local Member of Parliament urging him to use his influence to try to shape the review. However, in light of the above, it is difficult not to anticipate that subsequent recommendations will be cosmetic, failing to address the cornerstones of the prejudicial detention process. I hope I am proved wrong.
Photo courtesy of winnond at FreeDigitalPhotos.net