A major review commissioned by the government into mental health legislation has failed to recognise the important role played by nurses, a nursing chief has warned.
Catherine Gamble, professional lead for mental health at the Royal College of Nursing, said the recommendations made as a result of the inquiry were “less than radical”.
“The experience of people detained under mental health legislation would improve by extending the role of nurses”
Prime minister Theresa May announced in October 2017 that the Mental Health Act would be reformed due to concerns about rises in the number of people being sectioned and the disproportionate detention of those from black, Asian and minority ethnic (BAME) backgrounds.
An independent review was carried out and the findings were published today (see PDF attached below).
One of the key themes in the report is around the need for seriously mentally ill patients to have a greater say in their care and be given more chances to challenge treatment decision.
The report also calls for improvements to community mental health services to reduce the need for people to be held in hospital to keep themselves or others safe.
While the RCN was consulted as part of the review, Ms Gamble expressed concern that the views of members were not properly heard.
She said: “Nurses had hoped this report would empower clinicians and allied health professionals to act more autonomously, reduce barriers to patients receiving a seamless service and prove to nurses they’re a valued aspect of the system that cares for our most vulnerable and severely mentally ill. It’s difficult to see how this report will enable that.”
‘Disappointing’ lack of progress in community mental health
Ms Gamble said nurses were the largest and most diverse professional group in the mental health workforce and they should be “tapped into” to support, represent and advocate for BAME patients, whom the report noted were more likely to be admitted for treatment against their will.
She also said there was a need to address variation in teaching of the Mental Health Act for nurses in this field.
“The experience of people detained under mental health legislation would improve by extending the role of nurses, providing clear direction on the extent of nurses’ holding powers and addressing the varying quality of education mental health nurses receive on mental health legislation,” she added.
Ms Gamble added that it was “disappointing” that the report did not tackle safe staffing “head on”, noting that 14.3% of mental health nursing posts were vacant.
However, the report did highlight workforce shortages as a possible barrier to the reforms.
It said: “Many of the recommendations in this report depend heavily on the staff who work within our services. Their dedication, compassion and expertise play an essential part in the patient’s treatment and we know their working conditions are often very difficult.
”Services that are underfunded and overcrowded, with high turnover and vacancies adding to the challenges,” the report added.
The government has committed to delivering on two recommendations from the report as part of its new Mental Health Bill to modernise services.
The first is to enable those who are detained under the act to nominate a person of their choice to be involved in decisions about their care. Under the current system, patients have no say in the matter and their nearest relative is contacted.
”I am determined to make sure those suffering from mental health issues are treated with dignity and respect”
The second is to introduce law-binding “advance choice” documents in which patients can express their preferences for care and treatment that must be followed should they lose capacity.
A spokesman for the Department of Health and Social Care declined to comment on the criticism from the RCN but said the government would issue a formal response to the review’s recommendations in the new year before preparing the new legislation.
Ms May said: “The disparity in our mental health services is one of the burning injustices this country faces that we must put right.
“For decades it has somehow been accepted that if you have a mental illness, you will not receive the same access to treatment as if you have a physical ailment. Well, that is not acceptable.
“I commissioned this review because I am determined to make sure those suffering from mental health issues are treated with dignity and respect, with their liberty and autonomy respected,” Ms May said.
She added: “By bringing forward this historic legislation – the new Mental Health Bill – we can ensure people are in control of their care, and are receiving the right treatment and support they need.”