Implications of Mental Health Laws: The Mental Health Act, United Kingdom

This article is a part of the Mental Health Series under SDG -3 of the United Nations. Target 3.4 is “By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.” This article looks at the Mental Health Act and considers whether mental health laws achieve the aim of treating mental illness and promoting well-being.

The need for legislation

Until very recently, mental health disorders were swept under the rug and dealt with in secrecy. As a result, treatment facilities- many of which were torturous and inhumane- were run virtually unchecked. However, in jurisdictions across the world, growing mental health awareness has led to new legislation to protect patients. A prime example of this is the Mental Health Act (1983) in the UK, which illustrates the strides and shortcomings of modern mental health legislation.

The Mental Health Act 1983

In the UK specifically, The Mental Health Act is one such example of legislation meant to cover psychiatric treatment. The Act is split into numerous sections covering compulsory hospital admissions, consent under guardianship as well as how tribunals can review a patient’s admissibility for discharge.

At first glance, the Act seems to and indeed it is a crucial positive development in the law to acknowledge and provide legal protections that both safeguard patient’s rights and their treatment interests. But the law does not begin to unpack and address the complex issue of psychiatric treatments and falls short in a number of ways.

Getting admitted to a hospital

Section 2 of the Act deals with shorter admission periods- up to 28 days- which gives professionals the time to assess the patient, who is usually admitted for the first time without any prior known mental illnesses.

Section 3, on the other hand, is for persons pre-diagnosed with a mental illness and treatment is therefore a compulsory component to be discharged. To prevent this from becoming an indefinite detention, this is regularly reviewed by a mental health tribunal. But in practice, there are many issues that arise with this. Even if these tribunals regularly review decisions, it is often the case that the process involves little sympathy with the patient, under the assumption that they are fully incapable of taking part in the decisions affecting their personal health and wellbeing. Whilst this is clearly to ensure that the best decision is being taken, it significantly compromises a patient’s basic autonomy.

Dignity of treatment

The MHA works alongside a ‘Code of Practice,’ which outlines how patients ought to undergo treatments, as well as the procedures that ought to be followed to obtain patient consent insofar as it is possible to do so. Alongside these two legal aids, the courts must consider issues of the MHA in tandem with the Human Rights Act (1998).

The HRA for instance protects the right to freedom from inhumane or degrading treatment. But all too often, patients are pinned down and physically restrained against their will, with treatments conducted that they cannot physically or mentally consent to. This begs the question of how exactly the law will protect both the non-derogable right to freedom from degrading treatment whilst ensuring patients are treated?

Consent to treatment and hospital admission

One of the biggest ethical dilemmas of psychiatric treatment under the MHA is how consent is obtained from patients. Treatment facilities must grapple between the potential incapacities of patients to consent due to their warped mental state and their right as a free person to decide over what is being done to them.

The Act tries to provide for this alongside the Code of Practice by encouraging facilities to adopt numerous means of establishing consent. This could be oral, written or communicated by other means. Sometimes consent is also obtained from legal guardians. But these measures are clearly inadequate. Some people do not have legal guardians with their best interests in mind and there are limitations to obtaining patient consent if it is for their own well-being or that of others around them.

There are not any straightforward answers or solutions here, although reports done on the efficacy of the Act support the idea that staff should receive more training on how to handle patients in clinics with greater empathy and respect. After all, sometimes a person’s state of mind is not an accurate reflection of who they truly are, nor does it justify them losing their humanity and autonomy in the name of treatment.

Wider implications

The UK’s Mental Health Act is only one of many examples that illustrate the limitations of the law in governing the treatment process in psychiatric care to protect patients’ interests. There are however reforms being proposed to the MHA currently as well as bids for reform in other jurisdictions. It is undoubtedly a step in the right direction but where the law cannot fully provide measures that satisfy patient needs, it is up to institutions to recognise and implement practices which remind all involved that psychiatric patients are people and should be treated as any other; with dignity and respect.

By Nargis Babar