Mental Health Act Review

On Wednesday 16 November 2022, the RCN gave oral evidence to the Joint Committee on the Draft Mental Health Bill in England and Wales after submitting written evidence. The Joint Committee is made up of MPs and members of the House of Lords, and has held several oral evidence sessions from stakeholders, including from the criminal justice system, NHS leaders, people with lived experience of being detained under the Mental Health Act, and Royal Colleges.

Panellists’ during the evidence session

• Carol Webley-Brown, Council Member, Royal College of Nursing
• Robert Lewis, Vice-Chair, Approved Mental Health Professional (AMHP) Leads Network
• Dr Gareth Owen, Special Adviser to the Royal College of Psychiatrists on Mental Health and Mental Capacity Law, Royal College of Psychiatrists
• Dr Ruth Allen, CEO, British Association of Social Workers.

A transcript of the session has now been published. You can also rewatch the session online.

We spoke candidly about the challenges nurses are facing within these services, including under staffing, burnout, worries about patient outcomes, and the continued racial inequalities resulting from the existing Mental Health Act. We told the Joint Committee about how many mental health nurses feel undervalued in their roles and the importance of nursing leadership:

“When nurses work very hard and get up to consultant level, they are not valued enough to do what they need to do for their patients, by which I mean that if we are prescribing nurses we still need a doctor to sign off things. It is not that we do not like our colleagues—I love them very much—but we need to be seen in our own right as professionals and to be valued. We can make a definite difference in the workplace and community.”

While speaking about the racial inequalities in mental health services, we made clear to the Joint Committee that unless there is an anti-racism approach taken throughout any legislative changes to the Mental Health Act, these inequalities will continue.

“Who is more detained than others is very visible without collecting the data. Unless you have anti-racism threading through the whole of the legislation, we will not solve the problem. A lot of the structures and systems mean that it leans heavily on that racialised group. Until you unpick the things that seem to weigh heavily on those individuals, it will not change. More choice, greater use of the community and people who serve and deliver the services looking as they do will make a difference, because if you come from the same or similar background you have a better understanding.”

As the main professional group implementing and delivering care under the Mental Health Act (MHA), alongside patients and service users’, it is vital that the voice of nursing staff is heard throughout the development of these reforms. 

The published consultation questions cover a wide scope of the proposed reforms set out in the department of Health & Social Care’s (DHSC) the Reforming Mental Health Act white paper. Feedback from members suggested that the RCN should provide a more concise summary of key areas most pertinent to the nursing workforce. The Royal College of Nursing (RCN) reviewed the 36 consultation questions, consolidating and organising key questions into eight themes. 

This response has been developed in collaboration with a wide range of RCN members and staff. We have received contributions from multiple sources including the RCN Mental Health Forum, Learning Disability Nursing Forum, policy-makers, clinical nurses (NHS and independent sector), academic nurses (individuals and groups), as well as people with lived-experience of mental illness. 

Read our full response here: Reforming the Mental Health Act

This response was formed alongside our submission of written evidence to the Joint Committee of Human Rights.

Catherine Gamble, the RCN's Professional Lead for Mental Health from 2017-2020, represented mental health nurses (MHN) on the review. The role was deputised by RCN member Alison Blofield, nurse consultant and approved clinician.

The RCN response to the interim report published in May 2018 was informed by:

• expert MHN RCN forum members working in acute care, community, court and liaison services
• those with experience of being held on sections of the current Mental Health Act
• nurse consultants, working as Approved Clinician/Responsible Clinician (AC/RC)
• consultation with the College of Policing, Chief Inspector Michael Brown. 

Read the full response here: Response to the publication of the report of the Independent Review of the Mental Health Act