The introduction of the Coronavirus Bill has dealt a significant blow to the essential freedoms and rights of citizens within the UK.
Many civil liberties have been dialled back and restrictions placed on the most fundamental parts of daily life. A seriously concerning element of this, are the changes that have been made to the Mental Health Act 1983.
The government has stated that these temporary measures have been made over fears that there will be fewer mental health practitioners available due to COVID-19. The government says this move will help with ‘easing the burden on frontline staff’.
However, mental health charities across the UK have said that these changes pose a serious threat to the rights of individuals with mental disorders. They have subsequently warned against this ‘suspension of safeguards’.
Prior to the changes, to be detained, three people needed to agree that the detainment was necessary. These three people would be made up of two doctors, and a further Approved Mental Health Professional (AMHP). Now, only a single doctor is required.
Additionally, under Section 35 and 36 of the Act, if an individual commits a crime, and their mental health is determined as having contributed to it, the court can send them for a mental health assessment in hospital. This assessment was limited to 28 days, with the possibility for an extension by the court of up to 12 weeks. The new legislation means there is no limit on the extended time an individual can be held for.
Further to this, according to the original legislation, if an individual has a mental disorder, and police believe they are a threat to either themselves or others, under sections 135 and 136 they have the right to detain that individual. This could be at their home, a hospital or a police station.
Individuals could then be held for up to 24 hours, with a possible extension of 12 hours. Any more than this, and a full Mental Health Act assessment had to be conducted. The new rules mean that an individual can initially be held for up to 36 hours, which can be extended by a further 12 hours.
On top of this, the legislation permits the complete removal of time limits on detention, meaning that individuals may be released into the community before they are ready. More worryingly, after individuals have been discharged, there will be significant delays to assessments checking if the patient requires more care. While local authorities now have the right to scale back care supplied to vulnerable people in their homes.
Under the new legislation clinicians also have the right to forcibly extend a patient’s medical treatment, without their consent, and without an SOAD (Second Opinion Appointed Doctors).
Many of the legislative changes seriously undermine the human rights of those with mental disorders. Specifically, they endanger both, Article 5 of the Human Rights Act (Right to Liberty) and Article 8 (Right to a Private and Family Life).
Even prior to the COVID-19 crisis, The Independent Mental Health Act Review had stressed the importance of SOADs. Further to this, it recommended that more safeguards should be put in place to make it more difficult for clinicians to forcibly administer medication to patients when consent had not been given. Entirely removing the current safeguards means that patients are at high risk of having their right to liberty eroded.
Another significant concern raised by the National Survivor Network (NSUN), is that the role of AMHPs in the legislation must be clarified. As it stands, the legislation seems to infer that their role has been extended. However, this is without increasing their numbers or capacity. As such, NSUN has said if there are no AMHPs available, the entire ability to detain is called into question in terms of legality.
A spokesperson for Campaign to Save Mental Health Services in Norfolk and Suffolk has also noted that there is a risk of: “Cramming people into already overcrowded mental health wards”.
Moreover, MP Jon Ashworth raised an important point about the implications of requiring only one doctor to sign off on detainment. Speaking in Parliament he said: “There will be no requirement for anyone involved to have prior involvement with the patient. Our medical professionals are going to be under huge pressure over the coming months and mistakes may well be made”.This is exactly why Akiko Hart, Chief of National Survivor User Network (NSUN), has called the extension of powers and removal of safeguards a: “Step in the wrong direction”.
Then, there is the issue of neglect. The legislation removes further safeguards, by permitting the release of patients without ensuring sufficient support is available to them outside in the community.
After years of austerity and budget cuts from the Conservative Party, mental health services in the UK have been significantly cut back. Mental health trusts in England have suffered budget cuts of 8% year on year since 2011. And back in 2019, before COVID-19, Pat Heron of the National Women’s Committee said: “Mental health services are broken and heading for crisis”.
Many are understandably concerned about what this means for mental health services in the current crisis. And, with the potential removal of NHS Continuing Healthcare Assessments, many perceive the new legislation as completely abandoning those who are most vulnerable.
These legislative changes have the potential to hugely impact the lives of those with mental disorders. So, the fact that they have been rushed through Parliament without sufficient scrutiny is deeply concerning.
The bill builds on an Act that is already deeply flawed. The MHA was already under review when the new changes were proposed. And, as recently as February 2020, the Care Quality Commission stressed the need for mental health services to have more respect for the rights of those detained under the MHA.
Speaking about this, Vicki Nash, Head of Policy and Campaigns at Mind said: “This announcement also comes at a time when a long-overdue White Paper was expected to address pre-existing injustices in the way people are sectioned and treated in hospital. At the earliest possible opportunity the Government must act to change mental health laws to strengthen people’s rights in the long-term”.
While Dawn Collins, Deputy Chief Nurse at the Norfolk and Suffolk NHS Foundation Trust (NSFT) has said that the changes were ‘not unexpected,’ it is vital that these measures are regularly monitored, scrutinised, and scaled back. Ultimately citizen’s fundamental human rights should not be jeopardised and violated due to a ‘lack of resources’.