The 1983 Mental Health Act sets out a legal framework for the compulsory detention and treatment of the mentally ill. In a speech to the Royal College of Psychiatrists, Lady Hale mentioned the following statistic from an independent review of the Mental Health Act that was set up by the government. ‘Over the last 10 years, detentions in England have risen by 47% – from 43,000 in 2005/6 to 63,500 in 2015/16.’
Lady Hale stated that the evidence suggests more individuals are being detained, rather than the same people being detained more frequently. There are many possible factors that can be attributed to this rise in detentions. It could be due a lack of mental health awareness and help within the community, or perhaps as Lady Hale suggests there is ‘culture of blame, shame and fear’ that judges themselves have contributed to.
‘Risk-averse’ doctors need also be considered as a cause of the increase in detentions. Here ‘risk-averse’ means a fear of repercussions and possible liability. This would lead doctors to be more likely to keep patients under section; and with the rise of detentions this ‘risk-averse’ mind-set would lead to a larger total of patients detained under the Act. The more patients detained, the more patients each Responsible Clinician would have discharge powers over; could this lead to a deteriorated quality of care?
Under the Mental Health Act Doctors have to review if a patient has met the criteria to be detained under section. The criteria is if the patient has a mental disorder which makes it appropriate for them to be detained in hospital receiving treatment, and if it is necessary for their health and safety or for the safety of others that they receive said treatment. Once analysed the reason doctors tend to become ‘risk-averse’ could be due to the pressures and responsibilities created in the Mental Health Act. When the Act was first drafted the media as it is today and the pressure that it adds on top of the responsibilities stated in the Act, could not have been predicted.
An example of such media induced pressure is the case of Rabone v Pennine Care NHS foundation trust [2012]. In this case a woman who voluntarily admitted herself into hospital was released for home leave. While on home leave she committed suicide; and the hospital was found liable. This case and the media coverage adds to the pressures and responsibilities that the Mental Health Act already places on doctors. It is no surprise that doctors often tend to be ‘risk-averse’.