Decision-Making Behaviour under the Mental Health Act 1983 and Its Impact on Mental Health Tribunals: An English Perspective

Abstract

In England and Wales, the Mental Health Act 1983 (MHA 1983) provides the legal framework which governs decisions made concerning the care and treatment of those suffering from mental disorders, where they may pose a risk to themselves or others. The perspective of the patient and the care provider may conflict and can be a source of tension and challenge within mental health law. Through access to a mental health tribunal, patients are offered the apparatus to review and challenge their detention. With detention rates under the mental health legislation rising exponentially, this is having a knock-on effect upon tribunal application numbers. As there is a legal requirement to review all cases of individuals detained under the MHA 1983, understanding the key drivers for this increase in detention is essential in order to understand how to better manage both detention rates and the upsurge in tribunal caseloads. With the increase in overall activity, mental health tribunal workloads present significant practical challenges and has downstream cost implications.

Reasons behind the rising rate of involuntary admissions under the Mental Health Act (1983): Service use and cost impact

“…We found some evidence that reductions in mental health bed availability may explain some of the post-2008 increases in involuntary admissions and Place of Safety detentions. A plausible explanation is that the MHA is being increasingly relied upon to secure a hospital bed (Glover- Thomas, 2018). For example, the CQC report proposed (Care Quality Commission, 2018) that changes in mental health service provision and bed management may have reduced the occurrence of voluntary admissions.…”

A Structured Narrative Literature Review of Approved Mental Health Professional Detention Decisions: An Infusion of Morality

“…However, others cite the limited choice of alternatives to admission as deterministic (Haynes 1990;Quirk at al. 2003;Buckland 2016;Stone 2017;Glover-Thomas 2018). Quirk et al (2003) problematised a lack of time to organise alternatives, reinforced by Kinney (2009) citing pressure to resolve a situation quickly.…”

Patients’ and staff members’ experiences of restrictive practices in acute mental health in-patient settings: systematic review and thematic synthesis

“…5,6 The rise in detainment rates under mental health legislation has meant that a larger proportion of in-patients are receiving care against their will, rather than agreeing to their admission. 7,8 Under these circumstances, behaviours such as self-harm, suicide, violence and aggression can be common in acute psychiatric in-patient settings. 9 In the management of high-risk behaviours, clinical guidelines recommend that staff employ a non-coercive method to de-escalate a situation.…”