‘Waiting for the verdict’: the experience of being assessed under the Mental Health Act

Abstract

BackgroundFollowing the Independent Mental Health Act review, there is increasing focus on this coercive part of mental health services and a call for service user views to be central to proposed changes.Although there are numerous studies into being detained in hospital, there is a lack of data exploring the service user experiences of the assessment process. AimTo explore the subjective experience of being assessed under the Mental Health Act (MHA). Method 10 participants were interviewed about their recent assessment experience and the transcribed interviews were analysed using framework approach. ResultsThe overarching theme of person centred care emerged from these interviews with interconnecting sub themes: 1) information and options; 2) "the barrage of three"; 3) "sit down and listen"; and 4) service user voice. ConclusionAs one of the first studies into service user experiences of MHA assessments, this exploratory study indicates that there is lack of person centeredness. The Independent Mental Health Act review has set a challenge for treating person as individual and increasing rights and involvement of service users. This study suggests service user's experiences do not yet meet this aspiration and they want to discuss these experiences and have their voices heard.

A qualitative meta-synthesis of service users’ and carers’ experiences of assessment and involuntary hospital admissions under mental health legislations: a five-year update

“…Involuntary assessments and admissions were reported (35, 36, 37, 38, 39, 40, 41, 42) to be met on occasions with acceptance where this involved accessing support and a safe environment. At the same time, the impact of detention (32, 33, 35, 36, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53), or more specifically the impact of coercive treatment was presented (34, 37, 41, 42, 44, 48, 50) as a typically negative, traumatic experience for many. Feelings following discharge appeared to be mixed, with reported difficulties with coping in the community and managing mental health post-discharge (33, 37, 39, 41, 47, 48, 49, 51).…”

“…The balance between coercion, consent and choice was varied, with many accounts (32, 33, 34, 36, 37, 39, 40, 41, 42, 43, 44, 45, 48, 49, 50, 54) reporting service users being offered little choice or opportunity to meaningfully consent, with fewer reports of collaborative care. Healthcare staff providing information and explaining legal processes, being given better access to advocacy and other forms of representation, where available, enabled service users to exercise their rights and navigate complex legal processes according to some of the primary studies (36, 39, 41, 44, 49, 52).…”

“…Several papers also reported that information on what’s happening (32, 36, 39, 40, 42, 43, 44, 45, 47, 50, 51) and involvement in treatment decisions (32, 33, 34, 35, 36, 39, 41, 42, 43, 45, 49, 50) were important aspects of service users’ admission experiences. Others suggested (33, 34, 36, 39, 40, 41, 42, 45, 49, 50) the importance of the way medication was discussed, explained and administered.…”

“…Positive and negative experiences were both present in reports containing reflections on the relationship with police and emergency department staff (32, 34, 35, 36, 44, 48, 51, 53), and inpatient staff (33, 34, 35, 36, 39, 42, 43, 44, 45, 48, 50, 52, 54). Approachable, caring, skilled communication was seen as valued in some reports, whilst experiencing inadequate, forceful, bullying behaviour from professionals was also often described.…”

“…'Cause it gave a lot of discussion time, and a lot of facts. And rather than just sort of sugar-coating stuff and dumbing it down, they were happy to answer questions and air anything you wanted to discuss, so that was empowering' (49) 2 Impact on self-worth In the sub-theme Power, several studies (32,33,36,40,42,43,44,47,48,49,50,52) reported on how admission affected people's ability to have an influence on their progress and treatment, and the common feeling of disempowerment due to depending on staff to access basic necessities on a day to day basis, and ward routines. It was reported (33,34,37,39,41,42,44,45,50,51,52,53) that involuntary assessment and admission often led to feeling dehumanised: 'It's just one big black hole that assessment room they keep you in, nothing, no information as to what is going to happen, by when and who is doing it.…”