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Professor Kam Bhui, Departments of Psychiatry and Primary Care Health Sciences, University of Oxford, comments on a recent POSTnote briefing (based on literature reviews and interviews) from the UK parliament. The Parliamentary Office of Science and Technology has summarised the evidence - Mental Health Act Reform - Race and Ethnic Inequalities - to inform debate and offer a series of resources to support legal scrutiny and apprise parliamentarians.

Psychiatrist hands together holding palm of her patient.

Professor Bhui explains:

As parliament prepares to scrutinise the Act and future recommendations for reform, clinicians and patient groups well know that changing legislation alone is not enough to reform community care for people with mental illness. We need more capacity, resources, and more flexible and multifaceted care models that offer more choice and consistent standards across the country. Parliamentarians will need to make sense of a complex evidence base, which even clinicians, researchers, policy makers and the public continue to debate.

The Independent Review of the Mental Health Act took place in 2018, and finally made the Queen's speech this year (2022), so I anticipate a period of scrutiny in parliament as new legislation is drawn up. The Review made a number of recommendations to improve the experience of those being detained in hospital for mental health care, and their right to appeal and challenge the detention decision.

The language used in the Act was perceived to be out of date, and not reflecting the support and recovery orientating intentions of the Act. We know that detentions have been increasing year on year, especially since 2007, when the Act was amended, and also during the period of austerity.

There are ethnic inequalities in the use of the Act with some black and minority ethnic groups receiving care more often through detention under the Act, through contact with the police, and following contact with the Criminal Justice System. Some recommendations from the Review specifically sought to reduce these excess detentions by ethnic group, for which there are no consistent or strongly evidenced explanations. Indeed, previous research that informed the Review shows many explanations that are frequently proffered have no substantive evidence to support them.

Clinicians, patient groups, carers, and other stakeholders, such as the police, social workers, and policy makers, will all be on standby anticipating what a new era of mental health care might look like and whether the legislation can drive reform in health and social care systems to benefit the most marginalised in society.

The CHiMES Collaborative (Creativity, Health Improvement, Multimorbidity, Ethnicity, Service Users Research), which promotes and protects mental health through investigation and research, is run by the Cultural Psychiatry and Health Inequalities Research Group. We are leading a project called Co-Pact (Experience based investigation and Co-design of approaches to Prevent and reduce Mental Health Act Use), where we investigate patient experiences of the Mental Health Act. This is one of four research projects funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme. Co-Pact will report over the next 1-3 years.

The project seeks to gather patient, carer, and stakeholder experiences using photovoice (a qualitative method used in community based participatory research) to inform the co-design of new solutions informed by recovery orientated values and by prioritising patient and carer views. Stakeholders will have opportunities to participate in the research, however, we urge everyone to also be generous and support the 'careful scrutiny legislation' as it passes through parliament.

Read the full POST - Mental Health Act Reform - Race and Ethnic Inequalities.

For more information about the The CHiMES Collaborative.