Research from ScHARR into compulsory psychiatric inpatient admission in England

Weich et al

Prof Scott Weich of the Mental Health Research Unit in ScHARR has led a team of researchers looking at the issue of compulsory psychiatric inpatient admission in England and the results were recently published in The Lancet Psychiatry. For World Mental Health Day 2017, we asked him a few questions about the research and its implications.

What are the main findings of your research?

The research looked at the variation of rates in compulsory psychiatric inpatient admission in England. It was motivated by the well-documented finding that every year, more and more people are subject to the Mental Health Act - the number of people being detained under the Mental Health Act is up by 47% in under 10 years and currently stands at around 60,000 people per year. Added to this is the finding that people from black and ethnic minority communities are 3-4 times more likely to be detained than people from other communities. Our research documented the extent of the use of the Mental Health Act and also the variation between people, places and services.

The United Nations Convention on the Rights of Persons with Disability has expressed concern that the Mental Health Act in England may discriminate against people with mental illness in this country. That is because of the question about “mental capacity” and the continuing difference in conditions that apply to the treatment of physical illness compared to mental illness. In some circumstances it is possible to be forced to have treatment for a mental health problem even though you are capable of deciding against this. The same does not apply to physical conditions, which you can almost always refuse.

One consequence of this is that there may be fear among people with mental illness that if they come forward, they may be forced to have a treatment they don’t want. People from a black and ethnic minority community are more likely to be admitted to hospital against their wishes for mental health problems. We want to reduce unnecessary compulsion, for all members of the community, and this research may help us identify things that can be changed to achieve this.

This research highlights the difficulties that people with mental health problems often have in getting the help they need, when they need it, and the importance of continuing to find ways to address this. This research has contributed to the government's decision to review the Mental Health Act, which is another step towards protecting the human rights of people with mental health problems.


Why is this an important topic to investigate?

Because so many people are being subjected to the Mental Health Act. People are naturally fearful of being compulsorily detained. Over the past 15-20 years, mental health services have become more patient-centred. They are more readily available in people’s home and in the community, and shaped by patient choice. Fewer people are admitted to hospital every year. So it is paradoxical and worrying that when we think we are being more patient-centred, we are also detaining more people than ever. It feels counter-intuitive as well as wrong. It probably contributes to the stigma that people with mental health problems face, that they are perceived as a risk to themselves or others, and in some way dangerous. This doesn’t help therapeutic relationships or self-esteem.

What else are you doing related to this research?

We are currently researching the uses and outcomes of Community Treatment Orders, which were introduced when the Mental Health Act was last amended, in 2007. We are also trying to develop interventions to reduce compulsory admissions and use of the Mental Health Act in general.

On this World Mental Health Day, can you say something about how research can help to improve people’s mental health?

Through working out which approaches to mental health problems work best, and for whom, we can provide people with access to appropriate help - the kind you want, when you want it. And research into these areas can really help us to understand more about the nature of mental health problems, which helps to reduce the stigma which so many people still experience.

The British government has in the last week announced an independent review of the Mental Health Act, so this will be an opportunity to think more about how some of the powers to treat people against their will are used. But in a way, when researching compulsory psychiatric admission, we are looking too far downstream - the real problem is that services are too hard to access. People are ending up being much more ill than they need to be. We should be lobbying for better services and better access to those services.

Prof Weich and colleagues’ research can be found here.
He will be appearing in a Maudsley debate about this topic on November 22nd 2017. 
For more information about the review of the Mental Health act, see here.