Bipolar UK's response to the Mental Health Act reform
- Posted: 15 November 2024
In July 2024, the King’s speech included a commitment to legislate to modernise the Mental Health Act. On 6 November, the government announced details of the proposed changes, promising to give patients sectioned under the Mental Health Act more dignity and say over their care.
To help ensure the voices of people with bipolar are heard as this Bill goes through parliament, Bipolar UK surveyed its community to understand how the proposed reforms will impact people who live with the condition.
This week, Bipolar UK sent the briefing below to every MP outlining the key findings of the survey and our recommendations. It is crucial that the upcoming changes to the Mental Health Act are aligned with the needs of the bipolar community.
The impact of bipolar
Bipolar affects 2% of the UK population - more than one million people. However, the current care system fails to meet their needs, leading to long delays in diagnosis, inadequate care, high rates of relapse, co-morbidities and high suicide rates.
Survey findings
Sectioning
Being sectioned under the Mental Health Act remains a deeply traumatic experience for many people in our community. 40% of survey respondents have been detained under the MHA. Of these, a significant proportion (40%) felt that the reasons for their sectioning were not made clear to them, with 21% believing that their sectioning was unjustified. Many described the lack of communication around the decision, with one respondent noting, “The explanation of why I was sectioned was never given, but just assumed.” This lack of clarity can compound the trauma of being sectioned and erode trust in the mental health system.
Community Treatment Orders (CTOs)
The use of Community Treatment Orders (CTOs) also presents challenges for many people living with bipolar. Whilst CTOs are intended to support individuals in the community, 31% reported that the conditions of their CTO were not clearly explained to them, leading to confusion and a sense of disempowerment. One respondent described the stigma associated with CTOs, saying, “It creates a kind of class system in the mental health community.”
Nearest Relative
The current Nearest Relative system was another area of concern for many survey respondents. Under the existing MHA framework, the Nearest Relative is automatically assigned based on a hierarchical system, which can sometimes lead to inappropriate choices. Our survey found that 75% expressed a strong desire to choose their own Nominated Person to represent their interests during treatment. Allowing individuals to select a trusted person—who may not be their nearest relative—would lead to better decision-making and more effective support during care.
Care and Treatment plans
Personalised Care and Treatment Plans are crucial for effective management of bipolar, yet many people with the condition are not receiving this essential support. According to the survey, 51% of respondents either never had or do not currently have a Care and Treatment Plan, while 61% expressed a desire to have one. A personalised plan, co-created with healthcare professionals, can help individuals manage their condition more effectively, yet many feel left out of the process. One respondent shared, “My input hasn’t been considered at all—I feel strongly that my feelings don’t count.”
Advance Choice Documents
Advance Choice Documents (ACDs) offer individuals the opportunity to make their preferences known for future treatment, yet awareness of ACDs remains low. Our survey found that 54% of respondents had not heard of ACDs, and of those who were aware of them, only 27% had written one. However, there is a clear desire for greater use of ACDs, with 56% of those who hadn’t written one expressing an interest in doing so. ACDs provide reassurance to individuals that their wishes will be respected if they become too unwell to communicate them directly.
Racial Inequality
Racial inequalities in mental health care urgently need to be addressed as part of the MHA reforms. Our survey revealed that 33% of respondents from minority ethnic backgrounds experienced racial discrimination while receiving mental health care, and 50% felt that services were not culturally appropriate. One person wrote that iImposing a one-size-fits-all model onto people of all ethnicities refuses to take differences into account […] and when we get frustrated, we are often dismissed with the stereotypical ‘angry minority’ trope which is unfair.”
Conclusion
We support the current Bill's provision to shift to a Nominated Person system to give individuals control over their representation and the call for culturally appropriate services. However, we believe the Bill could be strengthened by asking for enhanced communication standards for sectioning and Community Treatment Orders, and endorsing the creation and clinician adherence to Advance Choice Documents.
In line with the Bipolar Commission’s recommendations, we also strongly urge that the diagnosis of everyone who is admitted to a psychiatric unit or sectioned is recorded and published as standard. The Bill will only be effective in reducing the number of hospitalisations, repeat admissions and sections if people with bipolar get earlier diagnosis and have ongoing access to a specialist bipolar pathway.
How you can help
- Promote adherence to enhanced communication standards for sectioning and Community Treatment Orders, as per the Bill’s guidelines.
- Recommend that Care and Treatment Plans are offered to everyone with a diagnosis of bipolar, regardless of their detention status, to provide early intervention and ongoing management, reducing the risk of crises and hospitalisation.
- Advocate for the proactive creation of Advance Choice Documents for all individuals diagnosed with bipolar, with guidance and support from healthcare professionals, even when they are not currently detained.
- Advocate for clinician adherence to Advance Choice Documents by urging the statutory obligation to respect patient choices wherever feasible.
- Endorse the shift to a Nominated Person system to give individuals control over their representation.
- Call for culturally appropriate mental health services to address racial disparities and enhance mental health outcomes.
- Highlight the need for clinician training specific to bipolar disorder to ensure appropriate care during both inpatient and outpatient treatment.
- Encourage the Secretary of State for Health to review specialist care provisions to ensure treatment parity for bipolar.
- Encourage proactive, preventative care strategies that provide early intervention and community-based support to reduce the need for sectioning.
