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The Mental Health Act Commission ORIGINAL PAPERS The Mental Health Act Commission Christopher Curran and William Bingley The aim of this article is to promote a clearer under for Health to establish the Mental Health Act standing of the Mental Health Commission's develop Commission. The Commission was established ment, structure and function. Over recent years, mental on 1 September 1983 under the Mental Health health professionals and patients have become more Act Commission (Establishment and Consti aware of the organisation and its work, although some tution) Order (S.I. 1983 No. 892), and started may remain uncertain about its function and how it work on 30 September 1983. fits into the overall care of detained patients. The Commission's fundamental job is to safeguard the well- being and interests of patients detained under the Act. Present structure and composition of Its remit does not extend to informal patients. Unless the Commission otherwise indicated, all statutory references are to the 1983 Mental Health Act. The Commission is governed by the Mental Health Act Commission Regulations (S.I. 1983 No. 894). It is a special health authority within the National Health Service (Fig. 1) and com Historical perspective prises approximately 90 part-time Commission From the 18th century, special bodies have ex ers. They are appointed by the Secretary of isted to monitor the use of statutory powers and State for Health for England and the Secretary of ensure that mentally disordered people receive State for Wales, usually for four years. Commis appropriate care. Early forerunners of the Mental sioners are drawn from a multi-professional Health Act Commission were the Commissioners background, and they include lawyers, doctors, in Lunacy, established in 1774 under the Act for nurses, social workers, psychologists, academ Regulating Private Madhouses. Under the Mental ics, other specialists and lay persons. There is a Deficiency Act (1913), the Commissioners for chairman, vice-chairman, and chief executive. Lunacy were reconstituted as the Board of Con Commissioners tend to offer their services two trol and were further reorganised under the Men days a week, working within a specified geo tal Treatment Act of 1930. The Board of Control graphical area. All have a special knowledge and was dissolved in 1960 with the implementation interest in mental health issues. What may not of the 1959 Mental Health Act. Its statutory be realised is that Commissioners not only con duties were distributed among a number of new tribute on a part-time basis, but live and work all organisations, e.g. the Mental Health Review over England and Wales. For a relatively small Tribunals were given the power to discharge organisation, the Commission undertakes a detained patients. Some patients continue to complex range of tasks. Annually the Commis think that Commissioners have the power to sion visits 673 hospitals, mental nursing homes discharge them. Between 1959 and 1983 there and social service departments. Between 1991- was no equivalent to the current Commission. 1993 the Commission handled 1,220 complaints Two principal factors influenced its re-creation. and responded to 8,885 requests for second First, a number of inquiries into abuses and poor medical (S.58) and other opinions (S.57). conditions in psychiatric hospitals in the 1970s and 1980s (Martin, 1984) and second, concerns Centralisation of the Commission about the treatment of detained patients without In 1990 the Mental Health Act Commission ap consent (Fennell, 1986). pointed its first chief executive and centralised its administration in Nottingham. This has en abled the commission to fulfil its statutory duties The Mental Health Act Commission more effectively and to make an improved contri for England and Wales (the bution at the level of general policy making. Commission) Section 121 of the Mental Health Act (1983), and Central Policy Committee (CPC) section 11 of the National Health Service Act The Commission is governed by the Central (1977), imposed a duty on the Secretary of State Policy Committee whose 12 members are 328 Psychiatric Bulletin (1994), 18, 328-332 ORIGINAL PAPERS Secretary of State for Health Department of Health NHS Management Executive Regional health authorities (RHAs) Mental Health Act Commission Regional secure Family health units service authorities (RSUs) (FHSAs) Directly managed GPs units (DMUs) Community health councils (outside the managerial structure) Fig. 1. The Mental Health Act Commission in relation to the National Health Service appointed by the Secretary of State for Health. patients are protected, the Commission also The CPC has overall responsibility for the ac comments on the services that detained patients tivities and financial administration of the receive (Table 1). Consequently the Commission Commission. within the context of its statutory duties at tempts to influence both current mental health Commission visiting teams (CVT) and Special service delivery and future policy development. It hospital panels (SHP) has recently commenced the issuing of practice notes which offer advice on issues of good The Commission is organised into seven com practice under the Mental Health Act (1983). The mission visiting teams, comprising a number of first of these relate to: commissioners who are responsible for all visits and responses to complaints in a specific geo (i) the administration of clozapine and other graphical area. Commissioners are also mem treatments requiring blood tests bers of one of three SHPs. Each SHP undertakes the commission's responsibilities in one of the (ii) nurses, and the administration of medicine for mental disorder three special hospitals. Each team is led by an (iii) section 5(2) of the Act and transfers. experienced commissioner (Fig. 2). National standing committees (NSC) Complaints There are nine national standing committees, A major function of the Commission is to in dealing with specific policy and practice areas vestigate complaints. Each complaint is dealt with by experienced Commissioners. Section 120 (Fig. 2). Commissioners may also be a member of (1)(b) imposes a duty "to investigate": at least one NSC. (i) "any complaint made by a person in respect Mental health policy and practice of a matter that occurred while he was de Whereas the primary focus of the Commission's tained under this Act in a hospital. .and work is to ensure that the rights of detained which he considers has not been satisfactorily The Mental Health Act commission 329 ORIGINAL PAPERS Chairman & Vice-Chairman Central Policy Committee (CPC) National Standing Committees Special Hospitals Panels Commission Visiting Team (NSC) (SHP) (CVT) Code of Practice Broadmoor (SHP B) CVTS 1 to 7: each Community care Rampton (SHP R) covering a geographical Complaints Ashworth (SHP A) area of England & Wales Consent to treatment Learning disabilities Legal and Parliamentary Mentally disordered offenders Race and culture Research and information Fig. 2. The Mental Health Act Commission internal structure dealt with by the managers of that hospital or would not be right to accept this recommen mental nursing home"; and dation. The Commission feels that its existing (ii) "any other complaint as to the exercise of complaints jurisdiction should be enhanced. As the powers or the discharge of the duties con hospitals, mental nursing homes and social ser ferred or imposed by this Act in respect of a vices authorities continue to improve their own person who is or has been so detained." response to complaints, the number filtering through to the Commission should gradually If a Member of Parliament requests the Com reduce. mission to investigate a complaint within their remit, it has a duty [S 120(3)1to report directly back to him or her. Patients have recourse to Visiting the Health Service Commissioner if they are not Section 120 (l)(a) of the Act imposes a duty on satisfied with the way their complaint has been the Commission to ". visit and interview in handled. private patients detained under this Act in hos In the light of the Report of the Committee of pitals and mental nursing homes". The Commis Inquiry into Complaints about Ashworth Hos sion visits all psychiatric hospitals and mental pital (1992), some may question whether the nursing homes providing care for detained Commission has been as effective as it might patients at least once a year. Special hospitals have been. The Commission acknowledges are visited every two months and regional secure this view and the report's recommendation that units every six months. Despite the fact that at the Commission withdraws from investigating any one time approximately 5% of psychiatric complaints. It has concluded, however, that it in-patients are detained, most are likely not to Table 1. The Commission's statutory and other duties The Commission's statutory and other duties are to: 1. keep under review the operation of the Act in respect of detained patients 2. visit and interview detained patients, in private 3. investigate complaints which fall within the Commissions'sremit 4. review decisions to withold the mail of special hospital patients 5. appoint second opinion doctors and other personsfor the purposes of Part IV of the Act 6. publish a biennial report 7. monitor the implementation of the Code of Practice and advise Ministerson amendments 8. offer advice to Ministerson matters falling within the Commission's remit. 330 Curran & Bingley ORIGINAL PAPERS have a chance to raise their potential concerns (ii) other persons, who are lay persons and with Commissioners. This is because their aver experienced health professionals (not doctors), age stay is thought to be approximately 21 days in relation to certifying a patient's consent and is unlikely to coincide with a Commission to treatment under S57(2)(a)(b)(3) regarding visit. Perhaps less than 20% of such patients psychosurgery and hormone treatment. have therefore been seen by a Commissioner. There were 65 referrals to the Commission Ethnic minority issues (1989-1991) under section 57 for psychosurgery and certificates were issued for 56 patents.
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