When Arden and I first started working with the Mental Health Act (MHA), we realised just what a complicated piece of legislation it was. We both had family and friends who experienced the MHA, but neither of us had first-hand experience. We were keen to understand how the process worked, what each section meant and who was involved in care.

Learning about the MHA has been a truly fascinating experience. I’ve particularly enjoyed speaking with the different people involved and understanding their unique, and often very different perspectives.

We started looking at the binary moments, the parts of the act where something happened. The moment where something changed and this change was understood by everyone involved in care. This boiled down to the MHA statutory forms. It was these pink statutory forms often rather crudely referred to as the “currency” of the MHA which were completed at every stage of the acute mental health care pathway.

As we mapped out the MHA forms and their path two things became increasingly apparent:

  1. The individual at the centre of this process is named on every form, yet neither initiates nor signs them.
  2. There is no statutory form for the end of the care pathway.
The admission process

The first forms completed are the admission forms. Generally two doctors each send statutory medical recommendations to an approved mental health professional (AMHP), who completes a statutory application. The AMHP then shares this bundle of forms with a nurse, who completes another statutory form to confirm they have received the person into hospital. These four forms are then sent over to the hospital’s mental health legal team. Throw in a few other professionals who need sight of the forms along the way, such as the ambulance service, and it all starts to get fairly complicated. However, there is a shared understanding about what has to happen based on these universal forms.

The rest of the care pathway is form driven

From there, that person’s care journey is governed by forms. Consent to treatment, various forms of treatment, transfer between hospitals, out of hospital treatment in the community. At each step of the care pathway there is a form to complete, a legal process running in parallel to the healthcare one.

Ensuring the pathway to care is legal and ethical is of course paramount. There is a separate discussion around how this legal process is perceived by those subject to the Mental Health Act. This is probably a conversation for another day.

What is the path back out?

It’s not that there’s no way out of the MHA, a person may request discharge from the Mental Health Act by making a request to the hospital managers. They can also request a tribunal or their Nearest Relative can request discharge. From the perspective of the doctor or responsible clinician they may discharge someone if they feel the person no longer meets the criteria to be detained. There are many forms designed to keep people detained, or subject to the act in one way or another, but there is no universal MHA statutory form to release someone.

An opportunity perhaps?

There is such a clear route into the MHA, to provide treatment, to transfer people between hospitals etc. So why does the statutory forms process not have a natural end point? It feels strange to me that the discharge process is so different to the rest of the statutory form-driven care pathway which led up to it.

As Thalamos continues to support healthcare providers in digitising the MHA, I believe it’s important we recognise that by simply digitising the existing process we will not deliver on the potential of digital, we are at risk of replicating existing shortcomings. We must create technology which will allow for patients to be properly included in all aspects of their healthcare, particularly and most importantly in their discharge as surely this is the most important objective.