Reforming the Mental Health Act by advocating for patient rights

Professor Laing’s research, combined with her contributions to the UK’s Parliamentary Joint Committee on the draft Mental Health Bill, have been instrumental in advocating for patient rights and promoting autonomy in the reform proposals.

The research supports the importance of embedding guiding principles, such as patient autonomy and choice into the Act to ensure professionals make sound decisions about compulsory admission and treatment.

In her role as a Parliamentary Academic Fellow Professor Laing collaborated with House of Commons Library researchers to provide parliamentarians with the best possible analysis of the Mental Health Act reforms and she also worked on briefings related to the impact of COVID-19 on mental health and human rights.

Professor Laing has been a member of the Care Quality Commission’s (CQC) Mental Health Act advisory group and been consulted on their important work monitoring the operation of the Mental Health Act.

Strengthening patient choice with the support of a nominated person

Prof Laing is part of an inter-disciplinary team of researchers from the Universities of Bristol, Bath and the West of England. The team has conducted research with Approved Mental Health Professionals (AMHPs) to examine how they interpret their legal duties towards Nearest Relatives under the Mental Health Act 1983. The research identified challenges to the existing system and makes recommendations for policy-makers and practitioners.

Under the Mental Health Act 1983, people can be given compulsory treatment for their mental disorder in hospital. The current system assigns a 'Nearest Relative' – decided via hierarchical list of family members - as the person who can act on behalf of a patient when they are admitted to hospital. However, this system is often problematic for a variety of reasons. The research suggests that the Nearest Relative role limits choice for patients about who should be consulted about their care. It also creates huge emotional burdens for family members who often lack legal knowledge about what the role entails.

Following an Independent Mental Health Act Review team’s report, the Government pledged to replace the Nearest Relative with a new Nominated Person role in the Draft Mental Health Bill, which would give people with mental health problems greater choice about who should represent them. The government has also pledged to expand the role in several ways to provide stronger rights to patients.

Researching the evolution of mental capacity law and best interests decision making

The Mental Capacity Act 2005 and the Children Act 1989 include provisions to make decisions for adults and children who lack capacity to make their own decisions, including in relation to their health and welfare, based on what is deemed to be in their best interests.

Professor Laing’s research in the Law Workstream of the BABEL project explores how legal professionals interpret the concept of best interests when making medical treatment decisions for adults and children. Through interviews with a range of legal actors – including retired judges, barristers, solicitors, the official solicitor and expert witnesses who regularly appear in court - the BABEL law team have been uncovering the ‘hidden’ or less visible aspects of law making in this sphere. This includes exploring how discretion is exercised by practitioners in bringing cases to court and framing legal arguments and the influence of emotional and personal motivations on decision-making and outcomes.

The BABEL Law team responded to the government’s consultation and review of the Mental Capacity Act 2005 Code of Practice in 2022 to help strengthen guidance for professionals and other decision makers on how they implement the law to make decisions for people who lack capacity to do so.

Continuing influence: what does the future hold?

The government responded to a Joint Committee report on the Draft Mental Health Bill and announced in March 2024 it intends to press ahead with law reform when parliamentary time allows. This delay to the progress of the Mental Health Bill is disappointing, but there is still hope on the horizon that much needed legal reform to strengthen the rights of psychiatric patients will be introduced.

Reform is essential if we are to achieve meaningful change for persons with mental disorder and ensure our laws respect patient rights and comply with international human rights standards.