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John Williams outlines four principles at the heart of a major review of the Mental Health Act

One of the most important things for professionals working in mental health is to ensure patients feel respected and included. The Independent Review of the Mental Health Act 1983 sets out four key recommendations targeted at making patient care more inclusive.

The Review – Modernising the Mental Health Act, Increasing choice, reducing compulsion – was commissioned by the Government and published in December 2018. It seeks to place the needs of service users at the heart of treatment and care, and make sure staff are trained with the necessary skills and knowledge to deliver on four central “principles of co-production with patients and service users”. These principles focus on choice and autonomy, the use of least restriction, therapeutic benefits for patients, and treating people as individuals.

I believe the Independent Review will prove to be pivotal in the progression of the Mental Health Act and will bring it into line with modern healthcare standards. The four recommendations, which the Chair of the Review Professor Sir Simon Wessely has highlighted, will not only substantially improve the individual care of service users, but will also promote a more healthy relationship between patients and staff, and enable service users to take control of their treatment in order to live more fulfilling lives.

With the key principles set to play such a vital role in guiding standards, I think it is a good time to consider how healthcare practitioners and settings can implement these revised recommendations through training so both staff and service users see the numerous benefits.

Choice and autonomy

The principle relating to choice and autonomy comes into force when looking at health and social care services, which have a duty to support service users to balance safety from harm with freedom of choice. In order to ensure healthcare workers get this right, it is crucial that training prepares practitioners to accept both staff and service users as partners who have an equal say in healthcare provision. By embedding this principle in training we can develop a culture where staff involve the service user in decisions at the outset, talking compassionately with them and promoting an inclusive environment.

Least restriction

Supporting individuals to make decisions that boost their confidence and enable them to advocate for their own rights is absolutely essential. This also promotes proactive learning.

While restrictive practices are not utilised that often, where they are used there should be a restrictive intervention reduction programme in place, which healthcare professionals should discuss thoroughly during training. 

Plans for the use of restrictive interventions must not include the physical restraint of people in a way that includes the deliberate application of pain. Staff should become comfortable with, and confident in, using a graded response to any incidents that occur, ensuring all interventions are appropriate and ethical. Positive behaviour support techniques can also be used to prevent and respond to challenging behaviour, rather than responding with restraint.

Therapeutic benefit

This principle is concerned with enabling service users to recognise, engage with and develop their own sense of worth. For me, this is important as it supports individuals in building on their own range of capabilities and strengths, so they can ultimately live more independent and fulfilling lives.


Staff need to be encouraged to recognise that there is no one single concept of recovery for people with a mental health problem. Instead, they should identify the individual care needs of the service user and support them in regaining a meaningful life through interventions based on transition-focussed care, step-down community living, social integration and inclusion.

It’s imperative, as professionals, that we are able to recognise the best course of treatment for our patients, and engage with them and support them in their choices.

The person as an individual

This principle underlines the core belief that, during any interaction with them, a service user must always be seen as an individual and treated with dignity, respect and compassion. This approach should be ingrained in staff training and should underpin daily practice. Staff should listen to every individual and engage with them to ascertain their beliefs, needs and feelings, which must be respected.

Universal standards

I believe that the adoption of the principles discussed in Professor Wessely’s Report would greatly enhance patient care and create a common approach to mental healthcare provision; this could only be positive for the sector as a whole. By having a set of training standards that reaches right across the service, we can make sure that no matter where or why people access a service, they can be confident that the service provided will meet a minimum national standard.

About the author

John Williams is the Learning and Development Manager at Ludlow Street Healthcare, a specialist provider of care for adults over the age of 18 with complex mental health conditions, learning disabilities and neuropsychiatry conditions. The Group includes Beechwood College in South Wales.

lshealthcare.co.uk

@ls_healthcare 

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