Safeguarding Adult Reviews (SARs) can be a valuable source of learning to improve mental health care. In light of the government’s commitment to reform the Mental Health Act 1983, this report summarises the qualitative learning from 77 SARs published across 24 London boroughs covering the period January 2017 to November 2020. The premise of this report is that the reform of the Mental Health Act will also prompt a ‘wake up’ of the entire mental health system in London and the rest of England in which parity of social care with health care becomes the ‘new normal’. The SARs analysed for this report tell the stories of Londoners who experienced mental health problems and came to harm or died as a consequence of their condition despite having been in contact with mental health care services and others. From the rapid analysis of the SARs case clusters emerged, with similarities in the individuals’ stories and outcomes. These clusters show that there might be groups of people who require particular attention when it comes to reforming the Mental Health Act – and with it the mental health social care ‘offer’. The stories of these individuals also raise some concerns around human rights, equality and inclusion with the question: Is enough being done to protect the rights of vulnerable people with mental health problems who receive mental health social care and who may rely on social care to respect these rights? The analysis further suggests that there are two major problem areas across virtually all the cases and clusters – professional knowledge and usage of the Mental Capacity Act 2005 and inter-agency working and communication.

There is little empirical research focusing on how social workers experience the law in their everyday professional practice, and still less on how mental health social workers experience assessment for compulsory admission under mental health law. The article is informed by a hermeneutic phenomenological approach, drawing on in-depth interviews and practitioner diaries with social work Approved Mental Health Professionals (AMHPs), providing exploration of how social work AMHPs experience compulsory assessment under mental health law in practice. This is revealed as a socio-relational process, involving a focus on the person in their environment in relation to others, such as family and professionals. Ethical challenges realising human rights social work practice are illuminated. This draws attention to how space for such practice can be eroded by systems conditions. The importance of amplifying the voice of the person assessed is highlighted in the context that their voice is severely diminished during the process of assessment. The article provides insights on the complexity involved in compulsory mental health practice, drawing attention to trust as an important concept. Finally, the article argues that realising human rights-oriented AMHP practice requires social work to challenge systems conditions that erode the ability to do so.

Background: The use of advance care planning and advance decisions for psychiatric care is growing. However, there is limited guidance on clinical management when a patient presents with suicidal behaviour and an advance decision and no systematic reviews of the extant literature. Objectives: To synthesise existing literature on the management of advance decisions and suicidal behaviour. Design: A systematic search of seven bibliographic databases was conducted to identify studies relating to advance decisions and suicidal behaviour. Studies on terminal illness or end-of-life care were excluded to focus on the use of advance decisions in the context of suicidal behaviour. A textual synthesis of data was conducted, and themes were identified by using an adapted thematic framework analysis approach. Results: Overall 634 articles were identified, of which 35 were retained for full text screening. Fifteen relevant articles were identified following screening. Those articles pertained to actual clinical cases or fictional scenarios. Clinical practice and rationale for management decisions varied. Five themes were identified: (1) tension between patient autonomy and protecting a vulnerable person, (2) appropriateness of advance decisions for suicidal behaviour, (3) uncertainty about the application of legislation, (4) the length of time needed to consider all the evidence versus rapid decision-making for treatment and (5) importance of seeking support and sharing decision-making. Conclusions: Advance decisions present particular challenges for clinicians when associated with suicidal behaviour. Recommendations for practice and supervision for clinicians may help to reduce the variation in clinical practice.

Describes what an advance statement is, and contains an A5 form patients can use to write down their preferred treatments and strategies for care should they have a mental health crisis.

Describes what an advance statement is, and contains an A4 form patients can use to write down their preferred treatments and strategies for care should they have a mental health crisis.