Talking to strangers: The work of the Mental Health Act Commission

Abstract

Background:The Mental Health Act Commission (MHAC) is a body which monitors the care and treatment of patients compulsorily detained in hospital in England and Wales. It does this through listening to their views and by observing the conditions in which they are held; this direct exposure to the experience of service users contrasts with other models of quality assurance which rely mainly on secondary data.

Aims: This paper reviews the work of the Commission, focusing on its visiting role and methodology.

Methods: The paper is based on published and unpublished literature, drawing also on personal experience as a member of the MHAC.

Results: It argues that textual data tend to be privileged over talk because of the need for evidence-based recommendations and that patients' views are for this reason relatively neglected in Commission reports. The paper highlights ambiguities in the role of the Commission and identifies two divergent goals, firstly protection of legal rights, secondly audit and inspection.

Conclusions: The paper finds that it has been difficult for the MHAC to reconcile these goals. While it has successfully raised standards of compliance with the Mental Health Act, it has been less successful in tackling wider issues of quality of care. There is a risk that its user-centred approach may be lost as a result of changes in regulatory structures.

Keywords:

• Mental health
• evidence-based practice
• advocacy
• inspection
• regulation