Jo’s Blog: It’s not just about the rules on compulsion

We are still waiting for the UK Government to publish its White Paper on reform of the Mental Health Act. It was due by the end of 2019 but there was quite a lot happening up in Westminster late last year plus of course the General Election. But it should be published soon and I’ll need your help to give an informed response – I’ll publish an analysis once it’s published so you can get back to me with your views.

Meanwhile I’d like to raise an important point about patients’ priorities…

Pressure groups seeking reform of the Act focus mainly on the rules concerning how and when compulsion can be used to detain a patient. This is important – everybody I have spoken to agrees that this needs a fresh look and in Jo’s Law I propose radical reform of the rules aimed at reducing compulsion while ensuring safety.

But patients and families also tell me about another priority – improving the environment which patients find themselves in when they are detained.

Many of the people I speak to have been detained before and know that they may be detained again – and in many cases they accept that because it keeps them and other people safe. So their fear of detention is often based not on the fact of being detained but where they then find themselves.

The truth is that many inpatient units are drab and depressing places with no privacy and little to do. Too often they are also scary places where patients do not feel safe and I’m afraid patients sometimes do not feel respected either.

This sort of environment is itself a great injustice: it is bad enough to be locked up when you have done no wrong (even if it is sometimes justified) but it is unforgivable for the people who are locking you up to then place you in such poor conditions.

And there are other consequences: a bad environment means people do not recover as quickly as they should – and so the compulsion continues and the costs of inpatient care are increased; and patients are less likely to agree voluntary treatment when they become ill because they know the conditions will be poor – leading to more compulsion and more cost.

So a reminder of what I call for in Jo’s Law…

  • There should be a minimum, guaranteed choice of treatments available to all patients subject to compulsion – including psychological therapies
  • Minimum standards for hospitals for those detained including private rooms, gender segregation if chosen, access to phone and email, and education and recreational opportunities every day
  • A choice of location offered – for example whether to go to a local hospital or travel further to a specialist unit
  • All patients subject to compulsion (or their guardian team) should have the option to access a personal health budget (based on the cost of in-patient care) with which to design and purchase their own treatment and care package at an independent hospital or in the community – subject to the package meeting the threshold for reducing risk

…and take a look at Hafal’s inpatient facility – the Gellinudd Recovery Centre – here


Jo Roberts is a mental health campaigner who has been on the receiving end of the Mental Health Act – and is still subject to it today. In the past she has received compulsory treatment; some of that treatment was deeply unpleasant and even terrifying. Jo is campaigning for a progressive Mental Health Act fit for the 21st Century – an Act that gives patients and carers in Wales and beyond a fairer deal. Read more…