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Treading a tightrope: Professional perspectives on balancing the rights of patients and relatives under the Mental Health Act in England

Research output: Contribution to journalArticle

  • Jeremy Dixon
  • Megan Wilkinson Tough
  • Kevin Stone
  • Judith M
Original languageEnglish
Number of pages9
JournalHealth and Social Care in the Community
Early online date30 Sep 2019
DateAccepted/In press - 6 Sep 2019
DateE-pub ahead of print (current) - 30 Sep 2019


Involuntary detention is used internationally to detain and treat people who are deemed to have a mental disorder. In England and Wales, approved mental health professionals (AMHPs) co‐ordinate Mental Health Act assessments which allow for patients to be detained. AMHPs have legal duties to identify, inform and consult with a patient's nearest relative (NR), who are, in turn, given powers to initiate or challenge detention. Our study takes an original approach through examining how AMHPs interpret their duties towards nearest relatives. We adopted a two‐stage design, which involved an online questionnaire with 55 AMHPs and focus group discussions with 33 AMHPs. The research was conducted in England between 2017 and 2018. Our questionnaire found that a high proportion of AMHPs reported that they had spoken to NRs for background information when assessing patients under the Mental Health Act. However, AMHPs were less likely to ask patients about their views of involving the NR prior to assessment. Focus group findings showed that AMHPs saw the NR role as offering an important ‘safeguard’ on the basis that NRs could provide information about the patient and advocate on their behalf. AMHPs identified practical difficulties in balancing their legal obligation towards NRs and patients; particularly where issues of potential abuse were raised or where patients had identified that they did not want NR involvement. While AMHPs stated that they sought to prioritise patient wishes regarding confidentiality, their accounts identified that patient consent about information sharing was sometimes implied rather than sought explicitly. Our findings reinforce conclusions by the recent Independent Review of the MHA, which states that current NR provisions are ‘outdated, variable and insufficient’. We identify that current practice could be improved using advanced choice documents and outline implications for AMHP practice.

    Research areas

  • AMHP, carers, decision‐making, focus groups, mental health, Mental Health Act, social work and healthcare



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    Rights statement: This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Wiley at Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 351 KB, PDF document

    Embargo ends: 30/09/20

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