The Coronavirus Act 2020: a cause for concern among mental health nurses
Many thousands of service users could be affected over the two-year lifespan of the legislation, creating mistrust, suspicion, anxiety and anger
A key response in the UK to the COVID-19 pandemic has been the passing of the Coronavirus Act 2020, which modifies the Mental Health Act 1983 and related legislation. Although not activated at the time of writing, if used these modifications will change the working practices of many mental health nurses.
Legislation that restricts the autonomy and rights of a person raises ethical concerns, and mental health nurses are often placed in situations where they balance these rights against imposed restrictions.
‘Mental health nursing needs to address the potential cost in relation to how we care for people’
The Coronavirus Act 2020 places further potential restrictions on autonomy and freedoms and could create complexities for mental health nurses, directly affecting how care is provided in ways that may not be immediately apparent.
The focus of government policy so far has been towards increasing the available workforce through emergency registration of nurses and volunteering. But the act includes measures to ‘reduce the administrative burden on front-line staff and allowing tasks to be performed more quickly’ (Powell et al 2020) in the likelihood that many staff will be off sick or caring for others.
It is with these changes in mind that, as a professional body, mental health nursing needs to address the potential cost in relation to how we care for people with mental health problems.
Powers should not unfairly affect disadvantaged minorities or marginalised groups
Described by the government as ‘easements’ (Department of Health and Social Care (DHSC) 2020), the modifications have been alternatively viewed as an affront to rights and freedoms, with concerns voiced in the House of Lords during the bill’s passage through parliament.
Baroness Sarah Ludford said: ‘The overarching concern is that the powers in the bill should last no longer than is strictly necessary, should not overreach and should not set unwelcome precedents – one thinks, for example, of the reduction to one doctor for the exercise of Mental Health Act powers and the problems around care assessments,’ (Hansard, 24 March 2020).
An overarching concern has been that powers should not unfairly affect disadvantaged minorities or marginalised groups. It is hard to see how these changes, largely involving the removal of safeguards and oversight, can avoid falling foul of this concern.
‘One possible modification is to remove the safeguard of a review by a second opinion appointed doctor’
Mental health service users are often from the most marginalised groups, and people detained under mental health legislation are often from black, Asian or minority ethnic groups (Barnett et al 2019).
An example of one possible modification is to remove the safeguard of a review by a second opinion appointed doctor (SOAD) after three months of compulsory treatment. According to the Care Quality Commission (CQC), SOADs carried out 14,354 visits in 2018-19 (CQC 2020), resulting in a change to treatment plans in 29% of them.
Whether treatment would have changed if only the responsible clinician had reviewed is unknown, but the report shows that this safeguard could have affected nearly 5,000 people in that year.
Removing safeguards for a vulnerable population could cause further alienation
Across the two-year lifespan of Coronavirus Act 2020, this could well affect many thousands of detained people and leave them without an independent review of compulsory treatment.
Removing safeguards for a vulnerable population could cause further alienation when there is a need for transparency, inclusion and understanding (World Health Organization 2020). Use of the act could create mistrust, suspicion, anxiety and anger, all of which are undesirable when caring for someone.
It could also result in increases in restrictive responses such as restraint and seclusion which, in times where staffing levels are expected to be low, are dangerous for all involved.
‘Coercion and compromise to autonomy can undermine recovery’
These modifications to the Mental Health Act 1983 are aimed at helping to relieve workforce pressures, but their use in practice could be at a cost. It is imperative that at times when pressures mount during a state of national emergency, consideration to and balance of professional duties, rights and advocacy for vulnerable people are maintained.
Coercion and compromise to autonomy can undermine recovery and are an everyday reality for mental health nurse practice (Morgan et al 2016), so it is ever more imperative, in times when collective action is aimed at a common goal of managing a national emergency, that practice is not changed without such changes being questioned.
Mental health nurses must be involved at national and local levels in the development of guidance and policy if modifications are activated. They are uniquely positioned to provide expert, constructive critical knowledge and support, and to assess the effect on care of any change.
Will Murcott, @billymurcott, is a senior lecturer in nursing at the Open University
Find out more
- Barnett P, Mackay E, Matthews H et al (2019) Ethnic variations in compulsory detention under the Mental Health Act: a systematic review and meta-analysis of international data
- Care Quality Commission (2020) Monitoring the Mental Health Act in 2018/19
- Department of Health and Social Care (2020) Supporting disabled people through the coronavirus outbreak
- Hansard, 24 March 2020 – Coronavirus Bill
- Morgan A, Felton A, Fulford B et al (2016) Values and Ethics in Mental Health: An Exploration for Practice
- Powell T, Parkin L, Foster D et al (2020) Coronavirus Bill: health and social care measures
- World Health Organization (2020) Mental health and psychosocial considerations during the COVID-19 outbreak