Views and experiences of the Nearest Relative provision of the Mental Health Act (1983): A systematic review of the evidence

Status: Complete

Briefing Paper: We have produced a 4-page Briefing Paper which summerises the project and the main findings.

In March 2018, the Exeter Evidence Synthesis Centre were asked to carry out a six-week rapid review, looking at people’s experiences of the Nearest Relative provision of the Mental Health Act (1983). Below we explain what the Nearest Relative provision is, the aim of our project and how the team carried out this review. We also talk about how we involved people in this review and how people can read about what we have found and give their views.

The Department of Health and Social Care has published an Independent Review of the Mental Health Act (1983).

The Mental Health Act (1983) is a piece of legislation used to support people who need to be admitted to hospital because they may be at risk of harming themselves, or others, due to poor mental health. It is used in different formats, across England and Wales, Scotland and Northern Ireland.

When a person is admitted to hospital against their wishes for a period of assessment and/or treatment (known as compulsory detention), there are several safeguards the Mental Health Act (1983) has put in place to make sure that people are not kept in hospital inappropriately and their rights are respected. One of these is the Nearest Relative Provision. This states that a person who has been admitted to hospital has the right to have a person to support them during their hospital stay. The Nearest Relative is entitled to receive confidential information about the care the person in hospital is receiving and, amongst other things, can:

  • Ask for an assessment to see if their partner or relative needs to be admitted to hospital
  • Object to their partner or relative being admitted to hospital for a period of treatment
  • Request that the person be removed from hospital or a guardianship order

There are some concerns that the Nearest Relative provision of the Mental Health Act (1983) is too inflexible, and may not always represent the wishes of either the person admitted to hospital or the person identified as their Nearest Relative.

Aims of our project
We aimed to summarise and explore the different views and experiences of the Nearest Relative Provisions of the Mental Health Act (1983). We were interested in the perspectives of service users, family members, carer and professionals who work with the Act. This was to help the Department of Health and Social Care decide if any changes to the Nearest Relative provision of the Mental Health Act (1983) are needed.

Research question
What are the experiences of services users, family members, carers and relevant professionals of the use of the ‘Nearest Relative’ provisions in the compulsory detention and ongoing care of people under the Mental Health Act (1983)?

What we did
We carried out a systematic review of the evidence. This is a transparent and unbiased process, bringing together the findings of all the available relevant studies to find out what is already known about people’s views on the Nearest Relative provision.

How we did it
We searched different online libraries and organisation websites for all the research papers which have been written on this topic since 1998. We also contacted the authors and experts in the field and searched the reference lists of the papers we found. We only chose papers which met our selection criteria.

We then took out the information we needed from the relevant papers identified by our searches. This information included:

  • What people had said about their experiences of the Nearest Relative provision
  • Who was giving their views
  • How many people were giving their views
  • The country in which the person giving their views had experienced the Nearest Relative provision

We brought this information together to answer our research question. For more detailed information about how we did this, please see our project protocol here.

Involving Patients and the Public
We wanted to make sure that our review was relevant to people who are admitted to hospital against their wishes, their families and their carers.

Although we only had a short time available to carry out the review, we were able to check our final results with a carer who had experience of the Nearest Relative provision to see if they made sense.

Sharing our results
We shared our results with the Department of Health and Social Care so that they could use it to inform the independent review of the Mental Health Act.

You can listen to our podcast on our blog sifting and sensemaking to learn more about what we found.

Our blog also talks about the results of our review and how we found doing this piece of work in six weeks. There is space for you to comment on the work we’ve done. We would welcome your views.

Alternatively, you may like to read the full report, found here:  https://doi.org/10.3310/hsdr06390

If you have any feedback or comments about this review, please email:
Liz Shaw: E.H.Shaw@exeter.ac.uk or Jo Thompson Coon: J.Thompson-Coon@exeter.ac.uk