Experiences of the ‘Nearest Relative’ provisions in the compulsory detention of people under the Mental Health Act: a rapid systematic review

Background: Service users detained for assessment and/or treatment under the Mental Health Act 1983 (MHA 1983) are allocated a ‘Nearest Relative’ (NR). The NR has access to confidential information about the service user and can make decisions about their care and treatment. Tensions exist regarding...

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Main Authors: Liz Shaw, Michael Nunns, Simon Briscoe, Rob Anderson, Jo Thompson Coon
Format: Article
Language:English
Published: National Institute for Health Research 2018-12-01
Series:Health Services and Delivery Research
Subjects:
Online Access:https://doi.org/10.3310/hsdr06390
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author Liz Shaw
Michael Nunns
Simon Briscoe
Rob Anderson
Jo Thompson Coon
author_facet Liz Shaw
Michael Nunns
Simon Briscoe
Rob Anderson
Jo Thompson Coon
author_sort Liz Shaw
collection DOAJ
description Background: Service users detained for assessment and/or treatment under the Mental Health Act 1983 (MHA 1983) are allocated a ‘Nearest Relative’ (NR). The NR has access to confidential information about the service user and can make decisions about their care and treatment. Tensions exist regarding the identification, displacement and powers of the NR. Objectives: To examine the experiences of service users, carers and relevant professionals of the NR provisions of the MHA 1983, and the equivalent Named Person (NP) provisions in Scotland. Five research objectives were defined: understanding the experiences of and issues associated with (1) the identification of the NR, (2) the displacement of the NR, (3) confidentiality and information-sharing, (4) access to support from carers and (5) making decisions about treatment or care. Data sources: Seven bibliographic databases were searched: MEDLINE (via Ovid), MEDLINE In-Process & Other Non-Indexed Citations (via Ovid), PsycINFO (via Ovid), Social Policy and Practice (via Ovid), Health Management Information Consortium (via Ovid), Cumulative Index to Nursing and Allied Health Literature (via EBSCOhost) and Applied Social Sciences Index and Abstracts (via ProQuest). Citation searching, author contact and grey literature searches were conducted. Review methods: A rapid systematic review was conducted in 6 weeks. Evidence published after 1998 from the UK pertaining to the experiences of those involved in compulsory detention under the MHA 1983 (or UK variants), including service users, carers, family members, NRs, NPs, mental health professionals, policy-makers and lawyers, was sought. Study selection, data extraction and critical appraisal were completed independently by two reviewers. We looked for data about experiences, which were obtained through qualitative means or surveys. Included studies containing several paragraphs of participant quotations and/or author interpretations were entered into a framework synthesis; the rest were summarised descriptively. The framework synthesis was based on the five research objectives and refined using the findings of key studies from England and Scotland and an inductive thematic analysis. Results: Twenty studies were included with 12 prioritised for framework synthesis. Four themes emerged: (1) issues regarding the identification of the NR/NP, (2) confidentiality and information-sharing, (3) enabling the use of the NR/NP role and (4) the importance of maintaining relationships. The involvement of service users in choosing their representative and the role of services in supporting the NR/NP was identified as important. Limitations: There is little recent evidence to inform this important and complex discussion. The review was rigorously conducted despite the short time scale; however, a more in-depth, iterative thematic analysis of all the included studies may have provided additional insights into the mechanisms underpinning the issues. Conclusions: The NR provisions of the MHA 1983 are complex and of significant importance to individuals detained under the Mental Health Act and their carers. This rapid review provides specific examples of issues that individuals may experience. More research is needed to aid understanding of this complex topic. Future work: Primary research specifically focused on the perceived and actual use and impact of the NR provisions in England and Scotland. Study registration: This study is registered as PROSPERO CRD42018088237. Funding: The National Institute for Health Research Health Services and Delivery Research programme.
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spelling doaj.art-20cd1a24d17747b7b557accb5e4ffbad2022-12-22T01:53:50ZengNational Institute for Health ResearchHealth Services and Delivery Research2050-43492050-43572018-12-0163910.3310/hsdr0639013/182/13Experiences of the ‘Nearest Relative’ provisions in the compulsory detention of people under the Mental Health Act: a rapid systematic reviewLiz ShawMichael NunnsSimon BriscoeRob AndersonJo Thompson Coon0Exeter Health Services and Delivery Research Evidence Synthesis Centre, College of Medicine and Health, Exeter, UKBackground: Service users detained for assessment and/or treatment under the Mental Health Act 1983 (MHA 1983) are allocated a ‘Nearest Relative’ (NR). The NR has access to confidential information about the service user and can make decisions about their care and treatment. Tensions exist regarding the identification, displacement and powers of the NR. Objectives: To examine the experiences of service users, carers and relevant professionals of the NR provisions of the MHA 1983, and the equivalent Named Person (NP) provisions in Scotland. Five research objectives were defined: understanding the experiences of and issues associated with (1) the identification of the NR, (2) the displacement of the NR, (3) confidentiality and information-sharing, (4) access to support from carers and (5) making decisions about treatment or care. Data sources: Seven bibliographic databases were searched: MEDLINE (via Ovid), MEDLINE In-Process & Other Non-Indexed Citations (via Ovid), PsycINFO (via Ovid), Social Policy and Practice (via Ovid), Health Management Information Consortium (via Ovid), Cumulative Index to Nursing and Allied Health Literature (via EBSCOhost) and Applied Social Sciences Index and Abstracts (via ProQuest). Citation searching, author contact and grey literature searches were conducted. Review methods: A rapid systematic review was conducted in 6 weeks. Evidence published after 1998 from the UK pertaining to the experiences of those involved in compulsory detention under the MHA 1983 (or UK variants), including service users, carers, family members, NRs, NPs, mental health professionals, policy-makers and lawyers, was sought. Study selection, data extraction and critical appraisal were completed independently by two reviewers. We looked for data about experiences, which were obtained through qualitative means or surveys. Included studies containing several paragraphs of participant quotations and/or author interpretations were entered into a framework synthesis; the rest were summarised descriptively. The framework synthesis was based on the five research objectives and refined using the findings of key studies from England and Scotland and an inductive thematic analysis. Results: Twenty studies were included with 12 prioritised for framework synthesis. Four themes emerged: (1) issues regarding the identification of the NR/NP, (2) confidentiality and information-sharing, (3) enabling the use of the NR/NP role and (4) the importance of maintaining relationships. The involvement of service users in choosing their representative and the role of services in supporting the NR/NP was identified as important. Limitations: There is little recent evidence to inform this important and complex discussion. The review was rigorously conducted despite the short time scale; however, a more in-depth, iterative thematic analysis of all the included studies may have provided additional insights into the mechanisms underpinning the issues. Conclusions: The NR provisions of the MHA 1983 are complex and of significant importance to individuals detained under the Mental Health Act and their carers. This rapid review provides specific examples of issues that individuals may experience. More research is needed to aid understanding of this complex topic. Future work: Primary research specifically focused on the perceived and actual use and impact of the NR provisions in England and Scotland. Study registration: This study is registered as PROSPERO CRD42018088237. Funding: The National Institute for Health Research Health Services and Delivery Research programme.https://doi.org/10.3310/hsdr06390mental health act 1983englandwalesscotlandnorthern irelandmental healthinvoluntary admissionnearest relativeservice userrelativecarerprofessionalsystematic reviewqualitative research
spellingShingle Liz Shaw
Michael Nunns
Simon Briscoe
Rob Anderson
Jo Thompson Coon
Experiences of the ‘Nearest Relative’ provisions in the compulsory detention of people under the Mental Health Act: a rapid systematic review
Health Services and Delivery Research
mental health act 1983
england
wales
scotland
northern ireland
mental health
involuntary admission
nearest relative
service user
relative
carer
professional
systematic review
qualitative research
title Experiences of the ‘Nearest Relative’ provisions in the compulsory detention of people under the Mental Health Act: a rapid systematic review
title_full Experiences of the ‘Nearest Relative’ provisions in the compulsory detention of people under the Mental Health Act: a rapid systematic review
title_fullStr Experiences of the ‘Nearest Relative’ provisions in the compulsory detention of people under the Mental Health Act: a rapid systematic review
title_full_unstemmed Experiences of the ‘Nearest Relative’ provisions in the compulsory detention of people under the Mental Health Act: a rapid systematic review
title_short Experiences of the ‘Nearest Relative’ provisions in the compulsory detention of people under the Mental Health Act: a rapid systematic review
title_sort experiences of the nearest relative provisions in the compulsory detention of people under the mental health act a rapid systematic review
topic mental health act 1983
england
wales
scotland
northern ireland
mental health
involuntary admission
nearest relative
service user
relative
carer
professional
systematic review
qualitative research
url https://doi.org/10.3310/hsdr06390
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AT simonbriscoe experiencesofthenearestrelativeprovisionsinthecompulsorydetentionofpeopleunderthementalhealthactarapidsystematicreview
AT robanderson experiencesofthenearestrelativeprovisionsinthecompulsorydetentionofpeopleunderthementalhealthactarapidsystematicreview
AT jothompsoncoon experiencesofthenearestrelativeprovisionsinthecompulsorydetentionofpeopleunderthementalhealthactarapidsystematicreview