This rapid review synthesised qualitative evidence regarding experiences of service users, carers and other stakeholders regarding the NR provisions of the MHA 19831 in England and the NP provisions of the MHCT in Scotland. A number of common themes were identified across a small number of included studies. Given the paucity of evidence available, the outcomes that emerged from the synthesis must be considered as examples or indicators of experiences, rather than representative of the experiences and impact of current legislation across the UK.
The research included in this review indicates that:
The role of the NR under the MHA 1983
1 is important and can carry a heavy responsibility. It is important that the most suitable person is identified for the role, whenever possible. Possible issues to consider when trying to identify a suitable person to fulfil the NR role may include, but are not limited to –
considering with the service user who they feel would be a suitable person to fulfil the NR role
confirming with the service user that they have a good relationship with the potential NR, with no past or ongoing abuse
confirming that the potential NR is both willing and able to support the service user within the NR role
ensuring that the potential NR is aware of the service user’s wishes regarding future treatment and is willing to act on them when appropriate
ensuring that the potential NR has an adequate understanding of both the parts of the MHA 1983
1 relevant to the circumstances of the service user and their role as the NR
confirming that the potential NR is in receipt of appropriate support from services, both in terms of their own needs as a carer and in order to fulfil their role as NR.
Under the MHCT in Scotland, service users welcome the opportunity to choose their NP.
The power to easily displace the NR or NP is perceived as beneficial, but may be used in a manner that may be harmful to important long-term relationships between the service user and their relatives or carers.
The rights, powers and responsibilities of the NR or NP appear poorly understood by some professionals, and are sometimes poorly communicated to service users and carers.
When possible, a flexible and positive approach to communication between professionals involved with care, service users and NRs/NPs may help to achieve agreed suitable levels of information-sharing.
Although some carers value the opportunity to be involved with decisions about the care of the service user that the role of NR or NP confers, it should be understood that there are significant responsibilities that come with the role. The emotional and informational needs of carers in this situation should be considered and appropriate support provided.
Implications and recommendations for research
Implications
Evidence was scarce and much of it was over 10 years old and comprised samples of individuals from a limited range of localities and services. Studies also suffered from a lack of evidence of rigour when collecting or analysing qualitative data. Despite the general consistency of experiences that contributed to themes across studies, only 12 studies contributed to the synthesis. The timeline of this rapid review prevented further exploration of the evidence; however, drawing further conclusions from the limited evidence pool may have exacerbated the potential for biased, unrepresentative experiences to be captured.
For this reason, the main implications of this review are that the topic of the NR provisions of the MHA 19831 is complex, of significant importance to individuals detained under the MHA 19831 and insufficiently studied to date.
Recommendations for research
It is imperative that high-quality primary research is undertaken to explore the current issues around the NR provisions of the MHA 19831 in England and Wales. There is no population group that has been recently and rigorously sampled to inquire about their experiences of the NR provisions, particularly since the introduction of the 2007 amendments to the MHA 1983.1 Although all areas and topics related to the NR provisions of the MHA 19831 warrant further investigation, some of the specific directions for primary research include:
Examination of experiences of the NR/NP in the light of the most recent legislative changes throughout the UK, for example the option to opt for no NP in Scotland.
Further research is warranted in all areas of the UK. There was very little evidence from Northern Ireland and none from Wales and, although the studies based in Scotland were of good quality, they were few in number and all commissioned by the government. Despite the greater number of studies conducted in England, most of the useful evidence arose from a very small number of studies, and none of these had been conducted since key legislative amendments were made in 2007.
14There has been a lack of consideration of the experiences of those who are not married or in a civil partnership.
The views of mental health professionals and mental health advocates were not well represented.
A dearth of evidence was uncovered relating to the specific experiences of the NR/NP provisions from the perspective of ethnic minorities.
Qualitative methods may be the most appropriate means of eliciting data about experiences of the NR/NP provisions of the MHA 1983.1 However, reporting of methodological considerations could be improved.
