From Feb to April, I worked in Westminster writing a briefing for parliamentarians on optimising patient choice and autonomy in the proposed Mental Health Act (MHA) reforms. As a clinical and academic psychiatrist, the world of Parliament is very different to my ‘day job’, and my time as a fellow at the Parliamentary Office of Science and Technology (POST) felt like a whirlwind trip to another dimension.
My work with patients often involves the Mental Heath Act and my academic work is inspired by the need to develop more collaborative approaches with patients. Although Parliament feels far from my comfort zone, when the opportunity came up to spend time in the heart of the decision-making process at POST, the chance was too good to miss.
The current state of mental health policy
The topic I was tasked with researching was not so far removed from the day job. A Joint Committee, made up of members of both Houses had been convened to scrutinize the Government’s draft Mental Health Bill. It had released its report just days before I started at POST, so it was very much a live situation.
The Mental Health Act regulates compulsory treatment for people with a mental disorder and is something psychiatrists use regularly in everyday practice in treating some of their most unwell patients. The Act dates from 1983 and despite being amended in 2007 it is seen by many as needing urgent further modernisation. The latest reforms started with the Independent Review of the Mental Health Act, chaired by Prof Sir Simon Wessely, which reported in 2018. One of the core principles of recent reviews was optimising patient choice and autonomy. It was this aspect of the current proposals that my note ultimately focused on.
About POST and POSTnotes
POST works across both the Houses of Commons and Lords to provide parliamentarians with access to the best evidence, neatly summarised in short briefings called POSTnotes.
POSTnotes are produced following a very specific research process. A literature review is conducted alongside stakeholder interviews, typically including a range of academics, charities, Government organisations and campaign groups. These interviews help to explore stakeholder perspectives, contextualise the literature and draw attention to newer work which may not have made it to the scientific journals yet. This felt like a very different approach to the standard academic one, with a much broader definition of evidence - basically anything that helps parliamentarians understand the pertinent issues.
The interviews were a very enjoyable part of the experience. It was a real privilege to speak to leading experts in the field and hear the different perspectives of many diverse organisations and individuals.
My fellowship was not just about the POSTnote. It was also an opportunity to learn about our democratic process and explore the unique environment of the ‘mother of parliaments’. POST laid on some very helpful training sessions and an orientation tour. This revealed some surprising behind-the-scenes shortcuts at the Palace of Westminster - there is even a direct connection to the tube station – just turn right past the bins. I was also fortunate to witness the theatrical spectacle that is Prime Minister’s Questions, tour the archives hidden in the Victoria Tower, and dine in the rarified environs of the Strangers’ Dining Room overlooking the Thames.
And some more challenging aspects…
Less enjoyable was the process of drafting and editing the manuscript. Not only did it have to be short, but also adopt just the right neutral tone in line with POST’s guiding principle of impartiality. Another big shock I had to contend with was the timeline. Although my fellowship was three months long, I needed to have a complete draft after just two, to allow for the review and editorial processes. Subtract a couple of weeks at the beginning to get my bearings and that didn't leave much time!
Just when I thought I had cracked it we sent our draft out to external review, asking interviewees and other key people to cast an eye over it for accuracy and tone. My advisor Dr. Sarah Bunn cautioned me that nobody would tell me to take bits out, but many would suggest more things to add. Oh great! She was right. Despite the headache of integrating these to the already overly verbose manuscript, I could see the real value in the external review process. It served to test drive the material and ensure that it had all bases covered.
My time as a POST fellow was a fascinating excursion into the world of policymaking. It has given me new insights into the complex relationship between academia, clinical practice, and policy. When the new MHA legislation eventually comes into effect, I will doubtless be using it in my clinical work and will see firsthand the impact on my patients. This thought brings it home to me that policymaking is not some dry abstract process happening in a vacuum, but a very human activity with consequences for real people. The more that evidence in all its forms can inform this process the better.
My fellowship was generously supported by the Oxford Policy Engagement Network and Department of Psychiatry at the University of Oxford. You can find out more about the work of POST and routes for academic engagement with Parliament more widely, online:
- About POST
- Fellowships at POST
- Contributing to a POSTnote as an expert
- Research Impact at the UK Parliament
- Meet the other OPEN Fellows
- See all OPEN Funding
Reforming the Mental Health Act – Approaches to Improve Patient Choice, POSTnote 695 (11 May 2023), Parliamentary Office of Science and Technology, UK Parliament. Author: Dr Howard Ryland