A systematic review of the efficacy of psychological treatments for people detained under the Mental Health Act

J Psychiatr Ment Health Nurs. 2023 Jan 19. doi: 10.1111/jpm.12897. Online ahead of print.

Abstract

Introduction: The efficacy of psychological interventions delivered under the Mental Health Act (MHA) (1983) in England and Wales is unclear. While meta-analyses have reviewed acute and forensic psychological interventions in wider geographical areas, there has been no review specifically in the unique MHA context.

Aim: A systematic review was conducted of psychological outcomes for inpatients detained under the MHA in England and Wales.

Method: Diagnoses and type of psychological intervention were not restricted, provided a psychological outcome measure was used. Studies were identified through APA PsychInfo, MEDLINE, CINAHL and Academic Search using a combination of key terms. Data extraction included effect direction, statistical significance, intervention type, format and duration, study size, inpatient setting, control group and study quality.

Results: High quality evidence was sparse. Some improvements were found in overall wellbeing, self-esteem, social functioning, problem solving, substance use, anger, offending attitudes, fire-setting, violence, anxiety, depression, personality disorder and psychosis. However, the overall evidence base is lacking.

Discussion: Larger scale RCTs are needed across secure, acute and LD inpatient settings in England and Wales with longer term follow-up, blind assessors and both self-report and clinician-rated measures, as well as incident, readmission and reoffending rates. Greater representation is needed of females, non-white groups and affective disorders.

Clinical implications: The efficacy of psychological interventions for inpatients detained under the MHA in England and Wales remains unclear. Clinicians are encouraged to use relevant outcome measures in relation to treatment goals, to monitor the efficacy of interventions being offered to this client group.

Relevance to mental health nursing: This paper highlights the current body of evidence for psychological interventions in inpatient settings within England and Wales, which is an environment in which mental health nursing plays an important role in patients' recovery. This evidence is also particularly important as there is a shift in clinical practice to training nursing staff to deliver some of the low intensity psychological interventions, such as behavioural activation, solution focussed therapy and motivational interviewing.

Relevance to mental health nursing: This paper highlights the current body of evidence for psychological interventions in inpatient settings within England and Wales, which is an environment in which mental health nursing plays an important role in patients' recovery. This evidence is also particularly important as there is a shift in clinical practice to training nursing staff to deliver some of the low intensity psychological interventions, such as behavioural activation, solution focussed therapy and motivational interviewing.

Publication types

  • Review