Working in the NHS for almost three decades, Louise McLanachan has a wealth of experience in supporting countless patients and service users. For the last 17 years, she has worked as Head of Mental Health Legislation, ensuring that people detained under the Mental Health Act are done so lawfully and have the best possible experience.

The Mental Health Act (1983) is the main piece of legislation that covers the assessment, treatment, and rights of people with a mental health disorder. People detained under the Mental Health Act need urgent treatment for a mental health disorder and are at risk of harm to themselves or others.

In this Five Minutes With feature, Louise expands on what led her to pursue a career in this specific field and discusses some of the common misconceptions about the Mental Health Act.  

a picture of louise, blonde with glasses

Hi Louise, please could you start by telling us a little bit about yourself and what you do at Team BSMHFT?

Professionally, I am a nurse, and I will be celebrating 29 years this year, both as a nurse and working within BSMHFT. It seems a lifetime ago when I started my nurse training in Wolverhampton back in 1992!

I loved being a nurse and spent time in secure care and rehabilitation, but also wanted the challenge of influencing patient care and rights in a different way, that’s when I made the switch to Mental Health Legislation. 

I’m currently the Head of Mental Health Legislation and I have been doing this role for 17 years this year! This is the longest I have ever been in a role, but I think that is because the role changes so often I haven’t felt the need to move on.

The key aim of my role is ensuring the service users who are detained under the Mental Health Act (MHA) or Mental Capacity Act (DoLS) are done so lawfully and get the best experience. This could not be done without the very skilled and knowledgeable team of Mental Health Legislation (MHL) administrators who work tirelessly every day to ensure that detentions and treatment are done within the confines of the MHA. They are the unsung heroes.

I also work with partner agencies such as Care Quality Commission, police, local authority, Lay Managers and many others, and this gives different perspectives on the work we do in the Trust around the MHA and helps us to continually strive to be the best at what we do.

louise at the Trevi fountain in Italy

The role is very satisfying and challenging at times, and I am still learning all the time.

I’m a mom and a cat lover! My daughter is my greatest achievement in life. Despite some very challenging times and experiences, I think of myself as a survivor who has come out stronger! I love the theatre and crafting and often do craft fayres as an outlet for my makes. I also love to travel, and I have almost been everywhere I want to go, 24 countries at my last count, but those left on my list are Alaska, and Japan as I would love to see the cherry blossom. Although I’m sure new adventures will call me in the future…

Why did you decide to pursue a career in mental health specifically?

When I was at school, the career advice was army for the boys and teaching for the girls, so our options were limited! So I had always set my sights on teaching English in France and had worked as part of an educational psychology team in Limoges to gain the necessary experience.  

Back home, I had a summer job working with children with learning disabilities and fell in love with it! So, I decided to train to be a Learning Disability (LD) nurse instead of teaching. After passing the extensive recruitment process and exam to get onto the training, I was informed that the LD nurse training had been phased out, but I could do mental health instead. 

And the rest as they say is history. I instantly loved it from the first day on a ward and have never considered leaving.

This was back in the early nineties and mental health wasn’t really spoken about, so as a career option, it was never mentioned in school. Luckily, we have come a long way and hopefully more young people are aware of mental health nursing as a career.

For many patients and even families, the concept of sectioning can be scary, please could you tell us some of the common misconceptions you hear?

The thought of being sectioned must be very scary for people who are already suffering with their mental health. However, I would say that the Mental Health Act (MHA) offers very structured safeguards. The criteria for detention is set by the MHA, not by the professionals assessing the person, and two different professionals are involved, a doctor and an AMHP (Approved Mental Health Professional). This is usually a social worker but can be a nurse. 

This means that the decision to detain someone under the MHA is not in the hands of just one person and is independently assessed. There are also very strict rules about providing treatment, allowing leave from the hospital and the right to appeal against the detention. An additional safeguard here is if the person is too unwell to make that appeal, the Mental Health Legislation (MHL) team do so on their behalf. Patient rights are not only important but a legal requirement under the Mental Health Act.

All people detained under the MHA are provided with details of how to obtain appropriate legal representation if they wish, and also a referral to an Independent Mental Health Advocate (IMHA), who are advocates specifically trained to work with the MHA, to ensure they are supported every step of the way by people independent of our hospitals. The person’s nearest relative also has powers under the MHA, to be consulted for some detentions, and to request their discharge from others. The MHL offices are always there to provide this information and advice.

The MHL department do close monitoring of compliance with these requirements and require formal monthly monitoring from the senior clinicians in clinical areas and this is formally reported into the Trust committees to ensure any areas that may need improvement are supported to do so.

I was approached a few years ago to be an expert advisor on the MHA for the Care Quality Commission. I was proud to do this role as you have the opportunity to be involved in ensuring practice and procedures are appropriate and productive. There are service user and carer representatives on this group which provides greater insight of the impact the work we do as mental health care providers.

We are also closely scrutinised by Care Quality Commission to ensure we are acting in line with the Mental Health Act. They undertake a number of unannounced MHA inspections across our wards. Although we don’t get a formal rating for these visit, we are issued with a report and required to submit a formal action statement to address any issues raised. In the overall comprehensive inspection, both MHA and MCA had positive feedback for all areas, of which we are very proud.

We rarely get any complaints in relation to the Mental Health Act, and take these very seriously if we do, as our role is to ensure any detention with us is lawful. 

Has there ever been a stand-out moment in your career that has made you pause and reflect?

There have been many times in my career where I learnt something significant or been proud. 

However, of all of them, the first that comes to mind was when I was selected to represent the Trust with a couple of other senior colleagues in Finland. 

The purpose of this was to share how we managed violence and aggression without the use of seclusion. We presented to all disciplines of clinical staff in Kellokoski and saw how they treated their patients in mental health hospitals. It was an eye opener and reinforced how advanced and patient-centred we are here. 

Louise looking at a lake in the distance

Past, present or future, what three people would you most want to sit down for a meal with?

Past – Tina Turner. What an inspirational woman she was. Despite the horrendous domestic violence she experienced, she not only survived but was strong, kind and so talented!

Present – Will I Am. He was brought up by a single mom and shows the utmost respect and love for women. He does so much work for good causes, and he is the quirkiest most fascinating, intelligent man! I don’t think one meal would be enough.

Third person – Emily Bronte, to thank her for writing my favourite ever book Wuthering Heights. I won’t say how many copies of this book I have… but my earliest edition is 1942.

Tell us something that people might not know about you

I was the regional chess champion in Staffordshire, and I sang with Tina Turner on the stage at Wembley stadium back in the ‘90s.

Describe yourself in three words

Eternally loyal, strong but a terrible over thinker.