‘Landmark’ Mental Health Act reforms announced

The government has announced plans to reform the Mental Health Act and give those detained under it more control over their care and treatment.  

The Department for Health and Social Care (DHSC) said the Reforming the Mental Health Act White Paper aims to better meet the needs of people with learning disabilities and autism, tackle the racial disparities in mental health services and ensure appropriate care for people with serious mental illness within the criminal justice system.

The reforms will change the way people with a learning disability and autistic people are treated in law by recognising a mental health inpatient setting is often not the best place to meet their specific needs.

The proposal sets out that neither learning disability nor autism should be considered a mental disorder for which someone can be detained for treatment under Section 3 of the Act.

Instead, people with autism or a  learning disability could only be detained for treatment if a co-occurring mental health condition is identified by clinicians.

Health bosses said decisive action will also be taken to help tackle the disproportionate number of people from Black, Asian and Minority Ethnic communities detained under the Mental Health Act, as black people are four times more likely to be detained under the Act and over ten times more likely to be subject to a Community Treatment Order.

A national organisational competency framework for NHS Mental Health Trusts will be introduced, referred to as the ‘Patient and Carers Race Equality Framework’ (PCREF).

The PCREF will be a practical tool which enables Mental Health Trusts to understand what steps it needs to take to improve Black, Asian and minority ethnic communities’ mental health outcomes.

Improved culturally appropriate advocacy services will be piloted where needed, so people from BAME backgrounds can be better supported by people who understand their needs.

The benefits of reform will also be felt by people with serious mental illness within the criminal justice system. A 28-day time limit is being proposed to speed up the transfer of prisoners to hospital, ending unnecessary delays and ensuring they get the right treatment at the right time.

Sarah Hughes, chief executive at the Centre for Mental Health, welcomed the news, adding that she hoped the White Paper would be a step towards mental health legislation that respects and protects people’s rights and dignity

‘The need to modernise the Mental Health Act could not be clearer.

‘Every year, the number of people who are sectioned grows. While we know this can save lives, the use of coercion can also cause lasting trauma and distress.

‘And we have known for too long that Black people are subjected to much higher levels of coercion at every stage of the system. It is time for this to change.

‘We need to redress the power imbalance between people subject to the Act and the state and to make the system fairer for all.

‘We hope that today will bring us a step closer to mental health legislation that respects and protects people’s rights and dignity, that reduces inequality and that turns the tide on the growing use of coercion.’

The government will also consult on a number of proposed changes, including:

• Introducing statutory ‘Advance Choice Documents’ to enable people to express their wishes and preferences on their care when they are well, before the need arises for them to go into hospital;
• Implementing the right for an individual to choose a ‘Nominated Person’ who is best placed to look after their interests under the Act if they aren’t able to do so themselves;
• Expanding the role of ‘Independent Mental Health Advocates’ to offer a greater level of support and representation to every patient detained under the Act;
• Piloting culturally appropriate advocates so patients from all ethnic backgrounds can be better supported to voice their individual needs;
• Ensuring mental illness is the reason for detention under the Act, and that neither autism nor a learning disability are grounds for detention for treatment of themselves;
• Improving access to community-based mental health support, including crisis care, to prevent avoidable detentions under the Act. This is already underway backed by £2.3bn a year as part of the NHS Long Term Plan.

Sophie Corlett, director of external relations at Mind, said it is important that those who have been detained under the Act are included in the consultation.

‘We are pleased the government  has accepted the majority of the recommendations made in the Independent Review in their long-awaited Mental Health Act White Paper.

‘At the moment, thousands of people are still subjected to poor, sometimes appalling, treatment, and many will live with the consequences far into the future.  Change on the ground cannot come soon enough.

‘It is important those who have been detained under the Mental Health Act, as well as their loved ones, feed into the consultation, helping shape the reforms.

‘Given Black people are four times more likely to be sectioned than white people, it’s crucial the government hears from people from different Black, Asian and Minority Ethnic groups.

‘We want to see steps taken to identify, address and tackle underlying and systemic racism that results in disproportionate detentions and use of force.’

For changes which require legislation, consultations will continue until early spring 2021 to listen to the concerns people have, and a draft Mental Health Bill will be shared next year.

Health secretary Matt Hancock said the White Paper sets out the path towards the government’s commitment to introduce the first new Mental Health Bill for 30 years, and end the stigma of mental illness once and for all.

‘I want to ensure our health service works for all, yet The Mental Health Act is now 40 years old. We need to bring mental health laws into the 21st century.

‘Reforming the mental health Act is one of our central manifesto commitments, so the law helps get the best possible care to everyone who needs it.

‘These reforms will rightly see people not just as patients, but as individuals, with rights, preferences, and expertise, who are able to rely on a system which supports them and only intervenes proportionately, and which has their health and wellbeing as its centre.

‘This is a significant moment in how we support those with serious mental health issues, which will give people more autonomy over their care and will tackle disparities for all who access services, in particular for people from minority ethnic backgrounds.’

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