Assessing the landscape
December 2023 marked five years since the Independent Review of the Mental Health Act. The initial aims of this Review were to confront racial inequalities faced by black and ethnic minority communities detained under the Mental Health Act, address the sharp rates in detention and modernise mental health-related processes, with the goal of creating responsive and modern mental health services, fit for purpose in the 21st century.
Persistent disparity – racial inequality
There are substantial disparities between who becomes subject to the Act. The statistics are stark, particularly for black people, who are still four times more likely to be detained and eight times more likely to be discharged from hospital with the further restrictions of a Community Treatment Order (CTO). However, this is a slight decrease from 10 times more likely. There is an urgent need to ensure that people of Black African and Caribbean descent with poor mental health receive the treatment and support they need without being discriminated against.
The latest NHS figures (January 2024) have only demonstrated the continued urgent need for reforms, especially inequalities that are deeply rooted in our society.
Whilst there has been an 8% reduction in the number of people detained under the Mental Health Act, the figure remains at over 50,000, with people from deprived communities also almost four times more likely to be detained. This highlights the disproportionate impact not just on racialised communities, but also from those that may otherwise be marginalised.
Missed opportunities
As we look back, it’s clear that the recommendations from the Independent Review remain as relevant today as they were then – if not more so. While the mental health landscape has seen notable developments, including the launch of a Mental Health White Paper in 2021 and a Draft Mental Health Bill in 2022 which faced pre-legislative scrutiny in January 2023, the recent King’s Speech (Autumn 2023) omitted any mention of Mental Health Act reform, which means any reform will now most certainly be carried out by the next Government.
We know that the Independent Review recommended changes to the law to make it easier for patients and service users to participate in decisions about their care, to restore their dignity and recognise the importance of human rights in mental health care.
But, morally and ethically, we should all know that giving people more choice and control over what happens to them, ensuring they receive the care and support they need and are not treated differently based on their identity are the basic principles that should be upheld by all professionals and services. This shouldn’t require changes to a law. Is it not incumbent upon us all to read the original report again and take responsibility for enacting change where we can, to ensure that people who use services remain at the heart of everything we do and receive the support they need?
At the same time, we also know that there is a need for mental health to be centred, for the longstanding aim of parity of esteem to be achieved and for voluntary, community or social enterprise (VCSE) mental health services to be equally considered and valued alongside the NHS. However, Government’s decision to not proceed with the Mental Health and Wellbeing Plan amounted to another lost opportunity.
Ongoing challenges
In the years following the review, service providers and communities have continued to face considerable challenges, dealing with deep-seated structural inequalities worsened by the pandemic, an ongoing cost-of-living crisis and a renewed emphasis on tackling racial injustice, provoked by the tragic murder of George Floyd in 2020.
Therefore, it is crucial to recognise that mental health is impacted by several factors, including wider social and economic determinants as well as inequalities. So, any related legislation and proposals for change cannot be enacted in silo but must take a cross-departmental Government approach and be achieved through collaboration.
There needs to be a greater emphasis on preventing the development or worsening of mental health conditions to avoid people reaching crisis and improving the lives of individuals with mental illness. Considering the wider determinants of a person’s mental health, such as education, employment, financial security, housing/accommodation and good access to appropriate health and social care services, it is important that policies in these areas do not place a person’s mental health at risk.
Fixing a struggling mental health system is contingent on funding and we must emphasise that consistent financial support of NHS, VCSE, social care, community and primary care services is crucial to effect positive change and not burden a system already under strain.
Voices for change
As we look back on the five years since the Independent Review of the Mental Health Act and 2022’s consultation on the Mental Health and Wellbeing Plan, it is evident that significant work lies ahead. The unified voices of advocates, professionals and communities echo a resounding call for timely and substantive reform.
It is crucial for this Government and all political parties to not only hear but genuinely commit to reform – taking tangible actions and moving beyond mere promises and rhetoric. The mental health landscape necessitates a paradigm shift and the moment for transformative change is upon us.
In the pursuit of reforming the Mental Health Act and the wider mental health system, of which the VCSE sector is a vital component, it is essential to persist in amplifying voices, challenging existing norms and advocating for a system that prioritises the wellbeing of all, with a particular emphasis on marginalised communities.
A call to action
Despite breaking the Conservative Party’s manifesto pledge by excluding reform from the King’s Speech, the Minister of State for Social Care, Helen Whately, reaffirmed Government’s commitment to reform, achieving parity, and ‘bringing forward the Bill when parliamentary time allows’.
The Labour Party, as the Conservatives did pre-election, have also pledged to reform the Mental Health Act, if elected, in their first King’s Speech, a commitment that has been welcomed by the sector. Concerningly, however, Shadow Cabinet Minister for Mental Health, Dr Rosena Allin-Khan, had only resigned two months prior, having been informed by the Party Leader that he does, ‘not see a space for a mental health portfolio in a Labour cabinet’, a role now downgraded to combine with another portfolio.
Following many years of work and contributions by organisations, professionals and most importantly, people with lived experience of mental health conditions and their families and carers, we cannot lose the voices that have informed Mental Health Act reform and the Mental Health and Wellbeing Plan. As we draw closer to another election, it is essential that political parties make commitments that they can and will deliver to ensure that the mental health system is fit, not just for the future, but for now.
What action do you think needs to be taken to reform the Mental Health Act? Leave a comment on this article or join the conversation to share your thoughts.
Kathy Roberts is Chief Executive at the Association of Mental Health Providers.
Email: [email protected]