Landmark reform of mental health laws

January 13, 2021

The Government has announced landmark reforms of mental health laws today, which are said to provide more control over care and treatment for people detained under the Mental Health Act.

A package of reforms has been set out in a wide-ranging new Reforming the Mental Health Act White Paper, which builds on the recommendations made by Sir Simon Wessely’s Independent Review of the Mental Health Act in 2018.

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.

At the heart of the proposed reforms to the Mental Health Act is greater choice and autonomy for patients in a mental health crisis, ensuring the Act’s powers are used in the least restrictive way, that patients receive the care they need to help them recover’ and all patients are viewed and treated as individuals.

The Government said these reforms aim to tackle the racial disparities in mental health services, better meet the needs of people with learning disabilities and autism and ensure appropriate care for people with serious mental illness within the criminal justice system.

The Government will 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.

As part of the reforms, the Government says decisive action will be taken to help tackle the disproportionate number of people from Black, Asian and Minority Ethnic communities detained under the Mental Health Act. Black people are over 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 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 reforms will also 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 a learning disability or autistic people could only be detained for treatment if a co-occurring mental health condition is identified by clinicians.

Significant investment in community support has led to a 29% reduction since 2015 in the number of people with a learning disability and autistic people in a mental health inpatient setting. The Government has established the £62m Community Discharge Grant to make further progress on discharging people with learning disabilities and autism from inpatient care. The proposed changes in the legislation are said to help to further reduce reliance on inpatient care.

The White Paper also takes steps to ensure parity between mental health and physical health services. The Government is investing over £400 million to eradicate dormitories in mental health facilities as part of its response to Sir Simon’s recommendations and its commitment to level up access to mental health services and rebuild better than before, so people admitted to hospital can receive care in a modern and genuinely therapeutic environment. Capital spend on the mental health estate is to said to be underway and work to pilot and develop the Patient and Carer Race Equality Framework.

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.

The Government also said that 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.

Minister for Mental Health and Suicide Prevention, Nadine Dorries said, 'I am committed to improving people’s experience under the Mental Health Act, and most importantly to making sure their care and treatment  works for them. We know people are too often disempowered and excluded from decisions, which is where the Act, and our ability to successfully support people often fails. Informed by Sir Simon’s recommendations, we will transform the Act to put patients at the centre of decisions about their own care.'

Mark Winstanley, CEO of Rethink Mental Illness said, 'The publication of the White Paper to reform the Mental Health Act is a hugely significant milestone in a long struggle for change. Many people will take for granted their right to have choice and control over the medical treatment they receive. But thousands of people every year who are severely affected by mental illness and who are detained under the Act lose those rights and temporarily their liberty. The proposals set out in the White Paper, all informed by the Independent Review of the Mental Health Act, give real hope for a more person-centred and principled Mental Health Act which better reflects how a modern society thinks about mental illness.'

Professor Sir Simon Wessley said, 'Since the introduction of the Mental Health Act back in 1959 attitudes towards mental illness have changed dramatically. It was time for our legislation to  catch up, so two years ago I presented my recommendations to modernise the Mental Health Act,  so that it works better for those it protects. Today the Government is taking the next steps to making these changes a reality. The Mental Health Act White Paper proposes changes which address amongst others rising rates of detention under the act, the disproportionate number of BAME individuals detained, and allows the patient voice to be heard better than in the past.'

Dr Adrian James, President of the Royal College of Psychiatrists said, 'The Royal College of Psychiatrists welcomes the publication of the White Paper. This is a great opportunity to modernise mental health law and improve safeguards and support for people in a mental health crisis. We will consult with our members on how the changes will work on the ground and look forward to engaging positively with the consultation over the coming months. This includes exploration of the resources necessary to implement the proposed changes.'

Sarah Hughes, Chief Executive at the Centre for Mental Health said, '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.”'

Visit the UK Government website for the latest information and guidance on Mental Health.

Marc Caulfield, Chief Executive and Co-Founder at Demolish the Wall, helps us to understand our mental health and how we can ensure we support ourselves and those around us.

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