By Gavin Mackintosh-
A major reform of the Mental Health Act will empower individuals to have more control over their treatment and deliver on a key manifesto commitment.
The reforms will deliver parity between mental and physical health services and put patients’ views at the centre of their care. It is to involve a consultation process. The huge milestone will help 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.
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The plan will tackle mental health inequalities including disproportionate detention of people from black, Asian and minority ethnic (BAME) communities, the use of the act to detain people with learning disabilities and autism, and improve care for patients within the criminal justice system.
People with mental health issues who are detained under the Mental Health Act will benefit from the landmark reforms, which provide more control over their care and treatment, the government announced today.
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.
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It includes 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.
Other proposed measures include expanding the role of independent mental health advocates to provide greater support and representation to patients and limiting the circumstances in which people with autism or learning disabilities .
The British government has also committed to ending the practice of using prisons as ‘places of safety’ for defendants with acute mental illness. Instead, judges will work with medical professionals to ensure defendants can always be taken directly to a healthcare setting from court.
Racial Disparities
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.
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 proposal prohibits learning disability or autism from being 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.
Dr Adrian James, President of the Royal College of Psychiatrists welcomed the publication of the white paper as ”a great opportunity to modernise mental health law and improve safeguards and support for people in a mental health crisis”.
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 £62 million Community Discharge Grant to make further progress on discharging people with learning disabilities and autism from inpatient care.
The white paper also takes steps to ensure parity between mental health and physical health services. The government is already 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.
High impact changes are already under way – including vital capital spend on the mental health estate, and work to pilot and develop the Patient and Carer Race Equality Framework.
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.
Health and Social Care Secretary Matt Hancock said:
”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.
Independent mental health advocates are to offer a greater level of support and representation to every patient detained under the act. It will also
pilot culturally appropriate advocates so patients from all ethnic backgrounds can be better supported to voice their individual needs
Improving access to community-based mental health support, including crisis care, to prevent avoidable detentions under the act is already underway backed by £2.3 billion a year as part of the NHS Long Term Plan
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.
Decisive Action
The paper also proposes “decisive action” to address the substantial racial disparities in the use of the act, under which Black people are four times as likely to be detained and ten times more likely to be subject to a community treatment order than white people.
It includes piloting culturally appropriate advocacy services, and the further development of the Patient and Carer Race Equality Framework, which is designed to improve mental health trusts’ response to Black Asian and minority ethnic communities.
Health and Social Care secretary Matt Hancock said the proposed changes would “give people more autonomy over their care and will tackle disparities for all who access services, in particular for people from minority ethnic backgrounds”.
Wessley, the psychiatrist who chaired the 2018 review, said “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.”
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.
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 4 times more likely to be detained under the act and over 10 times more likely to be subject to a community treatment order.
Advocacy Services
A 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 £62 million Community Discharge Grant to make further progress on discharging people with learning disabilities and autism from inpatient care. The proposed changes in the legislation will 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 already 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.
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.
Lord Chancellor and Justice Secretary Robert Buckland said:
Prisons should be places where offenders are punished and rehabilitated, not a holding pen for people whose primary issue is their mental health.
Keeping people safe must be at the heart of everything this government does, and the reforms announced today will allow us to do this while ensuring offenders still get the treatment their conditions require.
The government also commits to ending the outdated practice of using prisons as ‘places of safety’ for defendants with acute mental illness. Instead, judges will work with medical professionals to ensure defendants can always be taken directly to a healthcare setting from court.
Victims of all mentally disordered offenders will now have the option of being assigned a dedicated victim liaison officer to keep them informed of key developments in the offender’s case, including when the patient is discharged.
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