A long-awaited overhaul of the Mental Health Act 1983 has been formalised by the Department of Health and Social Care in a white paper proposal. The reforms will potentially transform mental health care to a greater focus on prevention and individual patient needs.
For a long time, the nearly 40-year-old legislation has been criticised by mental health advocates and patients for the frequent draconian use of the Act to detain and treat individuals long-term against their wishes.
Often initial contact with mental health services, and being sectioned under the Mental Health Act, can be frightening, confusing, and occasionally violent. And routinely, this terrifying atmosphere has continued once detained, as many patients have experienced the excessive use of physical and chemical restraints and the enactment of counter-intuitive policies such as forced isolation and unconsulted treatment plans.
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Additionally, the Act's use has been misapplied to specific demographics, as detentions of individuals disproportionally affect Black people who are four times more likely to be held against their wishes and are ten times more likely to be subject to a community treatment order. Also including people with learning disabilities or autism, who have been sectioned under section 3 of the Act without a co-occurring mental health condition.
Public consultation on reforms to continue to early spring
The majority of the recommendations of the 2018 Independent Review have been incorporated into the provisional legislation, and the Government has now opened up a public consultation process for people to give their view on the proposed reforms.
Recommendations contained in the white paper’s package of reforms include:
- Ensuring that the Act is not used to detain people solely because they have a learning disability or are autistic.
- Proposing that the Act is used in less restrictive ways, and there is a facilitation of greater choice and autonomy for patients through the introduction of ‘advance choice documents’, which will allow people to express their prior wishes and preferences for care if they are incapacitated.
- The implementation of the individual's right to nominate a person who is best placed to advocate their interests under the Act if they cannot do so themselves.
- The tackling of racial disparities in mental health services, including the piloting of culturally appropriate advocates.
- An increased scrutinisation of how the Act is implemented.
- A greater focus on community-based mental health illness support to avoid preventable detentions.
- A 28-day time target for the speeding up of prisoners' transfer to hospital for mental health treatment.
Matt Hancock, Health and Social Care Secretary, said of the reforms that: “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.”
The long-awaited reforms have also been widely praised by mental health charities, who have welcomed the updating of legislation rooted in a 19th century understanding of mental health.
Sophie Corlett, director of external relations at Mind, said: “It is reassuring to see that many of Mind’s concerns – and those of the people with experience of the Mental Health Act who we supported to feed into the Review – have been heard. We must now see as many people as possible with experience of mental health problems take part in the public consultation process, to make sure their voices and experiences are at the heart of reforms.”
Sean Duggan, chief executive of the Mental Health Network, which is part of the NHS Confederation, also welcomed the reforms, as well cautioning that any additional cost that may incur from the implementation of any new legislation should come from new sources rather than from already stretched budgets: “We will work with our members to respond to the consultation, to help ensure that the practicalities of implementing the improvements have been fully thought through. This is more critical than ever as the impact of the pandemic means the very real prospect of significantly increased demand for mental health services.”
This white paper is one of the early steps in the process of changing the law, the next step is the public consultation that the Department of Health and Social Care said would last to early spring 2021, and then onto an aim that a draft Mental Health Bill will be shared early next year.