Commissioned by Theresa May in June 2017, an independent review of the Mental Health Act has proposed a myriad of changes. Sir Simon Wessley, the psychiatrist who led the review, has made 150 recommendations: from the right to challenge diagnosis to tackling racial inequality.
"This is what the Mental Health Act Review is about. It’s not about service improvement; it’s about making sure that when people are in most need their lives are made better, not worse".
Charities have, to varying degrees, welcomed the review's recommendations - here are some of their initial thoughts:
Lord Victor Adebowale - Chief Executive:
"This thoughtful and comprehensive report rightly puts the excessively poorer experiences and outcomes of individuals from black African and Caribbean communities front and centre. The charge of institutional and structural racism may make for uncomfortable reading for some but the evidence is overwhelming and it is high time this issue was addressed. The challenge now is to ensure that we rigorously implement Sir Simon Wesseley's recommendations in full."
Hearing Voices Network
Akiko Hart - board member and trustee:
"Whilst we recognise the good intentions, dedication and heart of those who contributed to this review, we cannot ignore its failure to address widespread and institutional abuse and the ongoing erosion of people’s human rights. This is not the time for timid changes or placating promises, it is a time for action and an opportunity to revision the support we offer to those in most distress".
Jacqui Dyer - Councillor:
"The review recommendations, if implemented robustly, will make a serious effort to address the “burning injustices” of variable experiences of detention under the Mental Act and of mental health care. Black African and Caribbean people experience significantly higher detentions under the MHA than other main ethnic groups. This inequality in access to mental health services is known to be one of the greatest across healthcare provision. As a carer and service user I do feel that if these recommendations were already present then my brother would still be alive and experiencing the most wonderful, culturally-appropriate and humane mental health services in the world. I am therefore hopeful, and will be leading, with equally committed peers, on making these transformations happen, which ultimately enable positive health outcomes for our citizens when they are at their most vulnerable".
National Survivor User Network
Sarah Yiannoullou - Managing Director:
"NSUN is network of people who have or might in the future be affected by the Mental Health Act. Our members, and the organisations they lead, live with the results of shortcomings in mental health legislation every day.The individuals and groups that form our network are far more likely to experience practices and events that result from the Mental Health Act than the rest of the population. These include being detained, spending time in secure units, or being assessed under the Mental Health Act. Our members have been calling for a reform to mental health law, through the Members’ Manifesto, to make sure vulnerable people do not have their rights ignored or suffer harms from services intended to help them when they are in need.
"NSUN recognises the recommendations of the Mental Health Act Review as incremental steps toward a better situation, but feel they are just that: steps covering ‘proposals on advance directives, nearest relatives, access to advocacy, better safeguards and a new right of appeal against compulsory treatment’. If they are put into action they will at best improve what is already in place; but they aren’t the end point for the change needed. It’s up to all of us to continue to refuse to have such low expectations for what could actually change.
"NSUN welcomed the surprise announcement of Independent Review of The Mental Health Act in June last year as an overdue opportunity to advocate for a rights-based approach to mental health treatment. The speed with which the review was set up and carried out reflects the real need for change. As an independent collective we were keen to contribute to the gathering of alternative approaches and solutions derived from the experience of people who have been subject to the Act.
"At the beginning of the review NSUN raised the issue of fundamental human rights and existing frameworks and recommendations (e.g. the UN Convention on Rights of Persons with Disability) for ensuring everyone is treated fairly and without discrimination. There will be a lot commentary about the potential impact of these recommendations now they have been published. We will be publishing our understanding of the difference they can make but will continue to call for a reform that is fully compliant with human rights arguing that currently all people have rights but some have more rights than others.
"If you were to turn up at A+E in distress you’d want to be helped with open arms and with care, you wouldn't expect to be turned away, left stranded and alone, scared of what you’re feeling and scared of having your freedom taken away. If you did find yourself needing ‘psychiatric care’ you wouldn’t expect to have to fight for the right to decide what should happen to you; you wouldn’t expect to have your concerns about what’s right for you minimised and you wouldn't expect to experience physical restraint, being ignored or being left with nothing to do but wait until you’re discharged.
"In any circumstance, you’d expect to have support to understand the treatments you’re being given; you’d expect that someone would explain to you what was happening, you’d expect that someone would help you plan what needed to happen when you went home. You wouldn't expect to be treated less well because of your ethnicity, your gender, your age, your diagnosis, your sexuality or your beliefs.
"When things are really bad and really, really hard you’d expect to be treated as someone in need of help and understanding not a criminal or an inconvenience. You’d expect that people would help you feel safe and that you matter. You wouldn’t expect to have to live to a set of rules that other people don't have to live to, you wouldn’t expect to have rights that could be taken away for reasons that aren’t clear to you at the time. You wouldn’t expect that your experience of treatment would be something that might also cause you further distress, isolation and trauma.
"This is what the Mental Health Act Review is about. It’s not about service improvement; it’s about making sure that when people are in most need their lives are made better, not worse.
"We must not forget that the Mental Health Act Review is about real people’s lives. The effects won’t end once the dust settles; NSUN members will live with the results every day. The recommendations of the review aren’t the achievement; it’s what happens and what changes because of the recommendations. We think there’s room for more exploration, more lived experience and more focusing on the future we want".
Centre for Mental Health
Sarah Hughes - Chief Executive:
“The Mental Health Act plays such an important part in governing the way people are supported when they are most unwell. It gives the state powers to detain and treat people against their will, and as such it is vital that the Act is modernised to ensure people have their rights taken seriously at every stage and that everyone is treated with dignity and respect throughout.
“The Mental Health Act we have today is in many ways outdated and paternalistic. The Review’s recommendations should go a long way to bringing the Act into the twenty-first century by ensuring people have more rights to say how they want to be treated, including by making advance decisions that professionals have to take more seriously. Its proposals to extend access to independent advocacy and restrict the use of community treatment orders should also help to put more limits on the use of coercion. And its recommendations for improved safeguards throughout the system should help to ensure that fewer people spend months and years in locked wards when they no longer need to be in hospital.
“The report makes important recommendations to tackle longstanding inequalities in the use of the Act, particularly among people from African and Caribbean communities and other minority ethnic groups who continue to be disproportionately subject to compulsory powers. It is vital that the review’s recommendations for race equality are implemented in full as part of a much wider effort to tackle racism and discrimination at every level in our society.
“It also makes important recommendations to ensure people in prison are transferred to hospital more quickly. We know that too many prisoners are made to wait for weeks and months for treatment when they are acutely unwell.
“The report’s recommendations in sum should ensure that the Mental Health Act is better governed, that people’s rights are respected and that fewer people are subject to compulsory powers and for less time. It is therefore essential that its recommendations are implemented in full in order to achieve the level of change we know is needed to modernise the Mental Health Act.”
Paul Farmer - Chief Executive of Mind:
"Mind welcomes the review and the recommendations of the panel. This outdated legislation has seen thousands of people experience poor, sometimes appalling, treatment, who still live with the consequences to this day. We are pleased to see that many of our concerns – and those of the people we represent and have supported to feed into the review – have been heard.
“The recommendations to strengthen people’s rights, empower them to question decisions about their care, choose their treatment and involve friends and family have the potential to make a real difference to those who are in an extremely vulnerable situation. We back the call for people on mental health wards to have a legal right to an independent advocate and agree that people who have been detained should be able to choose which family members and friends can make decisions about their care and treatment.
“It’s good to see the review address racial inequalities. We know that black people are disproportionately sectioned, are more likely to be restrained, and are most likely to be put on a Community Treatment Order. These orders have been proven ineffective in reducing hospital readmission. Tightening the rules for imposing them is a small step in the right direction but we are disappointed that the review has not called to scrap them. Likewise, we back the promotion of race equality in mental health services and in the use of the Act but this must come with concrete commitments, including that the NHS builds relationships with local communities.
“The Government now needs to take this review forward as soon as possible so that people with mental health problems get the support they need. A key test of the recommendations will be their impact racial inequality and we look forward to the NHS long-term plan which will set out how mental health care will be transformed. These recommended changes are much needed but detentions will only reduce when people have access to quality, culturally relevant and timely care, so that fewer people end up in a mental health crisis.”
Rethink Mental Illness
Mark Winstanley - CEO:
“Rethink Mental Illness has long campaigned for reform of the vital but outdated Mental Health Act. Countless people have told us how they felt disrespected and lost all control of their care while treated under the Act. The Review’s recommendations can change that. By giving people more rights to shape their own treatment, choose how to involve loved ones, and more power to challenge decisions, the Review shows how mental healthcare can respect people’s rights while they are very unwell. We are really pleased to hear that the Prime Minister has welcomed the Review and that the Government plans to bring forward a new mental health bill. We are ready to work with the Government, Parliament and the NHS to help make this happen.”
- See more: Interracial therapy: It's not as black and white as it may seem
- See more: Interview with Simon Wessely, the psychiatrist who led the independent review
Emma Thomas - Chief Executive:
"The Mental Health Act review represents a welcome step forward in reforming mental health law, and it's important that it focuses on children and young people's rights. The report includes some positive proposals that would mean that children and young people are only treated in hospital when absolutely necessary, and which would strengthen and clarify their rights to be involved in – and challenge – decisions about their care. We hope that the Government takes action to consider and implement these proposals. It is also vital that we see greater investment in early intervention, so that more young people receive support in their communities before they reach crisis point".
Marjorie Wallace - Chief Executive:
“The need for this review springs directly from the fact that psychiatric services are a broken system. More than half of mental health patients in hospital today are detained under section compared with less than ten per cent thirty years ago, a disproportionate number from black and other ethnic minorities.
“One reason for this is the continuing, relentless closure of psychiatric beds, which means some doctors can only obtain the care and treatment their patients need by having them sectioned and deprived of their liberty.
“Shockingly, those who have been detained report appalling experiences, with acute psychiatric wards so squalid and threatening that they refuse to be readmitted unless forced to do so.
“SANE hopes these recommendations might lead to more therapeutic conditions on existing wards, the creation of new safe places so that the police never need to use cells, and patients being supported when they are at highest risk after discharge. Inpatient treatment needs to be a positive experience, not a punishment.”
National Autistic Society
Jane Harris - Director of External Affairs:
"We welcome the review's recommendations to: strengthen people's right to challenge their detention; put care and treatment reviews on a statutory footing; give people greater rights to choose who in their personal life they want involved in their care; and set out the NHS and local councils' duties to create more community-based services for autistic people. These changes will improve autistic people's chances of getting out of inappropriate inpatient care more quickly.
“But we and many autistic people and their families are bitterly disappointed by the review's failure to recommend changing the definition of mental disorder. It is absolutely wrong that this includes autism as fundamentally autism isn't a mental disorder, it is a lifelong disability.
“The Government promised to review the definition in November 2015 and it needs to fulfil this promise urgently. Until this changes autistic people will continue to suffer from inappropriate treatment by professionals who don't understand them and the kind of support they need."
Tim Cooper - Chief Executive:
“Sir Simon Wessely’s review into the Mental Health Act shines welcome light onto some very disturbing assessment and treatment practices for some of the most vulnerable people in our society.The review’s findings are deeply worrying, especially those concerning people with learning disabilities or autism where compulsory treatment must be a last resort.
“It is absolutely unacceptable that more than seven years after the Winterbourne View scandal some people with a learning disability or autism are still being ‘warehoused’ in locked and unsuitable rehabilitation wards which only serve to exacerbate their problems.
“We fully endorse the review’s recommendations to restore dignity to people and to the system, and for more robust safeguards to ensure appropriate use of the Mental Health Act. But there is no getting away from the stark reality that these recommendations come at a time when adult social care faces a funding gap of £3.5bn by 2025 just to maintain existing levels of care. The CQC has recently confirmed that demand for care is rising and its sustainability is a huge challenge.
“Set in this context, the report’s key recommendation that social care commissioners must ensure a sufficient supply of community-based support for people with a learning disability or autism to avoid admission becomes an unachievable aspiration.
“The Government’s Transforming Care agenda referenced by Sir Wessely is widely perceived to have stalled because of the wider crisis in social care. Today’s recommendations are meaningless without genuinely new investment in social care infrastructure, funding for local authorities to pay care stuff at National Minimum Wage rates and a drive to fix the sector’s well-documented recruitment crisis.
“Government has an opportunity to set out its plans to fix social care with its long-awaited Green Paper, the content of which will dictate whether any of this review’s recommendations for the Mental Health Act are feasible.”
See MHT's In Our Right Mind campaign to see how we want the Mental Health Act to look: https://www.mentalhealthtoday.co.uk/in-our-right-mind
N.B. This page will be updated as more charities respond.