'Long overdue' reform of the Mental Health Act announced to tackle inequalities

The Government publishes its long-awaited plans today (13 January) for reforms to the Mental Health Act 1983.

The reforms have been set out in a wide-ranging ‘Reforming the Mental Health Act’ white paper, which implements many of the recommendations made by Sir Simon Wessely’s Independent Review of the Mental Health Act in 2018, ordered by then Prime Minister Theresa May.

The 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.

There are also plans for 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, replacing the ‘nearest relative’ role.

Also included in the white paper are plans to expand the role of independent mental health advocates, piloting culturally appropriate advocates so patients from all ethnic backgrounds, and improving access to community-based mental health support, including crisis care, to prevent avoidable detentions under the act.

Health and Social Care Secretary Matt Hancock said it was a “significant moment” in the support for those with serious mental health issues, adding that it “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.”

Currently, 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. The reforms aim to tackle this with the introduction of a national organisational competency framework for NHS mental health trusts, referred as the ‘Patient and Carers Race Equality Framework’ (PCREF).

The Government says 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 also be piloted where needed, so people from BAME backgrounds can be better supported by people who understand their needs.

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.”

The proposals also set 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.

Claire Murdoch, Mental Health Director for NHS England, said the proposed reforms were “a welcome step towards ensuring that people with mental health needs, a learning disability or autism, remain at the centre of decisions about their care, and that longstanding inequalities in experience and outcomes are addressed.”

Also proposed is a 28-day time limit to speed up the transfer of prisoners to hospital, ending unnecessary delays and ensuring they get the right treatment at the right time. The government has also committed 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 also 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.

Dr Adrian James, President of the Royal College of Psychiatrists, welcomed the reforms saying: “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.”

Mark Winstanley, CEO of Rethink Mental Illness, called the reforms a “hugely significant milestone in a long struggle for change”, adding: “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.”