The Government has published a white paper on reforming the Mental Health Act 1983, promising that its proposed changes would provide patients with greater choice and autonomy in a mental health crisis.
The Department of Health and Social Care said the reforms – building on the recommendations made by Sir Simon Wessely’s Independent Review of the Mental Health Act in 2018 – would also:
- deliver parity between mental and physical health service
- tackle mental health inequalities including disproportionate detention of people from black, Asian and minority ethnic (BAME) communities
- address the use of the 1983 Act to detain people with learning disabilities and autism, and
- improve care for patients within the criminal justice system.
The reforms, some of which will require a new Mental Health Bill, will also ensure 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 DHSC said.
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.
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.”
Amongst other things 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”, the Department said.
The White Paper also says 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, the DHSC said.
For changes which require legislation, consultations will continue until early spring 2021. A draft Mental Health Bill will be shared next year.
Four principles, developed by the review and in partnership with people with lived experience, will guide and shape the approach to reforming legislation, policy and practice, the DHSC said. These are:
- Choice and autonomy – “ensuring service users’ views and choices are respected”
- Least restriction – “ensuring the Act’s powers are used in the least restrictive way”
- Therapeutic benefit – “ensuring patients are supported to get better, so they can be discharged from the Act”
- The person as an individual – “ensuring patients are viewed and treated as rounded individuals”
Responding to the launch of the white paper, Cllr Ian Hudspeth, Chairman of the Local Government Association’s Community Wellbeing Board, said: “Mental health inequalities have been exacerbated by the coronavirus pandemic and this white paper is an excellent opportunity to update the law and improve support for everyone who needs it. We strongly support the objective to give people a stronger say in their treatment.
“Councils play a significant role in mental health, both in terms of its statutory duties under mental health legislation and supporting treatment and recovery.
“The challenges with the current Act are also indicative of a system that is under strain because of increased demand and reduced funding. Any reform of the Mental Health Act needs to include ongoing funding for councils’ mental health services, so they can continue to invest in effective support to meet existing, new and unmet demand.”