Reforming the Mental Health Act

 

This week the government published a White Paper on Reforming the Mental Health Act White Paper.  This act dates back to the 1980s. I remember having to apply it when I acted as a manager for the purpose of Mental Health Act appeals back in that decade. It wasn't perfect then - it is seriously out of date now. So I am very pleased to see that mental health laws will be brought into the 21st century by reforming the a law which is nearly 40 years old,  delivering on a key promise in the Conservative manifesto The aim is to ensure our health service works for all and that we deliver parity between mental and physical health services. 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 at the core of the new system.    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.

These landmark reforms aim to end the stigma of mental illness once and for all: Following Sir Simon Wessely’s Independent Review of the Mental Health Act in 2018, the government is modernising our legislation and ensuring patients are put at the centre of decisions about their own care…

Patients will have more choice and control over their treatment – ensuring it works for them.  We will consult on a number of proposed changes including the introduction of ‘Advance Choice Documents’ – enabling people to express their wishes and preferences on their care when they are well, before the need arises for them to go into hospital – and the right to choose a ‘Nominated Person’ to look after their interests if they aren’t able to do so themselves. We are also looking to expand the role of ‘Independent Mental Health Advocates’ to offer a greater level of support and representation to every patient detained under the Act.   There will be parity between mental health and physical health services – so everyone has access to the best healthcare. The government is already investing over £400 million to eradicate dormitories in mental health facilities in response to Sir Simon’s recommendations and has made a 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. High impact changes are already under way – including vital investment in the mental health estate, and work to pilot and develop the Patient and Carer Race Equality Framework.   These reforms will tackle disparities for all who access services, in particular for people from minority ethnic backgrounds. Black people are over four times more likely to be detained under the Act and over ten times more likely to be subject to a Community Treatment Order – and we will tackle this disproportionate number by introducing a new national framework. This 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. In addition, 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.   WThere will change the way people with a learning disability and autistic people are treated in law. A mental health inpatient setting is often not the best place to meet their specific needs – and our proposals 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.   We will improve the system for those with serious mental illnesses within the criminal justice system. Prisons should be places where offenders are punished and rehabilitated, not a holding pen for people whose primary issue is their mental health. We are therefore proposing 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. We are also 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.

Four principles will shape our approach to reforming legislation, policy and practice:

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

Positive third party comments:

The President of the Royal College of Psychiatrists said our reforms will ‘ensure that patients are heard, their choices respected and that they are supported to get better in the least restrictive way’. Adrian James said: ‘The Royal College of Psychiatrists welcomes the publication of the White Paper. This is a great opportunity to modernise mental health law and improve safeguards and support for people in a mental health crisis. The reform of the Mental Health Act will help ensure that patients are heard, their choices respected and that they are supported to get better in the least restrictive way’. The CEO of Rethink Mental Illness descried our proposals as ‘a hugely significant milestone in a long struggle for change’. Mark Winstanley said: ‘The publication of the White Paper to reform the Mental Health Act is a hugely significant milestone in a long struggle for change. 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’.