The government has published a new ‘Reforming the Mental Health Act’ white paper, which builds on the recommendations made by Sir Simon Wessely’s Independent Review of the Mental Health Act in 2018.

At the heart of the proposed package of reforms to the Mental Health Act is greater choice and autonomy for patients in a mental health crisis, ensuring the act’s powers are used in the least restrictive way, and that patients receive the care they need to help them recover and all patients are viewed and treated as individuals.

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.”

The government states that the aim of the white paper is to:

- Empower individuals to have more control over their treatment and deliver on a key manifesto commitment.

- Deliver parity between mental and physical health services and put patients’ views at the centre of their care.

- Tackle mental health inequalities including disproportionate detention of people from black, Asian and minority ethnic (BAME) communities, the use of the act to detain people with learning disabilities and autism, and improve care for patients within the criminal justice system.

Black people are more than four times more likely to be detained under the act and over 10 times more likely to be subject to a community treatment order. The government outlines that decisive action will be taken to help tackle the disproportionate number of people from black, Asian and minority ethnic communities detained under the Mental Health Act.

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.

Culturally appropriate advocacy services will be piloted where needed, so people from BAME backgrounds can be better supported by people who understand their needs.

The reforms will also change the way people with a learning disability and autistic people are treated in law by recognising a mental health inpatient setting is often not the best place to meet their specific needs. The white paper outlines 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.

Investment in community support has led to a 29% reduction in the number of people with a learning disability and autistic people in a mental health inpatient setting since 2015. The government has established the £62 million Community Discharge Grant to make further progress on discharging people with learning disabilities and autism from inpatient care. The planned changes in the legislation will help to further reduce reliance on inpatient care.

Claire Murdoch, Mental Health Director for NHS England, said: “The proposed reforms are 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.

“The NHS is delivering a package of important measures set out in our NHS Long Term Plan to transform mental health, learning disability and autism services, which will ensure everyone can access the right treatment for their needs, when they need it most, which will improve,” she added.

Sophie Corlett, Director of External Relations at Mind, said: “We are pleased the government has accepted the majority of the recommendations made in the Independent Review in their long-awaited Mental Health Act white paper. At the moment, thousands of people are still subjected to poor, sometimes appalling, treatment, and many will live with the consequences far into the future.  Change on the ground cannot come soon enough.

“It is important those who have been detained under the Mental Health Act, as well as their loved ones, feed into the consultation, helping shape the reforms. Given black people are four times more likely to be sectioned than white people, it’s crucial the government hears from people from different black, Asian and minority ethnic groups. We want to see steps taken to identify, address and tackle underlying and systemic racism that results in disproportionate detentions and use of force,” she added.

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 are unable to do so themselves.

- expanding the role of independent mental health advocates to offer a greater level of support and representation to patients detained under the act.

- piloting culturally appropriate advocates so patients from all ethnic backgrounds are better supported.

- ensuring 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.

The white paper also takes steps to ensure parity between mental health and physical health services.

A 28-day time limit is also being proposed to speed up the transfer of prisoners with mental illness to hospital, ending unnecessary delays and ensuring they get the right treatment at the right time.

The government also commits to ending the outdated practice of using prisons as ‘places of safety’ for defendants with acute mental illness. 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 now also 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.

Lord Chancellor and Justice Secretary Robert Buckland said: “Prisons should be places where offenders are punished and rehabilitated, not a holding pen for people whose primary issue is their mental health.

“Keeping people safe must be at the heart of everything this government does, and the reforms announced today will allow us to do this while ensuring offenders still get the treatment their conditions require,” he added.

Reforming the Mental Health Act