The Mental Health Act Consultation
In April 2021 the government asked the public how they thought the Mental Health Act should be changed. This is a key milestone in the campaign to reform the Act - it gave Rethink Mental Illness and our supporters the chance to shape the final bill that will be bought forward to parliament and turned into law. Below we set out how we responded as a charity and what’s next for the campaign.
What is the Mental Health Act White Paper?
Rethink Mental Illness has been campaigning for the reform of the Mental Health Act for a number of years, so we are delighted that the government published a White Paper in January 2021 setting out proposals for reform of the Act.
A White Paper is a document which sets out the changes that the government would like to make, in this case to the law and to mental health practice. The government also asked questions about some of those changes, which many Rethink Mental Illness campaigners with experience of the Act either directly or as a carer or professional with an interest responded to.
We also ran a series of online focus groups with people are currently detained under the Mental Health Act or who have previously been detained. These events helped to ensure that reform is informed by lived experience as far as possible.
In April 2021, Rethink Mental Illness submitted our own response to the government's White Paper setting out the improvements we want to see to the Mental Health Act. Our response to the consultation focused on questions which deal with enhancing the involvement of people detained under the Mental Health Act in their own care, improving the choices they can make, and preventing people from detained under the Mental Health Act in the first place.
As an organisation which focuses primarily on adults severely affected by mental illness, we did not respond to questions about children and young people and their needs under the MHA, or people with learning disabilities and/or autism.
Enhancing involvement in care
Since our landmark reports, A Mental Health Act Fit for Tomorrow and No Voice, No Choice; Making the Mental Health Act Person-Centred, Rethink Mental Illness has been campaigning for and working towards a Mental Health Act which delivers a holistic and person-centred model of care and treatment for people detained under it.
Too often, people experience detention under the Mental Health Act as a horrific necessity, one which may have helped to save their lives but that is far more traumatic and disempowering than it should be. Our aims since conducting this engagement have therefore focused on improving the ways in which the legal framework provided by the MHA protects and respects the people who rely on it.
As a result, we have provided a brief outline of the aspects of the White Paper most related to enhancing choice and involvement.
The White Paper proposes four Principles which will set out core expectations for the experience of a person detained under the MHA, and be written onto the legislation itself as well as the Code of Practice. The principles are supported by other recommendations throughout the White Paper, so they won’t be purely symbolic. The government asked people where the principles should be used, apart from in the law itself and the Code of Practice.
The government would like to make changes to the reasons for which someone can be detained, in order to reduce the number of people being detained. We are supportive of this ambition, as long as there’s appropriate provision of community services to reduce the number of people experiencing a mental health crisis in the first place. The NHS Long-Term Plan is intended to provide those services, but we want to make sure that it does so.
Choice and involvement
The White Paper places a great deal of emphasis on improving the legal mechanisms for wishes and decisions to be made in advance, in line with the recommendations from the Independent Review and our No Voice, No Choice report. These recommendations hinge on an “Advance Choice Document”, and how best that can be implemented. The government asked for feedback on what should be considered as a part of that document, as well as how binding choices are made and what they can refuse.
Carers and family involvement
The government are seeking to change the outdated Nearest Relative mechanism into a Nominated Person mechanism, by which carers and family members can be formally involved in the care and treatment of their loved one. They asked for feedback on the powers they’re proposing to provide the Nominated Person.
The White Paper rightly recognises the vital role that Independent Mental Health Advocates play in supporting people to be involved in their own care, and helping them to exercise their rights. The consultation asks about some additional powers which could be given to advocates to help them to carry out their functions more effectively. The potential expansion of advocacy services is subject to funding from central government.
Leaving hospital and challenging detention
There are a number of consultation questions about proposals which would change the number of opportunities people have to challenge their detention, or change the things that the Mental Health Tribunal can take into account, or instruct services to provide. The proposals are aiming to improve the access that people have to routes out of hospital, because that will ensure they’re discharged as soon as possible.
What next for the campaign?
They intend to publish a draft Mental Health Bill to be brought forward to parliament in early 2022.
In the meantime, we will keep campaigning to make sure that improving the Mental Health Act is a government and parliamentary priority.
If you responded to the consultation and would like to become involved in our ongoing campaign to reform the Mental Health Act, you can sign up to become a campaigner here.
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