How can we make sure the new Mental Health Act is fit for purpose?

The Mental Health Act was created in 1983 to allow people who need (but do not necessarily want) to go into hospital for mental health care and treatment. Sarah Anderson, policy manager at Rethink Mental Illness, outlines what reform the next government must deliver to make the Act fit for purpose.

Where are we now?

As the world has changed over the last 40 years, the Mental Health Act has not. It’s about time the laws dictating how some of the most unwell people are treated in the UK are updated in line with modern attitudes to mental illness.

Rethink Mental Illness has spent years campaigning to reform the outdated Mental Health Act to create a person-centred approach that involves people in the care they receive as much as possible.

The policy development process can be slow and complex. If done well, it can lead to effective legislation and a positive, tangible impact on people’s lives.

Doing the process well includes:

• Centering the views of people with lived experience.
• Listening to those working within the relevant systems. 
• Ensuring that new laws are backed up with appropriate funding, resources and guidance.

The current government’s decision not to include the 2022 draft Mental Health Bill as an Act of Parliament before the upcoming election represents a broken manifesto pledge and a profound betrayal of people living with mental illness.

The government have now responded to recommendations for improving this draft Bill made by a Joint Committee of MPs and Peers from three political parties. We were disappointed that the government chose to reject many key recommendations that have the potential to significantly change the lives of people living with serious mental illness.

What changes do we want to see?

A major concern about the draft Bill was that it did not go far enough to address the racial inequalities that are deeply entrenched within the application of the existing Mental Health Act.

For example, recent NHS statistics show Black men are 3.5 times more likely to be detained under the Act and eight times more likely to be placed on a Community Treatment Order after discharge.

The Joint Committee recommended the Bill should: 

• Include a statutory right to culturally appropriate advocacy to address the specific challenges racially minoritised people face.
• Take steps towards abolishing Community Treatment Orders, where people are supervised in their community after hospital discharge.
• Commit to improving the monitoring of inequality data and efforts being made to address these inequalities. 

The government rejected these recommendations.

Advance Choice Documents allow for a patient to inform professionals on how they wish to be treated in the event of a future crisis or relapse, including requests and refusals of particular treatments. There is significant research which demonstrates the benefits of Advance Choice Documents for all patients, and particularly those from racially minoritised communities.

The Joint Committee recommended that people should have a statutory right to request an Advance Choice Document and should have the support of a trained, independent person when making one. The government did recognise the important role of Advance Choice Documents in their response and suggested that services should have a duty to “carry out activity surrounding” them, but ultimately rejected these recommendations.

Independent Mental Health Advocates play an important role in ensuring that people who are in hospital have their rights protected. They also support people who may have been wrongfully detained to appeal and regain their freedom.

It was a huge step in the right direction for the draft Mental Health Bill to create a statutory right to advocacy for all patients whether involuntary (detained under the Mental Health Act) or voluntary (in hospital of their own free will). The Joint Committee recommended that all patients should be placed on an opt-out scheme for advocacy once staff capacity allows, to ensure that people’s rights are protected no matter their situation. The government, again, rejected this recommendation.

Where do we go from here?

It is extremely unlikely that the Mental Health Act will be reformed ahead of the general election, so our focus must turn to what can be achieved soon afterward.

It is crucial that this legislation is reformed soon given the significant delay, but the new Act must effectively serve all communities and address the deeply entrenched existing inequalities.

We hope that whoever forms the incoming government will work closely with us, the rest of the sector, and especially people with lived experience, to ensure that the new Mental Health Act is as effective as it can be.

They must embrace the key recommendations made by the Joint Committee, which honoured the views of people with lived experience, and seize what is the best opportunity in a generation to reform this archaic legislation for the benefit of those of us living with serious mental illness.