After many years of campaigning, research, and working closely alongside experts by experience, we were relieved when the draft Mental Health Bill (the Bill) finally landed on our desks. We still have a way to go, but it’s fair to say that it looks like we’ve passed the halfway mark, and an improved piece of legislation that will see greater choice and autonomy for people severely affected by mental illness should be within reach. In this blog, Danielle from our Policy Team explains the changes that the Bill is introducing and what needs to happen next.

What are the key positive changes and how will they improve the lives of people severely affected by mental illness?

One of the most pressing issues that emerged from both the Independent Review and our consultations with people with lived experience of the Mental Health Act (MHA), was that patients are often not treated with kindness and respect, and that this lack of dignity often worsened their mental illness, increased fear and distrust, and risked further admissions and/or disengagement with care. 

We have what we think is a realistic expectation that one key achievement of the Bill is that people severely affected by mental illness and their carers will have greater control over their care and treatment, and that this will support their sense of respect and dignity during an incredibly challenging and confusing time in their lives. 

The key changes that should improve choice and autonomy include: 

• The ability to formally challenge detention through more frequent access to Mental Health Tribunals.
• The introduction of advanced choice documents that will set out a person’s wishes and preferences for care and which must be used by clinicians to guide treatment.
• Allowing a person to choose their own nominated person to support them with decisions while they are detained (something we’ve called for for many years).
• The introduction of statutory care and treatment plans and the need to record the reasons for compulsory treatment and restrictive practices to improve transparency. 
• Increased access to Independent Mental Health Advocates, including for involuntary patients.

People should only be detained when absolutely necessary, and like other parts of the sector we are concerned with the increasing rates of detention. We greatly welcome the proposed increased threshold for detention, that means a person will only be detained when there is therapeutic benefit, and a person is at risk of causing serious harm to themselves or others. 

We also welcome the improvements to care in the draft Bill for people who are in contact with the criminal justice system, including ending prison as a place of safety and introducing a new statutory limit of 28 days for prison transfers. 

However, we must acknowledge and respond to the disproportionate application of the MHA on racialised groups.

Black people are over four times more likely than white people to be detained under the act, subjected to restraint and held in isolation. They are also over ten times more likely to be subjected to a community treatment order (CTO).

This disproportionate use of the Act against racialised groups must change, and we are calling for the government to do more to ensure that this happens, including to:

Commit to concretely improving disparities in detention rate by ethnicity, with publishing of clear annual targets to progressively reduce disparities by 2025.

Commit to long-term resourcing of all the recommendations pertaining to racialised groups outlined in the Independent Review, including ensuring that culturally appropriate advocacy is properly resourced and available across England.

We recognise that the high rates of detention can often reflect wider social determinants, including poverty and disadvantage, and so call on the government to do more to respond to these determinants in order to achieve real change. We were expecting a Health Disparities White Paper to be published this Summer. However, this hasn’t happened and we fear it might get lost in the current political upheaval. It represents an opportunity to challenge health inequalities and so we urge the government to commit to publishing the Health Disparities White Paper as soon as possible.

For the Bill to be effective, more investment and change to the mental health system is needed

Significant funding for both inpatient, community care and early intervention is needed.

For the Bill to achieve its aim to provide therapeutic benefit, mental health hospitals must be upgraded to provide a more therapeutic environment for people detained in hospital. The Independent Review found that mental health wards were “poorly designed” and “obstruct recovery by making it difficult to engage in basic therapeutic activities (getting outdoors or social interaction with others) and contribute to a sense of containment and control.”

We also need to see more funding for advocacy services, which will play a key role in supporting people to understand the new legislation and access its benefits.

More broadly, there is the need for robust and well-funded mental health support in the community, both in the NHS and in social care. The NHS Long Term Plan and Community Mental Health Framework will play a key role in this, but the social care sector still lacks the sustainable long-term funding it needs.

Similarly, to many organisations working with disabled people we have concerns that the new changes for people with learning disabilities and autism do not come with alternative models for care. Adequate mental health support services for people after they leave hospital (often referred to as aftercare) must also be properly resourced and available across England.

Early intervention is also crucial in reducing the need for to use the MHA later on, as we have highlighted in our work on early intervention psychosis services and campaigning to raise awareness of the first signs of psychosis.

What happens next?

We are pleased that the government has begun plans for pre-legislative scrutiny, including the establishment of the Joint Committee on the Draft Mental Health Bill and we expect a call for evidence in September this year. This scrutiny is needed to improve on some of the issues discussed above, and as we continue to digest the Bill, allow us to speak with and relay perspectives on the changes from people severely affected by mental illness, their carers and families.

We look forward to continuing to work with the government to ensure that this is a Mental Health Bill for the 21st century and ensure that it passes through parliament, so that people benefit from the much needed improvements as soon as possible.

Find out more information about the draft Bill and its proposed reforms.

Image of Parliament at Sunset by By Mike Gimelfarb on the social media share card for this article is used under Creative Commons 2.