There will be no reform of the Mental Health Act 1983 before the next election, the government has confirmed.
Today’s King’s Speech – setting out the government’s last full legislative programme before an election in 2024 or early 2025 – did not include a mental health bill, meaning any reform would have to be carried out by a future government, if at all.
It also means the Conservatives have broken their 2019 manifesto pledge to “legislate so that patients suffering from mental health conditions, including anxiety or depression, have greater control over their treatment and receive the dignity and respect they deserve”.
The news has been heavily criticised by social work and health leaders and mental health campaigners, who had mounted a last-ditch bid to push the government to include MHA reform in today’s speech.
Six-year reform journey ends
The decision also marks the end – for now – of a six-year project to overhaul the MHA, starting with the 2017-18 Independent Review of the Mental Health Act, followed by the 2022 draft Mental Health Bill and then the report of a parliamentary committee on the proposed legislation, published in early 2023.
The reforms were designed to reduce the use of detention and CTOs, tackle their disproportionate impact on black people and end the inappropriate, and often lengthy, detention of autistic people and those with learning disabilities.
What proposed legislation would have done
- Tightened the criteria for detention for assessment under section 2 of the act by requiring that there would otherwise be serious harm to the patient or another person and that detaining the patient is necessary given the nature, degree and likelihood of that harm. Currently, a person may be detained for assessment if they are suffering from a mental health disorder of a nature or degree that warrants detention and they ought to be detained for the purposes of their health or safety or the protection of others.
- Made equivalent changes in criteria for detention for treatment under section 3 and further tightened the criteria by requiring that a person only be detained if necessary treatment cannot otherwise be provided and that treatment that has a reasonable prospect of alleviating their condition, or preventing it from getting worse, is available.
- Prohibiting a person from being detained for treatment simply on the basis of them having autism or a learning disability. Currently, people can be detained for treatment on the basis of autism, while a person with a learning disability can be detained if this is associated with “abnormally aggressive or seriously irresponsible conduct”.
- Replaced the nearest relative (NR) role with that of nominated person (NP). While the roles would have had similar functions, including objecting to detention and discharging the person, the patient would have been able to choose their NP at any time they had capacity to do so.
- Extended the right to an independent mental health advocate to informal (ie non-detained) patients.
- Tightened criteria for the use of community treatment orders (CTOs) – which place conditions on people receiving community treatment after detention in hospital. Under the proposals, CTOs would only have been permissible if there was a risk of “serious harm” to the health and safety of the patient or others, consideration had been given to the “nature, degree and likelihood of the harm and how soon it would occur”, and there was a reasonable prospect of therapeutic benefit.
‘A significant failure of government’
The AMHP Leads Network, which represents approved mental health professional service managers, said the lack of a bill was “a significant failure of government”.
Co-chairs Christina Cheney and Robert Lewis said that, “while far from perfect”, the draft bill “represented at least an acknowledgement of the multiple racial disparities in the use of psychiatric compulsion and control”.
“It acknowledged also the need to increase individual choice in care and treatment matters,” they added. “That both priorities now appear lost from further statutory consideration at this time should be viewed a significant failure of government.”
They said the bill would have done little to “address the massive resource deficits in mental health” and provide the investment necessary to “truly reduce the need for compulsion and to provide more appropriate care and support for individuals at risk”.
However, without any reform, there was a “danger of perpetuating an already broken system, one that maintains professional power over individual choice and does little to direct or empower professionals to embed rights-based approaches”, they said.
Cheney and Lewis called on the government to consider amending the act to replace the nearest relative role with that of nominated person, “to ensure that at least some transfer of power and choice from the state to individual is enacted”.
They added that the network would also support a redrafting of the MHA code of practice, which “in the absence of meaningful reform, could still be a vital tool in changing cultures within mental health services”.
Current act ‘very out of date’
Commenting yesterday on the BBC’s World at One, psychiatrist Simon Wessley, who chaired the independent review, said: “The old act had gotten very out of date – there are lots of Victorian bits to it – and it clearly was not allowing people to make choices, there was a really worrying excess of people from black African and Caribbean communities being detained under the act and people were being detained for too long. That all needs to be addressed.
“The fact that there are still people with autism detained under the act isn’t of itself necessarily wrong but there’s evidence that they are being detained for too long and without therapeutic service.”
In anticipation of the reform being ditched, Wessley said he did not think it was because any political party rejected the idea, and that he believed it would go ahead in the future.
He added: “I think, simply, that they did not have enough time in the legislative programme. I hope that all parties in their manifesto retain a commitment to reform. That will take two to three years but I do believe that it will go through.”
‘A huge blow to our community’
Mental health charity Mind said the lack of a bill was a “huge blow to our community”.
“More than 50,000 people were held under the Mental Health Act last year, so it is incomprehensible that legislation which would help people at their most unwell has been de-prioritised,” said chief executive Sarah Hughes. “There could not be a worse time to abandon this bill, especially given the recent string of exposés revealing unsafe mental health care across the country.
“People with mental health problems, countless professionals and other experts poured huge amounts of time, effort and resource into reforming this legislation to make it fit for the 21st century. Their voices are being ignored.
She added: “Today is a huge blow for our community, but we will continue to fight to raise the standard of mental healthcare.”
‘Lost opportunity to reduce inequality’
The Race Equality Foundation, which works to tackle racial inequalities in the mental health system, also heavily criticised the government’s decision.
“Inadequate healthcare disproportionately affects Black, Asian and ethnic minority people,” said chief executive Jabeer Butt. “This is a real lost opportunity to have significantly improved millions of people’s lives and reduced inequality.”
For Mencap, acting chief executive Jackie O’Sullivan said the government had “missed a huge opportunity…to help end the inappropriate detention of people with a learning disability and autistic people in mental health hospitals”.
“This is a devastating blow to thousands of people with a learning disability and autistic people, their families and campaigners,” she added.
The British Association of Social Workers England issued a similar message under the auspices of its Homes not Hospitals campaign to support autistic people and those with learning disabilities to be supported effectively in the community.
“Learning disability and autism are not mental health problems, but the current act means that these very people can be detained against their will and held for lengthy periods in settings that are of detriment to their health, with instances of abuse being exposed time and time again,” said the campaign group.
“Failure to deliver much needed reform will only commit more vulnerable autistic people and people with learning disabilities to lengthier hospital stays for years to come.”
4o-year-old act ‘desperately needs updating’
NHS Providers, which represents trusts, said it was “deeply disappointed” by the bill’s omission.
“The 40-year-old Mental Health Act desperately needs updating so that patients can be at the heart of how they access care and treatment,” said deputy chief executive Saffron Cordery.
“This includes ensuring appropriate safeguards are in place as well as clearer individual rights and liberties that enable patients and service users to have a more active role in their care planning.
“Reforming the act would also help address severe race inequalities. Under the current mental health law, people from minority ethnic backgrounds are up to five times more likely to be detained than their white counterparts. Urgent action is needed to tackle this discrimination
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The decision to omit the MH legislation reform from the kings speech is utterly disgraceful and I would very much support the AMHP leads view that this is a failure of government. If they had parliamentary time to ban pedocabs and protest then they had time to see through this important reform and manifesto commitment. The current government has no interest in supporting or reforming social care or mental health and I don’t see any great hope for a future labour government either. It is all very depressing and I think we (voters and campaigners) will need to take a much more radical approach in future as working in partnership with govt doesn’t seem to get much done!
Absolutely agree Mark. This Government have no interest in reforming both the Mental Health Act or social care. I know that you worked hard as the mental health lead at the dept of Health and Social Care to ensure mental health and social care was given parity. I am sorry to say but they paid lip service. It is shameful.
I am a social worker and I have worked in mental health services for 16 years. I am also an AMHP. Too many people are detained when there is little evidence that the detention will make a meaningful difference. There are multiple occasions where I have tried to implement social care as an alternative to admission but due to poor commissioning and continued stigma and discrimination by care providers it is often an impossible task.
I had hopes that we would move to a MHA that was inching towards a more rights based framework. Clearly not and all the hard work, consultation and draft bills will go down the toilet – much like the reforms for DoLS and adult social care. This Government is a disgrace.
An absolutely shameful breach of trust — honestly, what is the point of the Tories’ ‘promises’ if they have no intention of fulfilling them? They certain are called the CONservatives for a reason. Conning us all. They need to go. Time for a new government. They might not be much better, but ANYTHING is better than this rotten, lying, self-serving lot.
A minister was on the news this morning saying it didn’t really matter about the legislation because they were doing so much good work in this area and piling so many resources in that all is well. That doesn’t quite fit in with what I hear and read about and know from friends with mental health issues.
The current Act in itself could be used in a far less restrictive way if AMHPs had the resources available to them to keep people in the community ,using the period of assessment that is available to them when they decide not to complete an application for assessment. Sadly these resources are entirely lacking , hence the huge level of detentions under the Mental Health Act which I believe would continue under any new Act , unless government has the backbone to actually fully fund the changes.
Well, it is really disgusting, but should come as no surprise for promises of any government mostly fail to be achieved and perhaps even more so with Tory governments.
Even more surprising is the great need for mental health provision when you look at many within the Tory government for would anyone in the right frame of mind act and do as they do.
Perhaps they are too far gone mentally to be of any use, but that is extremely worrying for they have been in power since 2010, (https://en.wikipedia.org/wiki/Political_history_of_the_United_Kingdom_(1979%E2%80%93present) )
but that is most likely to come to an end in 2024, can we even last that long, but what will replace it, well, looking at what is there just a slightly paler shade of blue, that is blue with a tinge of red, otherwise known as the possible ‘Starmer Labour government’ so unlikely to be too much change.
Now that is also extremely worrying.