Long-awaited reforms to the Mental Health Act in England and Wales are now a step closer thanks to the introduction of a bill to parliament.
The Mental Health Bill had its first reading in the House of Lords yesterday by Labour life peer Baroness Merron.
“Our outdated mental health system is letting down some of the most vulnerable people in our society”
Wes Streeting
It sets out proposed changes to the Mental Health Act 1983, which was last updated 17 years ago and is widely believed to be out of date.
The act provides a legal framework for the detention and compulsory treatment of people who have a mental health disorder and are at risk of harming themselves or others, informally known as ‘sectioning’.
However, there are concerns that the current act is overly restrictive and leaves patients with too little say over their care.
There are also issues with racial disparities, with Black people more than three times more likely to be detained under the act, and unfair treatment of people with a learning disability or autism.
Reforms have been in the works since 2017 when then-prime minister Theresa May commissioned leading psychiatrist Professor Sir Simon Wessely to review the Mental Health Act.
Sir Simon published his report in December 2018 and the new bill has been built from his recommendations.
The reform bill has been designed with four “principles†in mind:
- Giving patients choice and autonomy;
- Minimising restrictions on liberty as much as possible;
- Ensuring detention and treatment have a “therapeutic benefitâ€;
- Treating the person who is subject to the act as an individual.
The proposed changes include introducing a higher threshold for someone to be detained by saying that there has to be a risk of them causing “serious harm†to themselves or others, rather than just “harmâ€.
The same risk criteria would also be implemented for putting a patient on a community treatment order, which allows people to receive supervised mental health treatment in the community rather than in a hospital.
The bill would make it mandatory for care and treatment plans to be put in place for all patients detained under the act, setting out what is needed for the patient to progress toward recovery and be discharged.
It would make it the case that prison and police cells could no longer be used as “places of safety†for patients in a mental health crisis while they await assessment and treatment, rather than in a more appropriate healthcare setting.
A new 28-day limit would be introduced for the detention of people with a learning disability or autism unless they have a co-occurring mental health condition.
The bill would also provide patients with a new right to choose a “nominated person†to be their advocate rather than their nearest relative being automatically selected.
For clinicians, they would have to use a new “clinical checklist†when making treatment decisions.
Among the requirements on the checklist is to consider the patientâ€s “past and present wishes, feelings, beliefs and valuesâ€, to take all reasonable steps to involve the patient in decisions and to consult those closest to the patient.
The Royal College of Nursing (RCN) welcomed the bill but warned that the shortage of mental health nurses was a threat to the plans.
RCN chief nursing officer Lynn Woolsey said: “Modernising the Mental Health Act is welcome, but these long overdue reforms wonâ€t be successful unless we address the crisis in the workforce.
“A third of all nursing vacancies are in mental health services, meaning vulnerable people are routinely denied access to timely and appropriate care.â€
She added that it was “crucial†that the nursing profession was involved in shaping and rolling out these changes.
Health and social care secretary Wes Streeting said: “Our outdated mental health system is letting down some of the most vulnerable people in our society, and is in urgent need of reform.
“The treatment of autistic people and people with learning disabilities, and the way in which Black people are disproportionately targeted by the act should shame us all.
“By bringing the Mental Health Act in line with the 21st century, we will make sure patients are treated with dignity and respect and the public are kept safe.â€
Claire Murdoch, a nurse and NHS Englandâ€s national mental health director, described the bill as a “once-in-a-generation opportunity†to improve care for people experiencing serious mental illness and crises.
The bill will have its second reading – where it will be subject to debate and a vote – on 25 November.
If it passes all stages in the House of Lords, it will then have to go through the House of Commons.
