Two years after Sir Simon Wessely delivered his landmark independent review of the Mental Health Act, ministers have accepted and pledged to take forward the vast majority of its recommendations for change.
The final report from the 2018 independent review concluded that the Mental Health Act [1983] does not work in all cases as well as it should for patients, nor for their families and carers. In instances where the Act has failed individuals, it has led to those people becoming disempowered, excluded from decisions about their care and treatment, and being treated without dignity and respect. It also declared that existing legislation goes too far in removing people’s autonomy and does not go far enough to protect and support the ability of people to influence or make decisions about their own care.
In a statement responding to the independent review, the government said: “In 2017, the government asked Professor Sir Simon Wessely to lead the Independent Review of the Mental Health Act 1983, to examine issues around the use of the act and to propose recommendations for modernisation and reform. We welcome the considered work and in-depth engagement undertaken by the review. We accept, and we will take forward, the vast majority of its recommendations for change.”
In accordance with the review’s recommendations, the government has proposed a raft of changes to rebalance mental health legislation to help empower patients and put them at the centre of decisions about their own care. Four principles developed by the review will help form the government’s approach to changing legislation, policy and practice.
These principles include giving patients trust and autonomy to ensure their views and choices are respected; the least possible restriction to guarantee the Act’s powers are used in the least restrictive manner; therapeutic benefit to make sure patients are supported to get betted and be discharged from the Act; and respecting patients as individuals and treating them as such.
Ministers have also pledged to improve access to mental health support in the community for earlier intervention before detention and admission are necessary, through the transformation programme set out in the NHS Long Term Plan.
The NHS Long Term Plan, which will benefit from £2.3 billion of new funding for mental health services per year by 2023 to 2023, is geared toward improving mental health care for people of all ages and all types of mental illness.
The government has said that with these services in place, better and earlier support can be provided to reduce the risks of people reaching breaking point in their conditions, as well as offering better and alternative options to detention under the Act and arrangements for swifter discharge.
Detention criteria is also to be revised so that patients are only sectioned where absolutely necessary. As part of this, Westminster has acknowledged concerns around individuals with learning disabilities being admitted to mental health hospitals, and so autism and learning disabilities will not be considered reasonable grounds for detention under the reforms.
After the independent review uncovered a disproportionate number of Mental Health Act detainees from BAME backgrounds, the government has also committed to acting on the underlying causes of such disparities.
All reforms to the Mental Health Act proposed in the government’s White Paper on the matter follow key recommendations made by the independent review.
In a joint statement outlining the reforms, the Health Secretary and Justice Secretary said: “The review is already influencing the major decisions and actions the government is making to improve mental health care. We have already taken steps to introduce significant new investment to transform the mental health estate so that inpatients can have the privacy and dignity of their own bedrooms with en suite bathrooms.
“We are investing over £400 million to rid the mental health estate of dormitory provision, just as the review recommended. We will build new mental health hospitals – with two schemes already approved and with more to come – and will tackle the maintenance work needed in the mental health facilities where patients are treated.
“This government believes firmly in increasing the liberty of its citizens. And so, we will seek to implement reforms which see people not just as patients, but as individuals, with rights, preferences, and expertise, who are able to rely on a system which supports them and only intervenes proportionately, and which has their health and wellbeing as its central organising principle.
“Mental health services must be improved for people of BAME backgrounds. The government asked the Independent Review to take a close look at the disparities that exist and to make proposals to address them. This White Paper reflects on the progress that has been made in response to the review to enable organisations to take the steps they need to make improvements in access, experience and outcomes for individuals from different ethnic backgrounds. It also sets out future plans, including work to develop and support a more diverse and representative workforce and to launch a programme of culturally appropriate advocates, in order to better help patients from all ethnic backgrounds voice their individual needs.”
The government’s response to the independent review has been welcomed both within health circles and in the legal sector surrounding criminal, mental health, and mental capacity law.
It comes as a significant boost in particular to Devon-based legal firm AH Solicitors, who have been specialists in this arena since their establishment in 1985.
Indeed, little over a year ago, AH Solicitors Managing Director, Sarah Ackland, outlined her hopes that following the independent review, the government would consider some of its recommendations and take tangible action geared toward change.
Speaking to The Parliamentary Review in 2020, Ackland said: “In December 2018, Sir Simon Wessely completed the independent review of the Mental Health Act 1983. We welcomed the review and are optimistic that the government will consider some of his recommendations as they assured they would do in 2018.
“Through providing our clients with more control over their treatment they would be able to gain autonomy in terms of who provides their care. Ultimately, we hope our clients are able to have more say about their own care and treatment and that we move towards fewer people being detained under the Mental Health Act.
“Ensuring that our clients get the best possible treatment and care is at the core of what we do. It has always been important to us that they feel we have helped them to have their say; too often they are made to feel as though things are just happening to them.”
While the White Paper is a significant milestone in the push for reform, changing legislation will only be half of the battle. For the long-term sustainable change that AH Solicitors and all others affected by the Mental Health Act are striving for, the national health and social care sector, NHS mental health services, local authorities, courts, police force and third sector will all have a part to play.
