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In April 2021, the Fulfilling Lives South East (FLSE) team responded to the government’s Mental Health Act review and published a blog detailing our responses and thoughts.

We called for:

1. A commitment to invest in local mental health support services.
2. The Advance Choice Document to include a Nominated Person instead of next of kin.
3. To offer more advocacy support, ideally peer led, to help patients’ voices be heard.
4. The new guiding principles of choice and autonomy, least restriction, therapeutic benefit and the person as an individual to be integrated in day-to-day work.
5. Trauma informed practice training to be introduced to all staff members.
6. MCN and co-existing conditions to be recognised as a specific category.

1,700 organisations and individuals UK wide submitted their responses to the government, and it is reassuring to see that the majority of responses reflect our recommendations and suggestions.

The government reflected on how this wide-scale review had generated useful learning: ‘In 2017 the government asked for an independent review of the Mental Health Act 1983 (MHA), to look at how it’s used and to suggest ways to improve it. The review’s final report said that the MHA does not always work as well as it should for patients, their families and their carers. We’re now proposing a wide range of changes to rebalance the MHA, to put patients at the centre of decisions about their own care and ensure everyone is treated equally.’

Matt Hancock, Health and Social Care Secretary from January 2021 said in an oral statement to Parliament that ‘(…) this programme of transformation is ambitious and as we support mental health services now, so we must bring up to date the legislative framework also for the long term. The Mental Health Act was created so people who have severe mental illnesses and present a risk to themselves, or others, can be detained and treated. For their protection and the protection of those around them. But so much has changed since the act was put in place, nearly 40 years ago.’

Following the Consultation on the Bill between January and April 2021, the revised Act was released in October 2021.

Our Reflections

The FLSE team has since reviewed and reflected on this new content and would like to share our reflections below.

• We welcome the introduction of the Advance Choice Document which focuses on facilitating patients’ recovery and patients with capacity to be able to refuse treatment, for their wishes to be respected and for the Mental Health Tribunal judge to give orders for treatments not to be given.  
  As set out in the White Paper, the government will take forward legislative changes to replace the Nearest Relative role with the Nominated Person role so that individuals can choose who represents them. 
• Co-production and working with service users and carers is critical to the quality of advocacy services. 
  As set out in the White Paper, the government will take forward legislative changes to extend eligibility of Independent MH Advocate (IMHA) services to all mental health inpatients which means that their voices are being heard.
  The government will further explore with stakeholders the best way to improve the quality of IMHA services, whether through enhanced standards, accreditation, regulation, or increased training requirements. The government will continue to prioritise the development of culturally appropriate advocacy and work with stakeholders to ensure that ethnic minority backgrounds are considered as the reforms are implemented. 
• The government is reviewing their position on the proposed time requirement for health and local authorities to deliver on directions made by the MHT, as a five-week timeframe might not be sufficient for those patients who require a complex care package. 
  We agree that there needs to be a focus on services in local communities (statutory and third sector alike) and for them to collaborate.
• It is the government’s intention to take forward the proposals to increase the frequency of automatic referrals to the Tribunal as there have been concerns that some patients may never have access to a Tribunal hearing if automatic referrals are removed and that some patients “falling through the cracks.” 

There has been an acknowledgement that further development of the White Paper is needed when it comes to people with learning disabilities and autistic people and a commitment to discuss this further with an expert group. The need for appropriate community services was a common theme across responses to all of the learning disability and autism proposals. 

There are a number of areas that we believe remain unaddressed in the Act’s revisions:

• We would very much like to get clarification on the type of training staff members will receive and how co-production is ensured across the system, not just advocacy services.
• We are disappointed that ‘multiple and complex needs’ or ‘multiple disadvantages’ are not named and seen as a separate category in the MH Act.
• It is also unclear what the commitment is to extra resources, funding and a timeline to implement these changes.

Reform

There is a commitment from the government to take the proposed changes further, which includes stakeholder engagement and individuals with lived experience saying that ‘The proposals made in the White Paper represent once in a generation reforms to the Mental Health Act (…). Our job is now to continue to develop a new Bill to reform the Mental Health Act. We have listened, we will continue to listen, and we will deliver on enacting mental health legislation fit for the 21st century – legislation which will provide for the protections and support for people with severe mental health needs, which will strengthen their voice, choice and rights, support the increased use of community alternatives to hospital, will limit the use of the Act for people with learning difficulties or autistic people, will improve support for offenders with acute mental disorders, and which will aim to address the racial disparities that have too long been part of the way the Act has been used.’

The Rt Hon Sajid Javid MP Secretary of State for Health and Social Care
The Rt Hon Robert Buckland MP Secretary of State for Justice

As it stands, there is no fixed timeline or secured funding to implement said changes, saying that ‘We intend to bring forward a Mental Health Bill, which will give effect to many of the changes we wish to make, when parliamentary time allows.’  We look forward to hearing more about concrete implementations of the White Paper soon.

The full government responses can be found here: 

Reforming the Mental Health Act – GOV.UK (www.gov.uk)

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Authors:

Ian Harrison, Engagement and Coproduction Worker

Michaela Rossmann, Systems Change Officer

Rebecca Rieley, Systems Change Lead

For further information about Fulfilling Lives work in this area, please contact:

Rebecca Rieley, Systems Change Lead:

rebecca.rieley@sefulfillinglives.org.uk  

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