Together responds to reforms to the Mental Health Act

The Government launched a White Paper on reforming the Mental Health Act (MHA) on 13th January 2021

It sets out the key proposals and considerations by the government in reforming the Act, following the independent review led by Sir Simon Wessely and published in 2018, of which Together was an advisory group member.

Detention under the MHA affects a relatively small number of people who require mental health care, but it has a significant impact at a time of extreme distress. The experience can, itself, lead to lasting trauma if people are not treated with dignity and respect.  This is why, as a provider of mental health social care services, Together for Mental Wellbeing will be responding to the consultation.

Service user leadership is our core principle and central to all that we do at Together, with people being empowered to lead their own care and support. For this reason the strong focus on choice and control in the reforms is particularly welcomed but we need to understand the detail as to how this will be enacted.  Examples would include further details on the practical implementation of the Advance Choice documents and the nature of changes to the Nearest Relative to represent the person being detained.

We work alongside people in our services who have spent many years in secure hospital settings, many of whom have waited months to be discharged. Despite being well enough to live in the community they have previously been unable to due to an absence of suitable places for that transition. As such, we welcome the renewed focus in the reforms on the treatment of people in the least restrictive settings but are concerned that without community alternatives with the right levels of support and help, secure hospital settings will be the default pathway for support and care.

As a provider of statutory advocacy services, we are pleased to see a commitment to the strengthening and proposed expansion of the role of advocacy in the reforms. A focus of this should be on taking a considered and person-centred approach to supporting people with a learning disability or autism who experience mental distress and reach crisis point as many are often inappropriately detained. It is also reassuring to see those incorporating culturally sensitive, opt out principles, to ensure the rights of the person under the MHA or Mental Capacity Act (MCA) are upheld. However, this will be contingent on long-term funding that will be required to follow and this is where further clarity is needed. Our current experience is that whilst Local Authorities, the main funder of statutory advocacy, do the best they can with over-stretched budgets, commissioning of advocacy services is often predicated on the funding pot available rather than driven by the needs of service users. This, in turn, puts significant pressure on providers to do more for less, an unsustainable and precarious position that can negatively impact the support provided and put added strain on those providing it.

The reforms also focus on people experiencing mental health crisis in the criminal justice system. Far too many people are currently remanded inappropriately to prison in order to access treatment and support. Having operated mental health liaison and diversion services in court settings for over 25 years, we particularly welcome the government’s commitment to speeding up the process in magistrates’ courts. This will enable the diversion of people requiring mental health treatment under the MHA directly from the court to a healthcare setting as well as the more timely transfer of people already in prison to mental health inpatient settings.

Quote by Together CEO, Linda Bryant:

‘Depriving someone of their liberty to access mental health care and support, no matter the circumstances, should be a last resort. It requires decision-making based on compassion, respect and dignity and rights-based practices with the person at the centre. There is much to welcome in these long overdue reforms to the Mental Health Act. However, more clarity is needed in a number of important areas, including how the reforms will systemically and systematically address the disproportionate use of detention of Black people under the Act. Committing to better assessment and after-care is a good step but the root cause of high numbers of Black and Asian people being detained owe a lot to the racial inequalities that persist throughout our society requiring responses that are both structural and systemic.  Ultimately without long term funding, these reforms will fall short of their intentions, ‘to put patients at the centre of decisions about their own care and ensure everyone is treated equally’, particularly where mental health and social care needs intersect.’