The promise to overhaul the Mental Health Act 1983 is one of the few Conservative party manifesto pledges to survive the election. The decision to reform the act, which appeared in the Queen’s speech in June, means the government is committed to taking steps to overhaul the legislation in the next 12 months.
The 1983 act, which outlines how people can be involuntarily detained and treated in hospital for mental health issues, was amended in 2007. This included introducing the right to an independent advocate while in hospital; and the controversial community treatment orders that were criticised for failing to safeguard patients’ rights.
However, 30 years on, the legislation is regarded as outdated and in need of reform. Today, there is greater public awareness about mental health, more demands that the issue has equal parity with physical health, and increasing concerns about the numbers detained in secure care who might instead be treated in local, community-based services.
Theresa May acknowledged the inadequacies of the UK’s mental health system in her first speech as prime minister in July last year: “If you suffer from mental health problems, there’s not enough help to hand.”
Here, mental health campaigners, those who work in the sector and patients explain what they want to see in a new act.
The act should support people when they are most unwell by ensuring their care and treatment is timely, and helping them progress in their recovery.
Currently someone detained under the act can’t be confident that their rights, any advance wishes or their dignity will be respected – or even that they will be listened to.
The best place to start will be with people who are, or have been, detained under the act – such as myself. Embedding people’s experiences in any new legislation will ensure that the person is at the centre of their care, and that the best options are put in place at every step of someone’s treatment and recovery journey.
-- Ian Callaghan, mental health campaigner, working with charity Rethink Mental Illness
Cases of patients presenting with mental health conditions have risen significantly over the past few years across the NHS, especially in general practice. While this might sound alarming, it could also indicate that there is better identification and diagnosis of mental health conditions and that the stigma society attaches to mental health is reducing, so more people are seeking medical assistance. These would be positive steps as we strive for parity of esteem between physical and mental health.
Once diagnosed, many patients struggle to get the most appropriate treatment because there is a severe lack of specialist community mental health services. Additional and more varied community services must be made available, and GPs must have easier, quicker access to them. NHS England’s GP Forward View pledges that every GP practice will have access to a mental health therapist – this needs to be implemented as a matter of urgency.
-- Prof Helen Stokes-Lampard, chair of the Royal College of GPs
It is imperative that changes to the law are considered carefully and that the voice of patients, carers and medical professionals are listened to. The government is right to look at why detentions under the act have risen and why some ethnic groups are detained more often than others.
They must remember that the best way to prevent someone being detained is to prevent them from falling into a crisis in the first place; to understand that poverty, poor housing and poor physical health impact on a person’s wellbeing and psyche. With many services struggling to keep up with demand it can be hard to provide the early intervention needed to prevent people becoming seriously ill.
-- Prof Wendy Burn, president of the Royal College of Psychiatrists
Being detained under the act is one of the most serious things that can happen to a person when it comes to their mental health. The current legislation is outdated and not in line with the principles of modern healthcare. In the past 10 years in England we’ve seen a 47% rise in the act being used to detain people. This demonstrates that it fails to support people when they are acutely unwell.
Any new legislation needs to ensure that people with mental health problems have more involvement in decisions about their care.
Overhauling the act is a mammoth task and needs to be done in full consultation with people with lived experience. Changes to legislation need to coincide with the delivery of the ambitious plan to transform mental health services over the next five years.
-- Paul Farmer, chief executive, mental health charity Mind
I’m yet to be convinced that what was in the Queen’s speech will go far enough to meet Theresa May’s promise of mental health reform. I’ve spent the last 14 years, since my dad’s suicide in 2003, trying to rationalise successive governments’ cuts to mental health provision and disingenuous nods to change being needed.
Mental health should not be a game of political one-upmanship. Consistency is vital to those in treatment, other service users and those who care for them. There is no outright [government] majority, which should encourage all parties to provide a universally approved approach.
I want a commitment that goes beyond treatment and towards destigmatisation, requiring preventative measures in educational, workplace and public settings. Early interventions can help provide positive experiences of mental health for society and take away the negative perceptions of someone with mental health issues being unhinged or untrustworthy and volatile.
-- Kevin Betts, mental health campaigner
Mental health legislation has broadly resulted in increased rights and autonomy for patients – yet we still have a long way to go. New legislation must reflect modern day thinking around equality and treating everyone uniquely. Governments have always promised investment in mental health provision, but – with the exception of increased spending on ‘talking therapies’ – I’ve yet to see this. Staff are stressed and constrained by endless bureaucracy that undermines meaningful face-to‑face interventions.
Investing money to increase treatment options, staffing levels and mental health promotion – starting in schools – will help put mental health on par with physical health provision. The new act must continue to put the patient at the centre, be as unrestrictive as possible and reflect the importance of eradicating stigma.
-- Lol Butterfield, mental health anti‑stigma campaigner and registered mental health nurse
In the new act I would like mental health to be treated the same way as physical health. So if it’s OK to take days off sick due to being physically ill, it shouldn’t be looked at any differently if someone needs to take time off work because of their mental health. If my leg was broken, I would have to see a doctor straightaway; things would be done immediately to get me better. But apparently not being able to leave the house due to mental health issues doesn’t seem as important. I also think that nobody should be turned down or have to wait for over three months to receive any mental health treatment.
-- Kay Ska, mental health blogger and campaigner
A major challenge for mental health services is to end the practice of sending people miles and miles away from their own homes to receive inpatient treatment. This often occurs in relation to acute episodes of care, but is also a problem for longer-term care, in so-called locked rehabilitation hospitals. Social inclusion is a crucial part of recovery in mental health and isolation from family, friends and communities has a negative impact on care and recovery.
Having the right number of local inpatient beds is important, but the problem is about more than beds – it’s how the whole system works in an integrated way to provide the best possible care, close to people’s homes. The only way to achieve this will be to work with the people who use the services, to create better services that genuinely meet their needs.
--Dr Mike Hunter, consultant psychiatrist and medical director Sheffield health and social care NHS foundation trust