This year’s Queen’s Speech proposed reforms to the Mental Health Act 1983 (the Act), with the introduction of the Mental Health Act Reform Bill (the Bill). Care providers should take note of the planned amendments, which the Government hopes will cultivate a 'more person-centred system' of mental health care. Following issues identified in the Independent Review of the Mental Health Act 1983 and the Reforming the Mental Health Act White Paper the Bill aims to ensure that the Act’s powers are only used 'when absolutely necessary'.
Following concerns raised about the rising rates of detention, particularly amongst certain ethnic groups, it is expected that the Bill will introduce new detention criteria. Those with the responsibility for making a decision to detain someone will need to document a specific risk justifying the detention and identify how detaining the individual will deliver a therapeutic benefit under newly introduced statutory care and treatment plans. These criteria will also apply to continuing detention under the Act.
Additionally, autism and learning disabilities will not be considered grounds for detention in and of themselves under the Bill. To be detained those with autism or learning disabilities must also present with symptoms of mental illness that meet the threshold for detention. This is aimed at reducing the protracted detention of neurodivergent patients, particularly if this leads to patients not receiving appropriate therapeutic intervention.
Patients will also be given greater access to the Mental Health Tribunal allowing detentions to be scrutinised more easily, with the time limit to appeal detentions being increased for patients under both sections 2 and 3 of the Act. The frequency of automatic referrals to the tribunal will also be increased. Before detention, patients will be asked to select a nominated person to advocate on their behalf, replacing the role of nearest relative. This will give patients greater choice on who provides support to them.
Care providers should also be aware that the Government intends to create a clearer dividing line between detentions under the Act and Deprivation of Liberty Safeguards (shortly to be replaced by Liberty Protection Safeguards), with a presumption that the Act should only be used where the individual concerned is clearly objecting to their detention or treatment.
Whilst the reforms may not be of direct application for all social care providers, what is proposed will potentially be very significant for some of those they support. The proposed reforms aim to provide individuals with greater choice regarding the care they receive. Care providers should follow the progress of the Bill through Parliament, considering its practical impact for those they support.
Social care providers should consider the reforms alongside the CQC’s 'Out of Sight' report series. First published in October 2020 the CQC’s Out of sight- who cares? report reviewed the use of restraint, seclusion and segregation for autistic people, and people with a learning disability and/or mental health condition in care settings. The report raised serious concerns about potential breaches of human rights due to these procedures and concluded that ultimately, they often led to people not receiving the care they needed. In March 2022, the CQC published a Progress report on their recommendations and found that most had not been sufficiently progressed to have the impact that is needed. The CQC concluded that one significant factor was that there are “still too many people in hospital unnecessarily”. Given that so little progress has been made in the last two years to find more appropriate community placements, there will need to be a significant increase in community provision if the well intentioned aims of the Bill are to be put into practice.