How The Government Plans To Reform The Mental Health Act

Last week’s announcement that the Government plans to revamp the Mental Health system in England and Wales was received warmly received by campaigners. It comes a little over two years after an Independent Review in 2018 and seeks to build on the recommendations outlined by Sir Simon Wessely.

Putting The Individual At The Centre Of Care

The revamp intends to 'put the needs of the individual at the centre of care' by giving people greater autonomy over how they are treated and ensuring the act’s powers are used in the least restrictive way.

This has been a common slight against mental health legislation in England and Wales and was among the points highlighted for change by Rethink Mental Illnesses 2018 breakdown for how to improve service user care.

Additional recommendations included formalising mental health advocacy to increase the uptake of Independent Mental Health Advocates (IMHA’s) and to provide clarity to their role. Recommendations also included improving the provision of information for service users as well as increased awareness of making ‘advance decisions’. The latter refers to individuals being able to state how they would like to be treated in the future if they are unable to decide for themselves.

Very few service users and carers involved in the research were aware of the option to make and record Advance Decisions regarding their care as part of the Mental Health Act although there was a clear appetite for these.

~Rethink: No Voice, No Change, 2018

This makes the confirmation of statutory ‘advance choice documents’ as part of the White Paper especially significant. As mentioned previously, this aims to provide individuals with much needed autonomy by allowing them to express their wishes and preferences concerning their care when they are well, before they need to head to the hospital.

The principles that will guide professionals involved with caring for someone under the act also includes the Therapeutic Benefit principle. This ensures that care and treatment are delivered with a view to ending the need for coercion. The emphasis on aftercare in the 2018 review could also be implemented and would provide better access to long-term support which can play a pivotal role in maintaining good mental health and preventing readmission.

All of these measures should play a role in ensuring service users’ views and choices are respected which should also help Health care personnel and Independent Mental Health Advocates tailor their care accordingly.

Addressing The Overrepresentation Of People From Minority Backgrounds In The Mental Health System

These recommendations have also been enlisted to address another issue: the disproportionate detention of people from minority backgrounds. It’s formed a significant factor part of why the calls for change have grown louder, particularly given recent discourse regarding how inequalities play out across different walks of life. For instance, data showed that black people were four times more likely to be detained under the Mental Health Act than white individuals. This is while also being more than 10 times likelier to be subject to a Community Treatment Order (CTO). This relates to individuals undertaking supervised treatment and following conditions post-release.

In response, the White Paper will use the ‘Patient and Carers Race Equality Framework’ (PCREF) to help improve ‘BAME’ mental health outcomes in addition to piloting ‘culturally appropriate advocacy services’.

Bigger Structural Factors Still At Play?

While these measures re-define and tackle the question of management within the mental health system, there will still be further attempts to legislate for preventative measures. It should be noted that the White Paper has already outlined one - these are changes which will make it harder for autism and learning disabilities to be grounds for detention, something which the National Autistic Society describe as a ‘huge step forward’. However, Employing these same preventative measures elsewhere may prove a harder task.

The Mental Health Organisation 'Mind' found 1/3  people from 'BAME' backgrounds said problems with housing made their mental health worse during the pandemic.

As with the nation as a whole, the general outlook for mental health for individuals from minority backgrounds has not been helped by covid. Reports in the early phase of the pandemic not only crystallized this but crucially, highlighted existing inequalities within housing, finance and employment as weighing greater on minorities during the pandemic. 

This suggests that change within some of the overarching areas leading to disparities in mental health are not moving at the pace which is needed. This is why Operation Black Vote has, and continues to campaign for a Race Equality Strategy, because the overrepresentation of minorities in the mental health system is partly reflective of the structural inequalities we see elsewhere - in housing, in employment and in this case health. Failing to address these fundemental issues will see people from these backgrounds ultimately facing the same pressures.

The landmark announcement is the result of continued work of mental health advocates in the UK, this is important because while legislation has been slow to change they have not. The consistent outpouring of literature, academic research and willingness to address the UK’s mental health system has reaped its reward.

The work of groups such as Black Minds Matter UK, Mind, the National Autistic Society and YoungMinds have led to this point, but more aggressive management of mental health policy is needed in the future. A nearly 40 year wait to reform the UK’s mental health Act is too long a time to address an area of such importance.

If you wish to, you can respond to the government’s public consultation into the Mental Health Act here.

Mayowa Ayodele

References:

(1) assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/778897/Modernising_the_Mental_Health_Act_-_increasing_choice__reducing_compulsion.pdf

(2) www.rethink.org/media/2539/no-voice-no-choice.pdf

(3) https://www.gov.uk/government/news/landmark-reform-of-mental-health-laws

(4) www.ethnicity-facts-figures.service.gov.uk/health/mental-health/detentions-under-the-mental-health-act/latest

(5) www.autism.org.uk/what-we-do/news/change-to-mental-health-law?utm_source=twitter&utm_campaign=mh_law&utm_content=newsstory

(6) www.mind.org.uk/news-campaigns/news/existing-inequalities-have-made-mental-health-of-bame-groups-worse-during-pandemic-says-mind/

Pictures sourced from Theeyeopener & The Guardian.

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