Reforms to mental health legislation were set out in yesterday’s Queen’s Speech, including the introduction of a new form of supervised community discharge.
The Mental Health Act Reform Bill would allow the discharge of restricted patients – offenders subject to special controls in the justice system, for example after a court sentence or transfer from prison – into the community with the necessary care and supervision to adequately and appropriately manage their risk.
The definition of ‘mental disorder’ would be amended so that people can no longer be detained solely because they have a learning disability or are autistic; and the criteria needed to detain people would be changed so that the Act is only used where the person is a genuine risk to their own safety or that of others, and where there is a clear therapeutic benefit.
Applying to England and Wales, the draft Bill would also see everyone offered the option of an independent mental health advocate, and allow patients to choose their own ‘nominated person’, rather than have a ‘nearest relative’ assigned for them.
A 28-day time limit would be introduced for transfers from prison to hospital for acutely ill prisoners, and end the temporary use of prison for those awaiting assessment or treatment.
The frequency with which patients would be able to make appeals to tribunals on their detention would be increased, and tribunals would have the power to recommend that aftercare services be put in place.
A statutory care and treatment plan for all patients in detention would also be introduced, written with the patient and setting out a clear pathway to discharge.
The Bill is understood to be seeking to address existing disparities in the use of the Mental Health Act on people from ethnic minority backgrounds, especially detentions and Community Treatment Orders. In 2020-21, there were around 53,000 detentions under the Act in England, an estimated 4.5% increase from 2019-20. Black people were four times more likely than white people to be detained under the Act, and more than ten times more likely to be placed on a Community Treatment Order.
It comes after NHS England set an intention to begin work on an ‘implementation plan’ for new mental health waiting time standards in February.
Long-term plans needed
Director of policy and strategy at NHS Providers Miriam Deakin welcomed the proposals, which she said were ‘long overdue’. However, she highlighted that the Act on its own would not be enough to guarantee high quality mental health services, with services already under ‘severe strain’ following the pandemic. She said more support was needed, as well as a long-term plan to attract and retain staff.
It is estimated that up to 730,000 additional referrals for mental health services could be made each year between now and 2024, putting significant additional pressure on general practice.
Deakin added that mental health inequalities needed to be addressed, particularly to improve outcomes and access to services for Black, Asian and minority ethnic communities.
Dr Jennifer Dixon, chief executive of The Health Foundation, agreed that ‘much bolder action’ was needed, including more funding and reform in social care, and urgent action on health risk factors and the social and economic determinants of health in the forthcoming health disparities white paper.
‘The government still has a role to play in ensuring the health service has the resources it needs over the long-term and urgently addressing workforce shortages,’ said Dixon.
The Government is seeking views from healthcare professionals to inform its new 10-year mental health plan and has reaffirmed its commitment to expand and transform NHS mental health services to reach an additional two million people, backed by a £2.3bn increase in funding per year by 2023 to 2024.
Despite this, research has suggested mental health clinical support workers experience more abuse, poorer working conditions and fewer opportunities than other NHS staff.