Long-awaited bill to modernise 'Victorian' Mental Health Act is tabled

A bill to modernise the “Victorian rules” of the Mental Health Act has been introduced by the UK government, six years after a review recommended urgent reforms.

The bill aims to end the “horrendous” treatment of some people detained under the 40-year-old act during a mental health crisis.

It intends to deliver more humane, person-centred, support which gives individuals and their family and carers greater say over treatment.

It also seeks to address racial disparities and biases resulting in Black people being three times more likely to be detained. People with learning disabilities or austistic people are also more likely to be sectioned under the act.

BASW welcomed the bill but said implentation needed to be properly resourced and must not ignore the social determinants often behind poor mental health.

Chief executive Ruth Allen said: "BASW thoroughly supports the move towards an approach based upon principles relating to least restrictive intervention and therapeutic benefit, but we remain concerned that the approach taken in the bill still risks over-medicalising issues where societal factors are the dominant factors contributing to mental health distress.

"This bill cannot stand in place of action on public, preventive and community mental health measures for a healthier society overall."

Allen also called for clarification on the government's plans on mental capacity.

Headline reforms

• Ending the placement of people experiencing a mental health crisis in police and prison cells
• Limiting the amount of time someone with a learning disability or autistic people can be detained to 28 days if they do not have a co-occurring mental disorder and have not committed a crime
• Increase the frequency of clinical reviews
• Giving people the right to elect someone to represent their interests rather than default next of kin
• Greater access to advocacy for people who have been detained
• New rules for using Community Treatment Orders to address racial disparities
• A legal requirement for patients to have tailored ‘care and treatment plans’ setting out a route to discharge
• Setting a 28 day limit for the transfer of prisoners who need mental health treatment to hospital
• A new requirement for the ‘responsible clinician’ to consult another person before discharging a patient

Secretary of state for health and social care Wes Streeting said: Our outdated mental health system is letting down some of the most vulnerable people in our society and is in urgent need of reform.

“The treatment of autistic people and people with learning disabilities, and the way in which Black people are disproportionately targeted by the act should shame us all.

“By bringing the Mental Health Act in line with the 21st Century, we will make sure patients are treated with dignity and respect and the public are kept safe.”

Background

The bill follows concern that people detained under the act were often not treated with kindness, compassion and dignity, which served to worsening their mental health.

Behind it is a widespread recognition that the current Mental Health Act is based on outdated principles and laws around the treatment of people in a mental health crisis that do not fit with changing public attitudes to mental health.

In order to modernise the act, Theresa May’s Conservative government commissioned a review in 2017 led by professor Sir Simon Wesseley.

Published in 2018, it set out four principles for reform that promote choice and autonomy for patients; the use of least restriction; therapeutic benefit of services and seeing “the person as an individual”.

However, the Covid pandemic and political turmoil at Westminster saw the reforms repeatedly kicked into the long grass. A draft bill was published in June 2022 and the King's Speech in July this year raised expectations with a stated commitment to reforming the act from the new Labour government.

The bill will now work its way through parliament before entering the statute books.

Reaction

Professor Sir Simon Wessely, chair of the Independent Review of the Mental Health Act, said: “No one doubts that it is time to modernise our legislation, in order to achieve the goal of reducing coercion and increasing choice for those who suffer from the most severe mental illnesses.

“Our reforms will achieve that by ensuring better treatment and discharge planning with more family involvement, replacing outdated Victorian rules, and by reforming community treatment orders tackle unacceptable ethnic differences. Most of all ensuring that more attention is given to patient preferences will improve compliance with essential treatment, reduce coercion, whilst still protecting the public where necessary.”

Dr Sharif Haider, lecturer in social work at The Open University, said he was "optimistic" that the bill was a step in the right direction, but raised concerns over funding and the potential for increased bureaucracy.

He said: "The Mental Health Bill 2024 represents a significant stride towards modernising mental health legislation in England and Wales. It addresses numerous longstanding issues and aims to improve patient rights, reduce inappropriate detentions, and provide more dignified and effective care.

"However, its success will largely hinge on proper implementation, funding, and complementary improvements in mental health services and community-based support."

Dr Sarah Hughes, chief executive of Mind, said: “The announcement today marks a significant moment, but we know there is more to do and questions to ask about whether this will go far enough to fix the broken system as we know it. 

"The mental health emergency we are facing will need much more than a reformed Act. It will demand radical and brave action from government alongside proper funding.” 

Mark Winstanley, chief executive of charity Rethink Mental Illness, said reform was long overdue, adding: “People tell us that the Mental Health Act has saved their life, but that the experience was horrendous.

“It is hard to fathom that when people are at their most unwell they are still routinely placed in prison cells, have no say in who is appointed as their nearest relative and have so little involvement in their treatment.

"Reform should help ensure people are with dignity and respect, and help to protect us all.”

Mark Rowland, chief executive of the Mental Health Foundation, said: “People need support that reflects our modern understanding of how to help and care for people during a mental health crisis – not our understanding four decades ago. 

“The original version of the Act has driven racial disparities, stripped those who are sectioned of their humanity in a wholly unnecessary way, and all too often made crises worse.”

Claire Murdoch, NHS national mental health director, described the act as a “once in a generation opportunity to ensure that patients experiencing serious mental illness and crises receive safe, modern, evidence-based care", with the needs and wishes of patients and their loved ones are the centre.