Here is a summary of the main recommendations of the Independent Review of the Mental Health Act, our views on the recommendations and some of our work during the process.

It has been important to have a review of the Mental Health Act 1983.

We would also want to acknowledge that a considerable number of suggested improvements have been put forward in the report, including recommendations that:

  • There should be four new principles, now enshrined in the Mental Health Act itself and at the heart of all action taken: ‘Choice and autonomy, least restriction, therapeutic benefit and the person as an individual’
  • People should be detained only if there is ‘substantial’ risk of harm to themselves/others and it is thought that effective treatment cannot be provided without detention. The current risk aversion culture should also be tackled
  • More accessible and responsive mental health crisis services and community-based mental health services should be available to pre-empt detention and there should be increased scope for people to be admitted to hospital informally
  • Advocacy should be more widely available. People should also be able to choose a ‘nominated person’ for themselves, in place of being allocated a ‘nearest relative’
  • Detained patients’ wishes about treatment should carry considerably more weight, in particular if they are clinically assessed as ‘capable’. ‘Advance choice documents’ such as advance directives should have a greatly increased standing
  • There should be statutory care and treatment plans
  • Ward environments and conditions should be improved significantly
  • Community treatment orders should continue for the time being, but with tightened criteria.
  • More should be done about inequalities for people from black, Asian and other minority ethnic (BAME) communities, children and young people, people in the criminal justice system and people with a learning difficulty/disability and/or autism
  • Complaints systems should be improved and there should be increased access to tribunals.

However, many user-led groups and individuals have expressed disappointment about the scope of the Review report.

The recommendations fall far short of giving people with mental health diagnoses full human rights as set out in the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), still leave them without the same rights that other people have.

For example, people will continue not to have the right to refuse detention, even if they are clinically assessed as having capacity, and, whilst they will have increased treatment choices, these can still be overruled.

Thus ‘autonomy’ for mental health patients will not mean autonomy in the usually accepted sense of the word. There is a continuing reliance on capacity assessments, problematic though these have proved to be.

In addition, there has been a failure to draw actively on the type of supported decision-making recommended under the UNCRPD to enable decisions by people who are clinically assessed as lacking capacity. 

The recommendation that the Mental Capacity Act should be used for people who are assessed as lacking capacity and not thought to be objecting to hospital admittance is a point of concern;

The current Mental Capacity (Amendment) Bill appears to enshrine decreased, not increased rights.

Whilst the report makes considerable mention of service user and carer involvement in the Review - and there clearly has been consultation and involvement - we are also aware that significant numbers of service users and carers have not been involve and/or have been given limited information or scope to express their views.

It is far from evident that the Review recommendations adequately address concerns raised by people from marginalised communities, racialised groups, people with learning difficulties/disabilities and/or autism, children and young people and people in the criminal justice system.

In addition, there is a very concerning lack of focus on people who face other forms of additional discrimination, related, for example, to gender/gender identity, sexual orientation, socio-economic status, older age, other disability issues and/or dementia.

There is an emphasis on a clinical understanding of mental distress instead of a comprehensive look, too, at alternative models which many of us find more helpful.

The report also fails to include recommendations about the need for a significant increase in user-led services, non-clinical options and culturally appropriate alternatives.

Further reading on our concerns about and involvement in the review process are below.

Dorothy Gould, NSUN Lead on Mental Health Act Review