NSUN response: omission of Mental Health Act reforms from the King’s Speech

Yesterday, the final King’s Speech before the next general election took place without mention of a Mental Health Bill, which would have been the next step in the long-awaited reform of the Mental Health Act. This means it is now extremely unlikely that any changes under the Bill, which were meant to “modernise” a 40-year old Act widely regarded as not fit for purpose, will be passed before the next general election.

The reforms and recommendations, now abandoned indefinitely, included the following:

  • The creation of a new statutory Mental Health Commissioner role representing patients (similar roles include the Children’s Commissioner)
  • The inclusion of the principles of the Independent Review and an additional principle detailing respect for racial equality
  • Recommendations around the monitoring and collection of detention data, including ethnicity data and annual publishing of relevant figures 
  • The abolition of Community Treatment Orders (CTOs) for the majority of service users, except for those under Part III
  • A statutory right for patients who are detained or who have been detained previously to request an advanced choice document

The recommended reforms would have been, and still are, dependent on proper funding to enact and monitor them. We also urgently need to see a commitment to transformative change beyond the scope of the reforms in addressing practices and a culture of abuse, neglect, iatrogenic harm and exclusion in the mental health system outside of just inpatient settings. The Mental Health Act reforms would not have addressed the decimation of alternatives to detention and community care (both for those in crisis and for those living with long-term distress) under austerity.

We were not confident that the reform on the table went far enough, was driven by a truly rights-based approach, or would be backed by sufficient funding or a commitment to transformative culture change. However, many regarded it as a step in the right direction towards addressing some key issues within the Act around how people are treated and how they can exercise their rights when they are detained, and towards addressing racial disparities in how the Act is used. Under the current Act, Black people are four times more likely to be sectioned and eleven times more likely to be discharged from hospital under Community Treatment Orders (CTOs). The proposed reforms went some way in addressing this, however, the proposals in the Review did not fully address institutional racism, and the government’s response to the public consultation on the White Paper only mentioned racism once, in passing.

The changes also proposed taking more autistic people and people with learning disabilities out of the scope of the Mental Health Act, which might mean that they are eligible for detention under the Mental Capacity Act. This would not necessarily decrease the number of detentions or improve the conditions in which people are detained, but may instead mean that autistic people and people with learning disabilities would still be subject to detention, such as under the Mental Capacity Act or in Assessment and Treatment Units, with fewer safeguards.

People have campaigned for decades to reform the Act. People with lived experience of mental ill-health, trauma and distress have spent huge amounts of time and energy over the years engaging with the drawn-out process of legislative reform through the Independent Review, first announced in 2017, the consultation on the White Paper, engagement with the production of the draft Mental Health Bill, and the final report of the Joint Committee on the draft. Their voices and expertise are being ignored and disregarded. This reflects the reality of the slow and painful process of engaging with change and reform under institutional and bureaucratic processes.

Despite the “modernisation” of the Mental Health Act being a key point in the Conservative Party manifesto in 2019, the failure to deliver on promised reforms and include the Mental Health Bill in the King’s Speech confirms what we already knew: improving the state of mental health inpatient care is not a priority for this government.

Whenever the proposed reforms are finally implemented, we remain firm in our position that a real change in how people experience detention is not just down to legislation – or funding, resourcing, and workforce – but also a commitment to deep, transformative changes to harmful practice and culture. The urgent need for change in our mental health systems extends far beyond issues with detention under the Mental Health Act, and though the reforms had the potential to make a difference to the lives of people who are detained and somewhat increase choice and autonomy, the lack of community support and choice in what care looks like both for people experiencing crisis and for those living with long-term distress remains a critical issue which we cannot lose sight of.

Alongside 25 other mental health organisations, NSUN has written to the Prime Minister, Rishi Sunak, Secretary of State for Health and Social Care, Steve Barclay, and the Parliamentary Under-Secretary for the Department of Health and Social Care, Maria Caulfield, to express our concern about the King’s Speech not including a mental health bill. It reiterates that on top of legislative change, we also need resources to improve mental health care and community support with a focus on preventing crisis and inappropriate detention under the Mental Health Act.

For more information on the Act and the reforms, including previous NSUN responses to various stages of the reform process, visit our Mental Health Act webpage.