Today the Joint Committee on the Draft Mental Health Bill released their final report. Many stakeholders in and around the mental health sector, including NSUN, gave both oral and written evidence to the committee. The resulting report details many critical recommendations to improve the current state of play in mental health and is clear on the “collective failure that is unacceptable and inexcusable” when it comes to racism within use of the Mental Health Act. We welcome this strong, considered response to the untenable situation in mental health. However, serious questions remain as to how much of a difference these recommendations will make if there is insufficient funding to enact them and effectively monitor their progress. In addition, the lack of community care and choice in what care looks like remains a critical issue.
What are the recommendations in the Committee’s report?
The Committee’s key recommendations include:
- 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
In light of how much the economic context has changed since the impact assessment was first undertaken for the Draft Bill, the Committee also recommends that the impact assessment be revised to account for what has taken place in the intervening period.
These recommendations cover areas where there is need for deep, transformative change in the provision and practice of mental health care.
The recommendation for the abolition of CTOs is most welcome, however the exclusion of Part III patients, justified through some evidence that this enables less restriction for some of those subject to Part III of the Act, does raise the issue of the widening gap between civil and forensic sections and unintended consequences these may have. The lack of challenge towards the introduction of detention criteria that specify need for serious harm (on the civil side) and the need for therapeutic benefit, retains the risk that tightened criteria will mean further exclusion and gatekeeping in mental health.
Resourcing, workforce and implementation
The recommendations are strongly dependent upon a commitment to an implementation and workforce plan that takes into account the significant need for resourcing in mental health. They must be linked to the Long Term Plan and take into account the significant changes that have taken place since the Independent Review and Draft Bill were first published. The Committee outlines the risk in resources being diverted from existing parts of the mental health system to fund these changes, instead of committing new funding. Chronic underfunding and ongoing staff strikes reflect a climate where necessary change has historically been pushed aside and undermined.
We hope that the resourcing of reforms reflects the urgent need for change. These reforms are a starting point, not a destination. Without commitment to transformative change in what care looks like, in communities and inpatient settings, and to necessary evaluation and monitoring to understand how marginalised groups are impacted by detention, we will not move forward.