The Mental Health Act

"Mental Health Act 1983"

The Mental Health Act 1983 (MHA) is a piece of legislation in England and Wales setting out when people can be detained and hospitalised for mental health treatment against their wishes. 

This page outlines NSUN’s work relating to the MHA, namely around the White Paper (2021) which followed the Independent Review of the Act (announced in 2017), and the resulting Draft Mental Health Bill (2022).

NSUN’s response to the omission of the Mental Health Act reforms from the King’s Speech, 2023

In November 2023, 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 will be passed before the next general election. You can read NSUN’s response to this news here.

Alongside 25 other mental health organisations, NSUN wrote to the Prime Minister, Secretary of State for Health and Social Care, and the Parliamentary Under-Secretary for the Department of Health and Social Care to express our concern about the King’s Speech not including a mental health bill. We reiterated 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.

NSUN’s work around the draft Mental Health Bill, 2022/23

The final report of the Joint Committee on the draft Mental Health Bill

In January 2023 we published our response to the final report of the Joint Committee on the draft Mental Health Bill. We reiterate our concerns that the recommendations depend on proper funding and a commitment to transformative change in what care looks like, in communities and inpatient settings.

The draft Mental Health Bill

The Draft Mental Health Bill was published in June 2022 and “takes forward the vast majority of the Independent Review’s recommendations”.

In October 2022 NSUN gave oral evidence at the Formal Meeting (oral evidence session) held by the Joint Committee on the Draft Mental Health Bill. You can read the transcript of the session or watch the recording here.

In November 2022 we published an update on the Draft Mental Health Bill, which you can read here. We feel that the proposed reforms are not driven by a rights-based approach, though they do contain the potential to make changes to the experiences of some people who are detained, if properly resourced and implemented. 

Institutional racism within Mental Health Act Reform, 2021

In December 2021, NSUN, as part of the Mental Health Alliance, wrote to the Secretary of State for Health and Social Care, Sajid Javid, on institutional racism in Mental Health Act reform.

Black people are four times more likely to be detained under the Mental Health Act and ten times more likely to be discharged from hospital under a Community Treatment Order. However, the Government’s response to the public consultation only mentions racism once, in passing. There were no consultation questions specifically addressing the impact of MHA reform on people from racialised communities (“individuals who identify as BAME”). Many members of the Mental Health Alliance raised institutional racism in their responses to the public consultation. We did not see these contributions adequately reflected or responded to within the Government’s response.

Proposed initiatives such as culturally appropriate Independent Mental Health Advocates, the introduction of a Patient Carer Race Equality Framework (PCREF), and a small number of new research projects do not go far enough and do not all have clear long-term resourcing. Only by acknowledging and addressing structural factors and providing significant investment in alternatives are we going to be able to improve access, experience and outcomes for mental health care. The dial will not shift on tackling racial disparities in mental health services until the existence and impact of structural and institutional racism are acknowledged and challenged.

We asked the Government to commit to the following:

  1. Publically acknowledge institutional racism in the use of Mental Health Act.
  2. Commit to concretely improving disparities in detention rate by ethnicity, with publishing of clear annual targets to progressively reduce disparities by 2025.
  3. Commit to long-term resourcing of all the recommendations pertaining to racialised groups outlined in the MHA Review.
Read the full letter

Rt Hon Sajid Javid MP
Secretary of State for Health and Social Care
Department of Health and Social Care
39 Victoria Street London
SW1H 0EU

cc Gillian Keegan MP, Minister of State for Care and Mental Health; Dominic Raab MP, Secretary of State for Justice

December 2021

Re: Institutional Racism in Mental Health Act Reform

Dear Secretary of State,

We, as members of the Mental Health Alliance, a coalition of organisations working in the mental health sector, are voicing our concerns about the UK Government’s commitment to addressing institutional and structural racism within the context of the reform of the Mental Health Act (MHA).

One of the drivers of the reform of the MHA was racial disparities in the use of the Act. The data speaks for itself: Black people are four times more likely to be detained under the Mental Health Act and ten times more likely to be discharged from hospital under a Community Treatment Order. As Professor Sir Simon Wessely stated in the Independent Review of the Mental Health Act, “we have to accept the painful reality of the impact of that combination of unconscious bias, structural and institutional racism, which is visible across society, also applies in mental health care”.

However, the Government’s response to the public consultation only mentions racism once, in passing. There were no consultation questions specifically addressing the impact of MHA reform on people from racialised communities (“individuals who identify as BAME”). Nevertheless, many members of the Mental Health Alliance, who represent service users, carers, professionals and communities, raised institutional racism in their responses to the public consultation. We did not see these contributions adequately reflected or responded to within the Government’s response.

We cannot ignore such oversight, especially in light of the Commission on Race and Ethnic Disparities (CRED) report which has been described by the Royal College of Psychiatrists as doing “a huge disservice to decades of research and work into all inequalities, in particular race and ethnic inequality”.

While we welcome proposed initiatives such as culturally appropriate Independent Mental Health Advocates, the introduction of a Patient Carer Race Equality Framework (PCREF), and a small number of new research projects, they do not go far enough and do not all have clear long-term resourcing. Only by acknowledging and addressing structural factors and providing significant investment in alternatives are we going to be able to improve access, experience and outcomes for mental health care, especially for racial minorities.

Notwithstanding the proposed changes in related areas within the white paper which many stakeholders have welcomed, the dial will not shift on tackling racial disparities in mental health services until the existence and impact of structural and institutional racism are acknowledged and challenged.

We therefore ask the Government to take the following steps:

  1. Publically acknowledge institutional racism in the use of Mental Health Act.
  2. Commit to concretely improving disparities in detention rate by ethnicity, with publishing of clear annual targets to progressively reduce disparities by 2025[1].
  3. Commit to long-term resourcing of all the recommendations pertaining to racialised groups outlined in the MHA Review.

In order to build towards a future of just, equal and humane treatment for all, addressing racial disparities within mental health services is critical. The evidence tells us a story of deep and systemic inequality, and it is only through concrete actions that we can shift these patterns and achieve more equitable services.

To address current failings in the mental health sector, we must name the problem. You spoke in September on “ending historic injustices by updating our Mental Health Act, ensuring people in acute mental distress are still met with the compassion and choice they deserve.” We urge you to commit to addressing the structural and institutional racism that results in the racial disparities seen in detention under the Mental Health Act as an integral part of the reforms.

We look forward to receiving your response.

Yours sincerely,

Mind
Liberty
Rethink Mental Illness
Association of Mental Health Providers
National Survivor User Network
British Institute of Human Rights
Young Minds
OCD Action
VoiceAbility
Ethnic Health Forum
McPin Foundation
SANE
Platfform
British Association for Counselling and Psychotherapy
DCC-i
The Survivors Trust
The British Psychological Society
Adferiad Recovery
Together
BASW England
AMHP Network
UK Council for Psychotherapy
Centre for Mental Health

[1]We are aware however that decontextualised decrease in admission can be tantamount to or hide neglect. Any commitment to decreasing detention rates needs resourcing. This commitment needs to take place alongside the increased provision of alternative mental health support in the community.

NSUN’s work on the MHA Independent Review and the White Paper, 2017-2021

Background – the Independent Review

The Mental Health Act 1983 is a piece of legislation in England and Wales setting out when people can be detained and hospitalised for mental health treatment against their wishes. 

In 2017, an independent review of the Mental Health Act was announced with the intention of addressing concerns about issues such as rising detentions and the disproportionate number of people from Black and minority ethnic groups detained under the Act. You can read about the background here. It was chaired by Simon Wessely and concluded at the end of 2018.

NSUN worked throughout the process to consult with our membership and represent your views. NSUN also responded to the interim report. You can view the final report and recommendations here, which NSUN also analysed

The White Paper – NSUN’s response

In January 2021 the government’s White Paper (a policy document that sets out their proposals for future legislation, based on the Independent Review of the Mental Health Act) was released. The White Paper broadly followed the recommendations in the Independent Review. It was open to a public, online consultation until the 21st April 2021. 

Our starting position was that real change in how people experience detention is not just down to legislation, but will also be contingent on changes in practice and culture, and on the funding which follows. We worked to consult members in order to help us formulate a response but also to support people respond to the consultation directly. You can find out more about our work in the consultation process in the section below.

You can read our initial response (January 2021) here and our official response (April 2021) here.

March/April 2021: more information on NSUN’s work in the White Paper consultation period

Blog series: exploring experiences of detention under the Mental Health Act

Read:

Card Games & Colouring Books: an Inpatient Perspective on being Sectioned by Jennifer Reese

Autism and colour in a monochrome anti-neurodivergent psychiatric setting by Zaynab Sohawon 

My experience of being sectioned by Emily Katy

Mental Health Act webinars with BIHR

For people who are accessing, have accessed or are trying to access mental health services, we held a webinar with the British Institute of Human Rights on the reforms to the Mental Health Act and what they mean for human rights.

We also held a similar session for those working in or with mental health services.

If you weren’t able to attend these sessions but still want to feed into BIHR/NSUN responses you can answer their easy read survey by clicking here.

Mental Health Act Q&A Webinar

We held a Q&A webinar on the 6th April on the proposed changes to the Mental Health Act in the White Paper: understanding the changes & responding to the consultation. The recording is available below to watch.

We explored the changes to the Mental Health Act 1983 set out in the recent White Paper. We wanted to delve into the detail of the proposed changes to enable more people to understand the White Paper and respond to the consultation, which is running online until the 21st April.

Chairing the discussion was Mark Brown, Development Director of Social Spider and a well-recognised writer and tweeter on mental health, social innovation and social media.

Our panellists were:

  • Jabeer Butt, the CEO of the Race Equality Foundation. 
  • Joanna Dean, a lawyer specialising in prison and mental health.
  • Neil Allen, a Barrister and Senior Lecturer at the University of Manchester. With particular interests in human rights, mental health and incapacity law.
  • Jayne Gardner, an Approved Mental Health Professional. 

Mental Capacity Law and Policy “Shedinar” Episode on the MHA reforms

“In this ‘in conversation with’ Akiko Hart, Chief Executive of NSUN, we discuss the challenges of responding to reform proposals in relation to mental health law and practice as a membership organisation, and also get into some of the thorny issues around mental health reform more generally.

This ‘in conversation with’ is audio only, and you can most easily access it by the podcast link here.”

Mental Health Act survey series

NSUN ran a series of short surveys on the Mental Health Act White Paper. Responses helped us form the NSUN response to the White Paper consultation. Our surveys focussed on: discharge from hospital, the role of Independent Mental Health Advocates, racial disparities, and the newly proposed “guiding principles”.