Last week’s King’s Speech, setting out the Government’s legislative programme for the year ahead, was as notable for what it didn’t say as for what it did. Certainly from the perspective of the nation’s mental health, while there were announcements that will have major impacts, it’s what was missing from the programme that is felt most keenly as a broken promise.
In its 2019 manifesto, the Government pledged to legislate to modernise the Mental Health Act, the law that governs when and how a person in England and Wales can be subject to the powers of the state for mental health treatment. It is a hugely important piece of legislation, giving the state powers it has in no other area of our lives, and with no other group of people in society.
With just over a year (at most) to go in this Parliament, it is now clear that the Act will not be changed in that time – that the pledge will not be fulfilled barring a very speedy change of heart. Nearly five years after the Independent Review of the Mental Health Act published its final report – having involved many hundreds of people sharing their experiences (often invoking very painful and distressing times in their lives) and creating an expectation that change would follow – it is truly disappointing that it has been dropped without a word of explanation.
It’s reasonable of course to ask why this matters. Legislation by itself doesn’t and cannot improve mental health services, increase investment, or tackle the inequalities and injustices that put people’s mental health at risk in the first place. But it does govern the ways people are treated by the state. And it means we will continue to be left with an outdated legislative framework while we wait for government to act.
With an unreformed Mental Health Act, Black people are likely to continue to face a fourfold higher risk of being sectioned and an eleven times greater risk of getting a community treatment order when they leave hospital. Autistic people will continue to be detained for years on end in hospitals and care homes, even if they do not have a mental illness. Prisoners will still have to wait weeks or even months for a hospital bed when they need an urgent transfer. People won’t have the additional safeguards for their views to be heard, for example through advance statements and more proactive advocacy services.
Alongside reforming the Mental Health Act is the promise of a ban on conversion practices. That too was a promise from 2019 that appears to have been abandoned. This means that LGBTQ+ people will continue to face the risk of abusive practices, in the name of ‘therapy’.
There were some plans in the King’s Speech that could benefit people’s mental health. The introduction of a Renter’s Reform Bill could, if it was sufficiently robust, protect tenants in private rented accommodation from no-fault evictions. Legislation to reduce the use of remand and short prison sentences could prevent the harm caused by short spells in custody – if it is coupled with an expansion in mental health support for people on community sentences. And plans to create a ‘smokefree generation’ could have long-lasting benefits for people’s mental health, if they too come with the right support for people who want to quit.
Overall, the Government’s legislative programme for the year presents some opportunities for improving the nation’s mental health, but with it come some significant risks. And the absence of Mental Health Act reform means we must wait again for the changes it needs to be fit for purpose in the years to come.
Since the King’s Speech was delivered, promises have been made that reform of the Mental Health Act is still on the agenda. Labour announced that they would take this on if they form the next government, while the current Government has stated that it still plans to reform the Act. It’s vital that these promises are kept. Waiting another year is disappointing enough. More false dawns would be considerably worse.