The Mental Health Bill progresses to its Third Reading in the House of Commons today. We welcome the Bill’s introduction as a vital step towards reforming the Mental Health Act 1983 to strengthen people’s rights, reduce inequalities, and improve mental health outcomes for all, but believe there are several areas that require further attention to ensure it delivers a fairer, more rights-based mental health system.
Racial justice and equity in the mental health bill
One of the original drivers for reforming the Mental Health Act was the urgent and long-standing racial inequalities in how the Act is applied. Yet, in its current draft, the Bill contains no explicit provisions to address or reduce these inequalities. This omission is deeply concerning given the persistent overrepresentation of Black and racially minoritised people in detentions under the Act, and the well-documented disparities in the quality of care they receive.
Despite decades of evidence and lived experience testimonies pointing to systemic injustice, the Bill does not go far enough in establishing concrete mechanisms for change. Relying on updates to the Code of Practice alone risks deferring action and failing to deliver the scale of transformation that is needed. Racial justice cannot be a peripheral issue in the reform process; it must be embedded at the heart of legislation if we are to build a fairer and more equitable mental health system.
Recommendations: The Government should introduce amendments to the Mental Health Bill to:
- Place a statutory duty on all mental health providers to implement the Patient and Carer Race Equality Framework (PCREF)
– PCREF, launched by NHS England in 2023 as a key outcome of the Independent Review of the Mental Health Act, provides a vital anti-racism framework for local mental health services. A statutory duty would ensure that all mental health providers implement and embed PCREF, safeguarding its future and driving accountability.
- Establish a Responsible Person role within each provider and Integrated Care Board to ensure accountability and oversight in tackling racial disparities.
– Embedding this role in legislation would help ensure robust governance and sustained progress in addressing racial injustice in mental health care.
Community treatment orders (CTOs)
A Community Treatment Order (CTO) allows people who have been treated in hospital for their mental health to continue their care under supervision in the community, rather than remaining in hospital. Their use is marked by significant racial inequalities, with the latest data showing that Black people are nearly eight times more likely than white people to be placed on a CTO. We support Dr Danny Chambers MP’s amendment, which would require the Secretary of State for Health and Social Care to conduct a review of racial disparities in the use of CTOs within one year of the Act being passed.
Recommendation:
- The Government should adopt the recommendations from the Independent Review on CTOs in full and commit to a review of their use. As part of this, they should reassess and tighten the criteria for CTOs and consider alternative approaches with the view to phasing them out within five years if progress is not made.
Mental Health Commissioner
The Joint Committee on the draft Mental Health Bill recommended creating a statutory Mental Health Commissioner to oversee Mental Health Act reforms and monitor outcomes.
We have explored what this role might look like. Our review of the international evidence shows that similar roles can drive systemic change and improve outcomes, ensuring sustained focus on mental health at the highest levels of government.
Recommendation:
- We strongly support Dr Danny Chambers MP’s amendment to establish a statutory Mental Health Commissioner for England. This role would fill a critical gap by providing independent oversight and advocacy for people affected by the Mental Health Act.
Children and young people and a framework for assessing capacity
In partnership with the Children and Young People’s Mental Health Coalition, we have also been advocating for a stronger focus on the needs and experiences of children and young people.
Recommendation:
- The inclusion of a framework to assess competency for those under 16 would help clarify the rights and decision-making processes for clinicians, children, and their carers. This would ensure more transparency and consistency in how decisions are made for younger patients. We therefore endorse the amendment tabled by Josh Dean MP.
