What next? Delivering fundamental reform for the Mental Health Act

9 January 2019
By Andy Bell
Andy Bell
9 January 2019

The Independent Mental Health Act Review, led by Sir Simon Wessely, published its final report in December and set out more than 150 recommendations to modernise the law and make it work better for people.

The report was a full year in the making. In that time, it reviewed evidence that has amassed in the nearly twenty years since the last such review, it sought the views of thousands of people and it explored the range of options available to reform the law. The review sought particularly to investigate the stark and dramatic inequalities in the experiences of Black, Asian and Minority Ethnic communities of the Mental Health Act and how they could be addressed.

The Mental Health Act Review set out more than 150 recommendations to modernise the law and make it work better for people

Centre for Mental Health supported the Review by providing analysis of its survey results as well as working with the Review team on a number of topic areas. We also, during the course of the Review, published a number of guest blogs by people with a wide range of experiences and views about what should change. The blogs looked at the impact of the 2007 Mental Health Act, including the creation of community treatment orders and the scope for a wider range of professionals to take up statutory roles. They explored the impact of being sectioned on people’s housing rights and anomalies in prescription charging that disadvantage some people with mental health problems. And they explored the potential for the wider use of advance statements. All were written from either personal or professional experience of the Mental Health Act with a view to bringing first-hand knowledge to bear on debate about how it may be reformed.

The review’s final report received a range of responses. Many warmly welcomed its recommendations and its overall approach to making the Act work better for people. Some were more critical – in the main for not taking a more radical approach to changing the Act. Few, if any, however, suggested that reform to the Mental Health Act was not necessary or that the review had gone too far in its recommendations. So while there are different views about what needs to be done next, there is a clear picture emerging that we cannot leave the Mental Health Act as it is, and nor can we ignore the many wider changes that are needed to make it work better for people.

A clear picture is emerging that we cannot leave the Mental Health Act as it is

The challenge now is to consider what can be done, at every level, to bring about those changes. Many, indeed most, of the review’s recommendations require primary legislation. That will mean Parliament making very significant changes to the Mental Health Act. Such a process will allow further debate about whether the review’s recommendation really do go far enough in modernising the Act or if something more radical is needed to bring it into the twenty-first century. Like the review itself, it will raise some very difficult issues about the powers of the state and the way they are exercised. 

Other recommendations require different responses. Some of the most important proposals for addressing race inequality in the use of the Act, for example to create an Organisational Competency Framework, need concerted action rather than legislation. The review’s call for investment in mental health inpatient facilities and ambulance services needs dedicated funding. And the review’s far-reaching implications for the mental health workforce – including a substantial expansion in advocacy provision – will need significant planning to ensure a sufficient number of people are available to take up new or expanded roles. All of these have to start now to ensure they are in place when they are needed.

Like the review itself, it will raise some very difficult issues about the powers of the state and the way they are exercised 

Despite the challenges ahead, there are reasons to be hopeful. The last time the Mental Health Act was reviewed, the Government ignored most of its recommendations and took a very different path. The debate that followed, in the media and in Parliament, was often fuelled by fear and prejudice. This time, the process so far has been very different. The aim of the review has very clearly been to create a system that treats people with dignity and respect and reduces inequalities. People with mental health conditions have been at the heart of the process, not talked about fearfully in their absence. As we move on to the next phase of this process, it is vital that those principles are sustained and if anything enhanced.

Together we can now make the changes the review has called for (and maybe more) to modernise the Mental Health Act and the systems around it. This will not be easy, and a lot of it will not be quick. But we cannot turn our backs on it now, and we cannot ignore the need for fundamental reform.

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