This year’s King’s Speech made a number of eye-catching policy proposals on behalf of the new Labour government. For us, one of the stand-outs was a promise to reform the Mental Health Act. While not a surprise, the decision to feature it in the speech shows that it will be a focus for Labour, and something that may be implemented fairly soon.
Many experts agree that the Mental Health Act needs reform, but the stakes are naturally high. So what is the Mental Health Act, what potentially needs changing—and how can we do it in a way that ensures the welfare and dignity of people with mental health conditions?
What is the Mental Health Act?
The Mental Health Act 1983 is an Act of Parliament covering the treatment and stewardship of people with certain mental health conditions. It’s best known for providing a legal framework for people to be detained in order to assess and treat their mental health condition, a process informally known as ‘sectioning’. This allows for people to be detained for periods of up to a year, sometimes against their will, in order to pursue treatment.
The Act also allows for the treatment of ‘voluntary inpatients’ under certain conditions, and provides an appeals process for detainment. It also outlines the procedures for guardianship of people with mental health conditions, stipulating where they can live and work. However, many of these stipulations are not mandatory, and there is no weighting given to whether people should be detained or treated in situ.
What are the problems with the Mental Health Act?
The UK’s first provisions for mental health weren’t what we would call sensitive. The Madhouses Act 1774 was followed by the Lunacy Act 1845, both of which regulated the detention of people with severe mental health issues. This was the idea, anyway: many people were committed on spurious grounds, particularly women and people who would now be considered ‘on the spectrum’, who could be committed for not conforming to societal norms.
However, many people would contend that the current Mental Health Act is also massively outdated, and potentially dangerous or unfair to people with mental health issues. The Act features vague language in many areas with few safeguards, including its definition of a mental disorder as “any disorder or disability of mind”. This means that almost anyone could be imprisoned or undergo mandatory treatment under the Act, although this may not be how the law is commonly applied.
The law is also lacking in many other areas. The Act does not lay out conditions or processes for ‘care in the community’, with the focus being on treatment in healthcare facilities rather than treatment at home. It also doesn’t include any accommodation for physical health issues, and how these can influence and tie into mental health disorders. Other shortcomings have been addressed over the years, including a requirement for officer training in restraint techniques, after the death of patient Seni Lewis in 2010.
Fixing the Mental Health Act
Work was already underway to address the flaws in the Mental Health Act under the last government. A review into the legislation was commissioned by Theresa May, with a white paper published in 2021 and a Draft Bill submitted in 2022. There has been broad cross-party consensus on the need to fix the Mental Health Act, and Labour have made it a priority to push through the reforms.
The first thing to address will be the safeguards around involuntary detention. At present, the law allows for people to be detained for up to a year on vague and potentially spurious grounds, and kept in places like police stations, where officers may have insufficient training to restrain and look after them safely. The new Mental Health Bill plans to include much more specific language around who can be detained, with shorter detention periods and no detention in police stations or prisons.
People with learning disabilities and forms of autism will only be able to be detained under strict circumstances, while patients will also be given more choice over their care. This will include being consulted about treatment options, and the ability to nominate a responsible person, rather than responsibility being given to their closest relative. Cases will also be reviewed more quickly to ensure people don’t become ‘trapped’ in the system.
Arguably the most sweeping change may be the extension of the Mental Health Act to areas outside of emergency detentions. The previous government rejected the Draft Bill’s proposal for a Mental Health Commissioner, something which may be picked back up by Labour. This would be a huge statement on the importance of mental health to the new government, and help to ensure the delivery of Labour’s other policies on improving mental health. This would make sense given the scale of the task at hand, with significant resources required to shift detentions from police stations to secure areas of hospitals.
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Mental health is an increasing point of focus across society, with a recognition that more effort and resources need to be committed to improving people’s mental wellbeing. The planned reforms to the Mental Health Act are an extremely positive first step. They could not only be transformative for the most seriously ill people, but also set a precedent and a path forwards for mental health in the UK—making it both a social and political priority.