This article was amended at 9.45am on 5 October.
The prime minister has announced an independent review into the Mental Health Act 1983 that will examine rising rates of detention and the disproportionate numbers of black, Asian and minority ethnic (BAME) people detained.
Theresa May announced the review in her speech to the Conservative Party conference, saying it was designed to “tackle the longstanding injustices of discrimination in our mental health system once and for all”.
The review was promised in this summer’s Queen’s Speech, which said it would be the first step towards a new Mental Health Act.
Psychiatrist to chair review
It will be chaired by former president of the Royal College of Psychiatrists Simon Wessely, and is due to report by autumn 2018.
Official figures show that 63,622 people were detained under the act in 2015-16, almost 50% higher than the figure 10 years previously.
The review will examine the causes of this rise and the continued disproportionate use of the act in relation to BAME people.
It will also investigate concerns about safeguards available to people, such as tribunals and second opinions, the use of community treatment orders (CTOs) and the ability of people to determine which family members have a say in their care.
Detention rather than treatment
The terms of reference also state that the review will probe how far the act is used to detain rather than treat, and the time required to take decisions and arrange transfers for people subject to criminal proceedings.
The government said the review’s recommendations should be aimed at improving the treatment and support people receive when experiencing acute mental ill-health.
While the expectation is that it will lead to law reform, the government said that some of the solutions are likely to lie in practice rather than legislation.
Ministers will appoint vice-chairs to support Wessely in carrying out the review. The government said that the review should involve past and present service users and carers in all aspects of its work, including through an advisory panel that should have a direct input into the recommendations.
It added that the review’s recommendations should have broad support among service users, carers and professionals.
Reform or replace?
It is not clear at this stage whether the reforms will lead to a wholly new act or a further reform of the 1983 legislation.
Mental health law was last reformed in 2007, though this retained the 1983 act in amended form.
The 2007 reforms introduced CTOs, under which people are discharged from detention in hospital but with conditions placed on them designed to ensure they continue with their treatment, with the possibility of them being recalled to hospital under certain circumstances.
They also introduced entitlement to independent mental health advocacy for detained patients, and changes to professional roles, with the replacement of approved social workers by approved mental health professionals (AMHPs), a position open to nurses, occupational therapists and psychologists as well as social workers.
The announcement of the review was welcomed by mental health charities the Centre for Mental Health and Mind, though both stressed that the involvement of people with lived experience would be critical.
Centre for Mental Health chief executive Sarah Hughes backed the appointment of Wessely to lead the review, but added: “We expect the review to be comprehensive. It must look at every aspect of the Act and explore not just the legislation but the context in which it is used. We can only understand why use of the Act has risen every year since it was last reformed in 2007, and why some people are so much more likely than others to be detained, if we examine the way society has changed and services have developed over that time.”
Mind head of policy and campaigns Louise Rubin said: “People who are at their most unwell need choice, control and dignity and legislation needs to support that. We can’t look at the Act in isolation, without also addressing underlying failures in mental health services that see people ending up in crisis.”
But on Twitter, concerns were raised about the review by service users, survivors, professionals and academics.
The writer of the Sectioned blog, who has personal experience of being detained, questioned the choice of a doctor to lead a review into mental health law.
If you want a proper review of #mentalhealth law, put a legal specialist in charge. Why not an AMHP? They’re specialists in applying MH law.
— Mental Health (@Sectioned_) October 4, 2017
Mental health researcher and consultant Dr Sarah Carr, who specialises in service user involvement and co-production, raised concerns about how far service users and survivors would be involved in the review.
💯MHA Review MUST be with people with ‘lived experience’ of being sectioned, not occasionally tearful token mental Big Charity policy wonks https://t.co/56kIBrMOMk
— Dr Sarah Carr (@SchrebersSister) October 4, 2017
Other issues raised included whether law reform would tackle inequalities resulting from institutional racism, and whether any changes would be effective without adequate resourcing for community and inpatient services.