Proposed Mental Health Act overhaul included in Queen’s Speech

Draft bill would raise threshold for compulsory treatment to ensure therapeutic benefit and prevent detention solely on grounds of autism or learning disability

Young black man receiving a mental health assessment
Picture posed by models (Prostock-studio/Adobe Stock)

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Proposals to overhaul the Mental Health Act 1983 will be considered by Parliament over the next year, the government announced today in the Queen’s Speech.

It will produce a draft bill designed to reduce the number of detentions, tackle longstanding racial disparities in the use of compulsory powers and end the detention of people on the sole grounds of them being autistic or having learning disabilities.

The draft bill will likely be considered by a parliamentary committee, a process that will inform the production of full legislation to reform the act – though it is not clear when this will be published.

‘Greater control’

The reform plans are based on the government-commissioned Independent Review of the Mental Health Act, whose final report was published in December 2018, and a follow-up white paper produced in January 2021.

The government said the proposals were designed to provide greater control for people over their treatment and more dignity in care, and reduce the use of hospital care for autistic people and those with learning disabilities.

Specific proposals in the draft bill will include:

  • Amending the definition of a mental disorder so that people can no longer be detained solely on the basis of being autistic or having a learning disability. They would have to have a co-occurring mental health condition. Currently, people with a learning disability can be subject to the act’s powers if this is “associated with abnormally aggressive or seriously irresponsible conduct”, while autism is classed as a “mental disorder” for the purposes of the act.
  • Changing the criteria for detention so that the act’s powers can only be used if there is “genuine risk to [the person’s] own safety or that of others, and where there is a clear therapeutic benefit”. Currently, a person can be detained for assessment if necessary for the health and safety of the person or the protection of others, and for treatment if any of these conditions exist, appropriate treatment is available and it can only be provided under detention.
  • Allowing people to choose a “nominated person” to support and represent them when under the act’s powers, rather than have a “nearest relative” assigned to them.
  • Increasing the frequency with which people can make appeals to tribunals on their detention and providing tribunals with a power to recommend that aftercare services are put in place.
  • Introducing a statutory care and treatment plan for all people in detention, written with them and setting out a clear pathway to discharge.

‘Outdated legislation continuing to fail people’

Learning disability charity Mencap welcomed the announcement, pointing to the 2,000 people with learning disabilities or autistic people currently in inpatient settings.

“Laws are supposed to protect people, yet this outdated legislation has continued to fail people with a learning disability and/or autism,” said chief executive Edel Harris.

“There are currently over 2,000 people locked away in institutions, the vast majority detained under the Mental Health Act. Many are subject to physical restraint, solitary confinement and overmedication. They face increased abuse and neglect, and are often forced to live many miles away from their families inside institutions.”

Legislation ‘not enough on its own’

The draft bill was welcomed by NHS Providers, which represents health trusts, but it said that accompanying action needed to be taken to increase funding for mental health services, improve the wellbeing of a workforce put under great strain by Covid and tackle racial inequalities in mental healthcare.

Director of policy and strategy Miriam Deakin said: “We support proposed changes to the act that will give people a greater say in planning their care and recovery. It will be important for the bill to reflect consideration of the practical implementation of a number of proposals.

“A new Mental Health Act on its own won’t be enough to guarantee high-quality mental health services or transform the way we deliver them for years to come. Mental health services are under severe strain from huge demand and limited resources.”

‘Missed opportunity to value carers’

Meanwhile, carers’ campaigners expressed disappointment that the government did not bring forward its long-awaited Employment Bill, in which it had pledged to legislate to give carers the right to take five days’ unpaid leave from work a year. This was a commitment from the 2019 Conservative manifesto.

“This is such a missed opportunity to value carers and to ensure that they had the support to continue to juggle work and care,” said Carers UK chief executive Helen Walker.

“With severe social care shortages and pressures on the NHS, families simply can’t do it all. Many are at breaking point. This is precisely the time when government really should be investing in carers and their families as well as employers by bringing in the right to up to one week’s unpaid Carer’s Leave and a day one right to request flexible working.”

The latter is a reference to another government pledge, to enable all workers to request flexible working from the point they start a job, not after 26 weeks’ continuous service, as presently.

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26 Responses to Proposed Mental Health Act overhaul included in Queen’s Speech

  1. Steve Chamberlain May 10, 2022 at 5:37 pm #

    I absolutely agree that the current Act needs updating, but to suggest that a change in the legislation will address the overrepresentation of certain racialised groups, and will lead to a reduction in admissions is quite frankly laughable (if it wasn’t so serious)
    I’ve read that Johnson this afternoon has stated that the legislation will ensure “every patient receives the treatment they deserve and no patient is detained unnecessarily.”
    First of all, getting “the treatment they deserve” depends entirely on funding the whole system (community and hospital) sufficiently.
    And as for the suggestion that doctors and AMHPs are wandering the streets detaining people who don’t need to be in hospital (perhaps ‘wandering the streets’ is a bit extreme), belies the fact that all AMHPs and mental health services know that there are acutely mentally unwell people in the community for whom there is no crisis service to keep them out of hospital, and there are no beds in local NHS hospitals for them to be admitted to.
    I’m not sure how the CRED/Sewell Report from last year fits into the narrative of needing to reduce the number of people from racialised groups in hospital, and in the most restrictive environments.
    I wait to see what legislative suggestions will be forthcoming about improving culturally appropriate advocacy. One option suggested was to place a duty on the state (LA or NHS) to manage the advocacy market to ensure small providers catering for specific local minority communities are encouraged and funded. I have doubts whether this will find its way into the Bill.
    There is also work underway (Patient and Carer Race Equality Framework/PCREF) in relation to trying to address racial inequality, and that’s without a bill or a new Act.

  2. Terry McClatchey May 10, 2022 at 6:52 pm #

    The best way to reduce the proportion of compulsory detentions would be to make access easier to effective and welcoming services that people would choose to use on a voluntary basis. That does not require legislation.

  3. Tahin May 11, 2022 at 7:47 am #

    Perhaps if the staff Mr Chamberlain represents reflected the communities they “assess” they would not need a Tory government to help them tackle the “overrepresentation of certain racialised groups”. It seems that in the strange self defined world of the AMHP all the positives are from them and anything negative on somone else. Listening to AMHP’s berating mental health services is like listening to somone failing their driving test and blaming a sparrow obscuring their vision before they run over the dog. I mean, it’s not as if it needs an AMHP to “detain” somone in hospital is it?

  4. Adam May 11, 2022 at 8:42 am #

    Perhaps if the AMHP Leads Network put some effort into getting their AMHP’s to vaguely look like the ” racialised groups” they are detaining, they wouldn’t need an “advocacy market” to help ensure people aren’t misunderstood, victimised, othered, profiled, belittled and unnecessarily incarcerated. For a group of workers who keep telling us there are no beds, there seems to be an awful lot of people in hospital. Where are they all sleeping? Are there secret sheds that AMHP’s are detaining people into? Sewell report might have missed several obvious facts infront of them but so do AMHP Leads Network when they tirelessly blame the ‘system’ without acknowledging that they are the system too. There wouldn’t be a single person in hospital against their will without AMHP’s. That’s not a conundrum, it’s a legal fact. Pretend that you are not in the thick of it and ofcourse you will see it as someone elses responsibility to advocate. What’s that? You need an independent voice? I’m confused. I thought one of the unique skills and expertise of the AMHP was being independent of the wicked “medical model”? Speaking as a now retired AMHP, Bertrand Russell would struggle to bring logic into AMHP discourse.

    • Steve Chamberlain May 11, 2022 at 4:14 pm #

      Certainly some interesting points raised and I agree that AMHPs are part of the state system, along with all other professionals. The AMHP Leads Network is unable to influence the degree of diversity of the workforce – that’s down to employers. However, I’ll agree that there remain some significant issues around the limited diversity within the lead AMHP workforce (apart from from in London).
      I believe that most AMHPs find the most rewarding assessments are those where the person is not detained, and alternatives to admission have been found and mobilised. While you criticise people ‘tirelessly blaming the system’, I think it’s difficult not to recognise the impact of austerity across health and social care (and the rest of many people’s lives) over the past 12 years.
      It is interesting to consider that the use of the Mental Health Act remained fairly stable between the mid-90s and 2010. Since that time, the numbers have been rising around 5% per year, alongside concurrent reductions in community resources to prevent deterioration and relapse, and also ongoing reduction in acute psychiatric beds.
      There are around 25% less psychiatric beds available now compared to ten years ago, while the use of the MHA has risen by 50%. So yes, there are still a significant number of ‘beds’ but the occupancy rate is normally around 95% – 100%, meaning that people in acute mental health crisis who need hospital admission are regularly admitted many miles (sometimes over 100) from their home area, or cannot be admitted at all. If this was the case for cardiac or cancer care, it would be considered a national scandal.
      Yes, AMHPs have the difficult task of making decisions which lead to people being admitted to hospital, sometimes against their wishes. I will repeat the challenge to Johnson’s statement that new legislation will prevent people being ‘detained unnecessarily’, implying that this happens on a reasonably regular basis. As you will know as a retired AMHP, decisions regarding detention are taken based on the risk to the person themselves (or to others) and the availability, or otherwise, or alternative resources to manage that risk outside of hospital.
      And finally, yes, patients/users of services do need advocacy support to ensure their voice is heard. AMHPs (from whatever profession) are not their advocates. They have a particular role set out in legislation. However strongly one may attempt to maintain a human rights-based approach, it is not the role that an advocate will play. To suggest otherwise is naive in the extreme.

      • Adam May 11, 2022 at 6:05 pm #

        A naive question: if an AMHP queries unsafe treatment, are they advocating for safe practice or merely “discharging” their duties under the MHA? I suspect the answer will conform to the selective elasticity that bedevils AMHP discourses. Another naive question: does the increase in the use of the MHA post 2007 have anything to do with the AMHP role replacing that of the ASW?

        • Steve Chamberlain May 11, 2022 at 8:25 pm #

          Are you suggesting that the addition of nurses and occupational therapists to the AMHP workforce has led to increased detentions? Other than that, the 2007 changes made precious little difference to the criteria for detention.
          I suspect AMHPs from those professions would have some fairly to-the-point responses to that question.
          And given the fact that only 5% of AMHPs are from a non-social work background, even 15 years after the changes, the statistics for the hypothesis simply don’t add up.

          • Adam May 11, 2022 at 11:03 pm #

            No. They are miniscule to have made the disproportionate difference. Simply asking if AMHP training with the obsession of creating a ‘portfolio’ to ‘evidence’ their knowledge and expertise in law and medicine against the staunchly social work values entrenched willfully establishment challenging of the ASWs has contributed to the increased use of detention powers. It’s really not a trick question. Just seems a truism to me that there is a causal correlation between AMHP training and a corresponding increase in the use of the MHA. That’s my query. Nothing to do with the profession of the AMHP.

  5. Asif AMHP May 11, 2022 at 3:32 pm #

    I find myself wondering lots of things & what the difference between genuine & substantial risk might be & who gets to decide. Again I find myself wondering what therapeutic benefit looks like & to who & where & again who gets to decide & define it.

    I find myself wondering about £s & what exactly early intervention & community alternatives to admission look like.

    I find myself wondering about S.117 for autistic people & people & kids with LD & the LPS.

    As ever I find myself wondering about S.140 & how MH Crisis services are commissioned & about people/kids assessed as requiring admission, subject to the provisions of the #MHA, but waiting for the now near mythical bed. I find myself Wondering about those placed out of area, in Private for Profit Provision (P4PP) & miles away from home.

    I acknowledge that us #AMHPs are front & centre & in the middle of this stuff. Though you wouldn’t know it – because we are sort of invisible.

    We do know how many detentions there are each year – 53239 (England) last year (2021/22). We don’t actually know how many people/kids that figure relates to, or indeed how many Mental Health Act Assessments (MHAAs) #AMHPs co-ordinated that year. No one centrally collects that data. So we just don’t know. An educated guess is 145,00 MHAAs. the figure is based on some work carried out in 2017.

    I am certain that #AMHPs are not detaining people/kids every time that they are being invited to do so.

    So I will go back to wondering about stuff & things & about legal literacy & trying to do the best I can, within a system that is dysfunctional.

    • Tahin May 11, 2022 at 6:18 pm #

      I am wondering why the AMHP Leads Network isn’t collecting the data from their members organisations. Why is it always somebody else “centrally” who is expected to collect this for AMHP’s? Professional pride if nothing else should be motivation enough to want to know this. But maybe I am just out of my depth when S117, S140 and “Legal literacy” rolls off the tongue so readily instead. Unlike S26 it seems.

      • Steve Chamberlain May 11, 2022 at 8:21 pm #

        Hmm, this is about as realistic as asking the Royal College of Nursing to count how many times mental health nurses are asked to see patients in A&E, or asking the Royal College of Occupational Therapists to count how many stair lifts they have arranged. And the Royal Colleges are infinitely more well resourced.
        The only way it is possible to obtain reasonably reliable national activity data (and this includes mental health admissions to hospital, which is collected by NHS Digital) is by central direction. Without that, local authorities (or NHS trusts) have no requirement to cooperate.
        Work has been done to estimate how many assessments are undertaken, as the previous poster has mentioned. This suggests that there are around 140k-150k MHA assessments per year, which is three times the number of applications.
        That would suggest that twice as many assessments result in the person not being detained as those where the MHA is used.

        • Tahin May 11, 2022 at 11:09 pm #

          Really? I thought AMPH Leads had responsibility for collecting local information on AMPH activity. How difficult would it be to collate that into a bigger data set? Not everything has to be crushed by bureaucracy obsession.

        • Hamish May 12, 2022 at 8:37 am #

          Except that Hospital Trusts do actually know how many times psychiatric nurses see patients in A&E as it’s part of basic data collection. As is how many times a patient has been assessed by an AMHP. And collecting data from Leads shouldn’t really be that difficult. Where I work I have to fill in the electronic data form demanded by the Lead. It asks how many referrals I have received, how many I accepted for follow up, why I rejected and what signposting I did, time from referral, triage to action taken, if completed assessment what the outcome was, if admitting whether to a local or out of area NHS bed, contact with the NR, and Tribunal work. Just ask her I say.

          • Steve Chamberlain May 12, 2022 at 3:58 pm #

            My point entirely. Hospital trusts collect the data and feed it to NHS Digital as required by the regulations. The data isn’t collected by practitioner organisations.
            So all you need is for DHSC to ask local authorities to collect the data and submit it (after standardising it, otherwise the figures won’t be comparable), and pay them extra for doing it – this is standard procedure when additional information is demanded.
            Simples…

    • SAD May 12, 2022 at 12:33 pm #

      Risk is always defined by the AMHP ofcourse. Families, friends, neighbours and other professionals are just passing the buck overeactors aren’t they?

    • Kevin May 13, 2022 at 11:19 pm #

      Well given how much of a stickler for the law AMHPs are the answer must obviously be that it’s the AMHP who decides between what is genuine and what is substantial risk. It can’t be families because because and it most definitely can not be the NR because they don’t understand the role. Do I win the shadow an AMHP for the day special prize?

  6. Lou May 11, 2022 at 10:19 pm #

    Although this is probably unpopular as a concept , AMHPs can and do (as part of the wider mental health system) save lives / allow space a chance for someone becoming better. This happens by a team of three professionals making the always unpalatable decision to admit a person to hospital when they would choose otherwise. Where someone is seriously unsafe to themselves or others hospital care can provide another option. Where there is life there is hope.

    Alongside this I feel as an AMHP ( but always a social worker first ) that mental health services are wholly inadequate, chaotic and stretched to breaking point. There have been so many years of cuts. It is an awful system where people have to reach crisis before services step in, but this often happens. I recognise the racial and cultural inequalities in mental health care and sometimes often I feel helpless, depressed and ashamed.

    However perhaps like my colleagues in child protection who are also frequently vilified for getting it ‘ wrong’ whatever they do I need to remember that the social and political climate we live in shapes our worlds , and our opportunities and those of the people we serve. Boris Johnson might bang on about reforming the MHA but he doesn’t care, nor does his government about the real issues – poverty and deprivation, low social mobility and opportunities, gaping health inequalities. Much easier to perhaps blame the legal frameworks and the local authority workers trying to simply do the best they can with what there is – which is practically nothing. In light of all of this I am not sure that the reforms, however we’ll intentioned will make any real difference unless there is a real commitment to other wider changes.

  7. NR May 12, 2022 at 2:55 pm #

    This isn’t about vilification of the AMHP for getting it “wrong” for me. It’s about what AMHPs do to challenge and be social workers first. It’s not good enough fir AMHPs to blame a failed and getting worse system and blame employers and Trusts and the wicked Tories. I as an AMHP am part of the chaos too. When I raise questions and when I dare to challenge a quite word is had with me not by my supervisor but the AMHP Lead. Apparently doctors and medical directors feel they can dictate and disapprove and know they will be listened to. I joined a picket at our local A&E and was threatened with disciplinary action. It’s no.good us complaining about fewer and fewer beds, about poor staffing on wards and none worryingly at “Suites” from the sidelines. Claim of saving lives by admitting when hospital suicides are on the rise is a sobering thought. Yes we do.the best with what we’ve got but there’s a complacency about all of this. Politely pleading fir better services from the sidelines is a demoralising activity. Our leaders shouldn’t just get animated when the MHA reform hamster wheel begins to turn again. Our problems aren’t just legal. Personally I think the AMHP Leads Network shouldn’t be so aligned with BASW if we want to have a more radical voice. Saying which apparantly makes me “strident” in the eyes of our local Lead but has a rant over a typo AMHP/AMPH something I know is also dear to some of the other contributers here.

    • Asif AMHP May 13, 2022 at 8:29 am #

      I do like a good #AMHPrant & the “P” in the right place. Not because its really important. But because, most people have no idea what an AMHP is or does & that includes too many who should.

      AMHPs are pretty good at making noise, but we have been rubbish a organising ourselves as a collective or as a coherent voice. I do think there is something about LAs & the big cheese Chief Social Worker & leaders, needing to challenge the NHS/CCGs in a more robust manner, about the commissioning arrangements in place to support AMHPs to carry out their role. Like you, I have been dragged into little rooms & admonished for raising issues & rocking boats & for trying to do the right thing etc.

      Ultimately for me, its not really about the AMHP, but about the people/kids on the receiving end of what we & others do. But like you, I can only do what I can do.

      • NR May 13, 2022 at 12:45 pm #

        Most people don’t know what the “social” is for either but we don’t have pals chuckles over typos or because they should know better. If it really is about the people/kids at the receiving end, us AMHPs (phew) would spend more energy acknowledging our part in how people/kids are treated by the system we practice in. We are it too. That’s more important to me than getting het up about spelling. If we want people to know meanings why are we so nonchalant about using acronyms? Wouldn’t have anything to do with establishing status over clarity would it? We all do what we do in the best way we know. But when we are told that the assessment process is frightening, families and the NR feel marginalized, wards are unsafe, treatment oppressive, services indifferent until we decide there is risk, that we are too intimate with doctors, that we are quick to hide behind “our duties as set out” rather than acknowledge, accept and listen, that we don’t quite behave like the social justice advocates we believe we are, than I think there are better hills than typos frankly.

  8. Sean May 13, 2022 at 8:27 am #

    Steve I am baffled as to why you are taking this line. Who provides the data for hospital trusts to give to NHS Digital? Individual workers. AMHPs are your individual workers. Rather than expect a behemoth to do the work it clearly will not do, why doesn’t the Network own the professional responsibility? No everything should be about someone else giving money to somone to do the bits that would improve understanding and experience. Why turn what should be an commonplace activity into “It’s not our responsibility guv.” If you saw someone being run over by a car I hope you would ring for an ambulance rather than shrug and walk on saying the driver did it, they should ring for one. Surely BASW could boss this for the Network?

    • Steve Chamberlain May 13, 2022 at 10:15 am #

      Interesting that you suggest that BASW could “boss it for the network”, while someone above said the AMHP Leads Network “shouldn’t be so aligned to BASW”. The reality is that the Network has no formal links or alignments to BASW. Some leads are members while others are not.
      And simply put, is is just not possible for an organisation such as the AMHP Leads Network to instruct local authorities to hand over their activity data (which does indeed belong to the local authorities). Just like, as I mentioned above, the RCN or the RCOT has no authority to obtain information from NHS trusts on activity.
      This information is all protected by GDPR and the only way it can be obtained at a national level is through national reporting mechanisms.
      That is how MHA detention statistics are collected, as well as guardianship and Deprivation of Liberty data.
      Yes, the network is able to obtain rough pictures of activity through informal surveys, but that is a million miles away from a national reporting mechanism, which the network has been asking for for years.

  9. Lucy May 13, 2022 at 4:43 pm #

    I am a BASW member and currently work as an Associate Research Assistant at a university. Both of these have a relevance to my comment. Unless I am mis-remembering I recall a comment about the Network getting ” limited” admin support from BASW. There doesn’t have to be a formal statute for one organisation to have a link with another. Partnership it might not be, incorporation it might not be but a relationship is there. Bossing may be a bit strong but as a member of BASW I am aware of a link. Given that the Network exists on the good will and commitment of Leads I have no problem with that. But transparency is important too. Ofcourse as a non-statutory organisation the Network can’t compell employers to release employee and client confidential data. What is needed here isn’t data which would breach protection legislation though. Both the NHS and LAs release hundreds of pieces of anonymised information to researchers like me. Community Care is full of articles with data obtained from LAs. Somebody mentioned “elasticity” bedeviling discourse and I have to agree with that. What we all want is to improve the experiences of people in contact with mental health services and to eliminate the racial and gender biases that make that much worse. If somebody else is not going to do that work than we need to find the way to do it ourselves. I get your frustration Steve but “simples” it certainly isn’t. Colleagues should not overstate the relationship between the Leads Network and BASW.

    • Steve Chamberlain May 14, 2022 at 12:18 am #

      We’re moving well away from the point of the original article, but I think this deserves a brief reply.
      I’m not sure what you are suggesting when stating ‘transparency is important’.
      Your statement refers to a mention you have apparently heard from an unknown source.
      The limited admin support that the Network has received (for a past conference) is uncontested, but that doesn’t affect my statement about the fact that there is no formal relationship with BASW (or any other organisation).
      PS. the ‘simples’ comment was irony;

  10. Terry May 13, 2022 at 6:08 pm #

    Perhaps SWE could get the data to inform the consultation it just launched on the training of AMHP/AMCP.

  11. Carol May 16, 2022 at 11:02 am #

    We are indeed moving away from the central point of how enmeshed AMHPs are with the racialised response to mental health needs. Saying a thousand times it has nothing to do with how AMHPs practice doesn’t change that. AMPHs have collosal power, they are not passive, they are not compelled to follow orders. I am an AMHP. I experience all of the frustrations and the stress of my role. But I also know that willfully or otherwise I enable a discriminatory and sometimes abusive system. For me that is the transparency that matters. We can only change oppression if we acknowledge our part in it too. I really don’t care whether AMHP Leads Network and BASW are bosom pals or not. Neither has a relevance to my professional experiences.

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