Bolstering AMHP role can ‘vastly reduce’ detention numbers under existing MHA, say service heads

Bolstering approved mental health professionals’ (AMHP) role in preventing detention in hospital can “vastly reduce” use of the Mental Health Act within the existing law, say service heads.

The AMHP Leads Network made the claim as charities urged the new Labour government to bring forward a bill to replace the MHA in its first legislative programme, which will be set out in next Tuesday’s King’s Speech.

MHA reform is long overdue with the Conservatives having pledged to enact the change in their 2019 manifesto and brought forward a draft bill in 2022 but then failed to legislate before they left office this month.

In November last year, then shadow health and social care secretary Wes Streeting – who is now responsible for the two services in government – said Labour would bring forward legislation to replace the MHA in its first King’s Speech.

Manifesto pledge to overhaul legislation

In its election manifesto, Labour said the current act was “woefully out of date”, its operation discriminated against black people and that the treatment of detained autistic people and those with learning disabilities was a “disgrace”.

It pledged to modernise the law “to give patients greater choice, autonomy, enhanced rights and support, and ensure everyone is treated with dignity and respect throughout treatment”, a similar prospectus to the Conservatives’ draft bill.

However, the manifesto did not repeat the promise to legislate in its first year in office.

Draft bill ‘flawed’

The draft bill’s broad aims were to reduce use of – and racial disparities in the use of – the MHA, end its inappropriate use in relation to autistic people, people with learning disabilities and empower patients and their loved-ones.

The AMHP Leads Network, while supportive of MHA reform and its objectives, has previously described the Conservatives’ draft bill as flawed, including on the grounds that it would have “little or no impact” on tackling racial disparities and enhancing the rights of patients and families.

In a statement this week, network co-chair Christina Cheney said there were “many ways in which the desired outcomes for change may be achieved without the need for legislative reform”.

“We believe that attention on key practice challenges, with the support of current legislation and codes of practice, has the potential to vastly reduce compulsion, including for those groups overrepresented or poorly served by mental health environments,” said Cheney.

Call to strengthen AMHPs’ preventive role

In particular, this should “strengthen the emphasis on and support to” AMHPs’ role under section 13 of the MHA in considering a person’s case if a local authority has reason to believe that an application may need to be made to detain them in hospital or take them into guardianship.

In many such cases, AMHPs do not carry out an assessment to determine whether to make an application – which generally must be agreed by two doctors – to detain a person in hospital under the MHA. Instead, they find less restrictive care alternatives for the person.

Cheney said this AMHPs’ role under section 13 needed to be backed by a commitment from partner agencies to remain “proactively involved” in a person’s care throughout any period of consideration, assessment and admission.

She also said the network also wanted to see greater provision of social support for people, alongside medical care.

Cheney said taking these steps now would “achieve rapid change”, allowing the new government time to “take a braver and more radical approach to mental health legislative reform that can be informed by this and other developing work in mental health, AMHP and social care networks”.

Charities urge immediate MHA reform

However, charities said overhauling the MHA – to reduce the number of people detained, end the unnecessary detention of autistic people and those with learning disabilities and tackle racial disparities – was an urgent priority.

Mental health charity Mind pointed to figures showing almost 21,000 people were subject to the act, just over 15,000 of whom were detained in hospital, as of the end of April this year.

“Too many people are being sectioned under an outdated law which enables shameful, racist injustices; often in run-down, unsafe hospitals that aren’t fit for purpose,” said its policy and campaigns manager, Gemma Byrne.

“[The] statistics show why it’s essential the new government delivers on its promise to include reforms to the Mental Health Act in its first King’s Speech next week,” she added, saying this should “truly strengthen the rights of people when they are most unwell.”

For the Centre for Mental Health, chief executive Andy Bell said: “The new government can bring the Mental Health Act into the 21st century with a comprehensive new bill, including new conditions for the use of coercion, better safeguards for patients, and faster transfers from prison to hospital.”

Alongside legislative reform, Bell said there was an urgent need to modernise hospitals so “people aren’t detained in outdated buildings and facilities”.

Impact on autistic people and people with learning disabilities

MHA reform is seen as a key step in tackling the longstanding issue of autistic people and people with learning disabilities being detained in hospitals, often for long periods of time, rather than receiving more appropriate care and support closer to home.

For Mencap, head of policy and public affairs Dan Scorer said: “Many are locked away for years in these settings where they are at increased risk of abuse and neglect, often due to a lack of the right social care and suitable housing – not because they need inpatient mental health treatment.

“The government must deliver on their promise to introduce a new Mental Health Bill as a matter of urgency and bring an end to the scandal of inappropriate detention. Overhauling this outdated law, alongside investment in community support, will be a true test of their commitment for change.”

Ending ‘scandal’ of inappropriate detention

The National Autistic Society issued a similar message, saying that MHA reform was “an essential step in ending the human rights scandal of autistic people being inappropriately detained in mental health hospitals”.

“Autism is not a mental health condition, and should not be treated as such in law,” said its policy and parliamentary officer, Sam Forrester.

He said the draft bill put forward by the Conservatives needed to be strengthened, including by “guarding against alternative routes to detention, and [placing] greater emphasis on ensuring treatment is therapeutically beneficial”.

Forrester added that there also needed to be increased investment in “high-quality community support” for autistic people to prevent them going into crisis.

“The bill must now be brought before Parliament urgently, where it can be debated and strengthened – this crisis must end now,” he added.