Prime Minister: new mental health legislation to end injustice

The Prime Minister is today announcing the biggest change to the law on mental health treatment in over three decades.

Theresa May is pledging that, if returned to government, amongst her earliest priorities will be to introduce a Mental Health Treatment Bill to scrap the outdated and unfit-for-purpose 1983 Mental Health Act.

The current law – which was subject to amendment in 2007 – has attracted significant criticism for its anachronistic approach to mental health and the unintended consequences of how it is applied. In the last decade there has been a 43% increase in the number of people detained under the Act – which raises concerns that vulnerable people are being subject to detention, including in police cells, unnecessarily. Black people in particular are significantly more likely to be detained in secure mental health wards.

The Care Quality Commission, the independent regulator of healthcare services, identified in its last report on the Act “failings that may disempower patients, prevent people from exercising legal rights, and ultimately impede recovery or even amount to unlawful and unethical practice.”

The Prime Minister is also announcing sweeping changes to the Equalities Act to prevent workplace discrimination. Problems like depression, anxiety and bipolar disorder are often intermittent, but currently employees are only protected from discrimination if their condition is continuous for 12 months, so the law will be reformed.

On the back of a strong economy, funding for mental health services is currently at record levels – and up by £1.4 billion in real terms by 2020. In order to help deliver these changes, we are also announcing plans for 10,000 more staff working in mental health by 2020. We have pledged to increase medical training places by 1,500 in the coming years and to focus these on targeting shortage specialties including psychiatry.

Prime Minister Theresa May said:

“On my first day in Downing Street last July, I described shortfalls in mental health services as one of the burning injustices in our country. It is abundantly clear to me that the discriminatory use of a law passed more than three decades ago is a key part of the reason for this.

“So today I am pledging to rip up the 1983 Act and introduce in its place a new law which finally confronts the discrimination and unnecessary detention that takes place too often. We are going to roll out mental health support to every school in the country, ensure that mental health is taken far more seriously in the workplace, and raise standards of care with 10,000 more mental health professionals working in the NHS by 2020.

“These reforms are a vital part of my plan to build a fairer society for all, not just the privileged few – and they demonstrate the positive difference that strong and stable leadership makes. Jeremy Corbyn is too weak, and his policies are too nonsensical, to help those who rely on our NHS and mental health services.”

Over half of mental health problems start below the age of 14, and increasingly children’s mental wellbeing is being affected by internet harms like cyberbullying. So the Conservatives will ensure every primary and secondary school in England and Wales has staff trained in mental health first aid and a single point of contact with local mental health services. Under proposed changes to the curriculum, children will be taught more about mental wellbeing, especially in relation to keeping safe online and cyber bullying.

To further improve workplace conditions, we will change Health and Safety at Work regulations to take account of risks to mental health as much as those to physical health. Large organisations will be required to train mental health first responders alongside traditional first aid-trained staff.

We are today committing to funding the Samaritans helpline service through the next Parliament. And finally, Conservatives will end the practice by which indebted patients are charged up to £150 by their GP for a mental health and debt form to prove their mental ill-health to their creditors, following a review announced by the Prime Minister in January.

ENDS

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Notes to Editors

Scrapping the Mental Health Act. There is a significant body of evidence that the Mental Health Act 1983 requires review. In its 2016 Monitoring the Mental Health Act report, the CQC identified “failings that may disempower patients, prevent people from exercising legal rights, and ultimately impede recovery or even amount to unlawful and unethical practice.”

The Five Year Forward View for Mental Health recommended that:

“The Department of Health should work with a wide range of stakeholders to review whether the Mental Health Act (and relevant Code of Practice) in its current form should be revised in parts, to ensure stronger protection of people’s autonomy, and greater scrutiny and protection where the views of a individuals with mental capacity to make healthcare decisions may be overridden to enforce treatment against their will.”

Latest data from the HSCIC shows that:

More than 63,000 people were detained under the MHA in 2014/15, an increase of 43% compared to 2005/06. Black and Black British people are disproportionately affected, with a detention rate of 56.9 per 100 people spending time in hospital for mental illness, compared to 37.5 per 100 for white counterparts. (Link)

The Conservatives will replace the Mental Health Act in its entirety, consulting widely with mental health charities, clinicians, patients and their families about its replacement. A new Mental Health Treatment Bill will enshrine the principle of parity of esteem at the heart of mental health treatment, including:

- revised thresholds for detention, to protect the safety of individuals and wider society but prevent the over-use of detention. This follows similar tightening of thresholds for Section 135 and 136 detention under the Policing and Crime Act, which ended the use of detention among children in police cells and reduced the use of cells for adults.
- new codes of practice to reduce the disproportionate use of mental health detention for minority groups, especially black men, reduce unconscious bias and end discrimination.
- safeguards so that when people with mental health problems have the capacity to give or refuse consent, they can never be treated against their will. At the moment, those with mental ill health can be treated without their consent in detention and on Community Treatment Orders, with no right of appeal.

Improving services for children and young people. In January, the Prime Minister announced that all secondary schools would receive training for mental health first aid by 2020/21. This is already being rolled out and a further 1000 schools will be funded in 2017/18, at a cost of £200,000. The Conservatives will extend this to all schools, including primaries. We estimate this will cost a further £2 million, funded from within DfE budgets.

In the Children and Social Work Bill, the Government introduced statutory Sex and Relationships Education (SRE) in schools. As the DfE develops the curriculum for SRE, the department will include material to teach children about mental illness and to support their mental wellbeing, especially in the context of being safe online and the pressures of cyber bullying.

The Conservatives will reform child and adolescent mental health services to ensure that children are seen within an appropriate timescales and no child is forced to leave their local area – and be taken away from their family – for treatment. The Department for Health currently spends £564 million a year on CAMHS, rising to £700 million following extra spending announced in 2016.

Reforming the Equalities Act. The Equalities Act 2010 (which replaced the Conservatives’ 1995 Disability Discrimination Act) defines long term disability as continuous for twelve months or more. This fails to consider the fact that many mental disorders, like can be fluctuating or episodic. We will consider how best to ensure that mental illness is properly accounted for in discrimination legislation, including options such as: removing “long term”, inserting language to accommodate mental illness particularly, changing the definition of disability and considering whether employers who suspect, rather than “have knowledge of” mental illness, should be included within its provisions. This follows the Prime Minister’s announcement in January that the Government will review employment discrimination laws for employees with mental health problems to ensure they are properly supported.

Health and safety reforms. There are a number of pieces of legislation we might seek to change to ensure health and safety laws adequately cover mental illness. This might include amending the Health and Safety at Work Act 1974 to specifically refer to mental health as well as physical. The act states “it shall be the duty of every employer to ensure, so far as is reasonably practicable, the health, safety and welfare of all his employees” (s2). In reality, the vast majority of employers do not actively support the mental health of employees. We could specifically refer to mental illness in this Act to ensure it is given due weight.

Guarantees for community mental health services. The Conservatives will guarantee funding for telephone hotlines for mental illness and suicide. In 2015, Samaritans received around £750,000 in total from a variety of central government funding and grant bodies, for example, although not all of this went to the hotline. In 2015, Theresa May announced £15 million for community places of safety as Home Secretary. In January 2017, she pledged a further £15 million for places of safety and crisis cafes as Prime Minister.