Better care for mental health patients under major reforms

New laws will give patients sectioned under the Mental Health Act more dignity and say over their care in long-awaited updates to be introduced in Parliament today (Wednesday, 6 November).

Currently, outdated laws do not meet modern standards and fail to give patients an adequate voice. For example, individuals experiencing severe mental illness can be placed in police cells, and the law automatically gives a patient's nearest relative – rather than the person of their choosing such as a partner – a say in decisions about their care.

Black people are over three times more likely to be detained under the Act, whilst those with a learning disability and autistic people are also found to be inappropriately sectioned. Patients currently have little say over their care and treatment should they be detained, or over who should be involved in making decision related to their care, such as family members and carers. 

The new Mental Health Bill addresses the significant changes in attitudes towards mental illness since the original Act was passed, recognising outdated laws around the treatment of people in a mental health crisis are no longer tolerable. Modernising the Bill was a manifesto commitment and will reform the existing Mental Health Act to make it fit for purpose, improving patients' experiences of hospital and mental health outcomes, while also introducing stronger protections for patients, staff and the general public.

This includes making it a legal requirement for each patient to have ‘care and treatment plans' tailored and shaped by their individual needs that will make clear what is needed to progress them to discharge. The Bill will also give patients the right to elect a person to represent their interests and greater access to advocacy when they are detained. Together, these reforms will make it more likely for patients to stay in contact with health services and continue to engage with treatment.

As well as ensuring patients have a voice in their care, the reforms also recognise the critical role that families and carers can play in keeping patients safe – providing insight and knowledge of a patient's wishes and preferences and an understanding of what keeps them safe – including when a patient is too unwell to express this themselves. The Bill will strengthen the rights of families and carers through changes to the Nominated Person role, and require clinicians to consult with others close to the patient as they make decisions around their care where appropriate or where the patient wishes.  

Police and prison cells will also no longer be used to place people experiencing a mental health crisis, as well as creating more space for police forces to hold criminal suspects. Instead, patients will be supported to access a suitable healthcare facility that will better support their needs.

The Mental Health Act is vital to keeping people safe when necessary. It will continue to provide clinicians with the powers to admit and treat people if they become a risk to themselves or others.

Secretary of State for Health and Social Care, Wes Streeting, said:

Our outdated mental health system is letting down some of the most vulnerable people in our society, and is in urgent need of reform.

The treatment of autistic people and people with learning disabilities, and the way in which black people are disproportionately targeted by the act should shame us all.

By bringing the Mental Health Act in line with the 21st Century, we will make sure patients are treated with dignity and respect and the public are kept safe.

Safety is paramount, which is why the Bill also includes measures to ensure patients, staff and the general public are better protected. The Bill will improve decision making around detention, discharge, care and treatment. As part of this, the Bill will introduce a new requirement for the Responsible Clinician to consult another person before they discharge a patient. Increased access to second opinion doctors will help ensure care is appropriate, compassionate and effective. Discharge processes will also be reviewed more broadly and will include a safety management plan for the patient, to keep themselves and other safe.  

Claire Murdoch, NHS National Mental Health Director, said:

This new Mental Health Act is a once in a generation opportunity to ensure that patients experiencing serious mental illness and crises receive safe, modern, evidence-based care, and that the needs and wishes of patients and their loved ones are central to care and better mental health outcomes.

This comes alongside the NHS's work to transform mental health services – either through intervening earlier with hundreds of NHS teams working in schools, or trialling new 24/7 crisis mental health hubs to prevent people needing hospital care in the first place, and if an admission to hospital is needed the health service is working with local services to ensure this is delivered in a safe and therapeutic environment close to people's homes.

Lord Timpson, Minister for Prisons and Probation, said: 

This Bill will rightly end the use of prison cells for people who need care under the Mental Health Act and ensure they get the urgent specialist help they need.

It will also mean prisoners requiring mental health hospital treatment are transferred quicker, and builds on our ongoing work to ensure prisons make better citizens and not better criminals.

Whilst there have been decreases in the number of detentions from 2021/22 and 2022/23, latest data from NHS England shows an increase in 2023/24 with 22,000 people subject to the Act as of September.

An independent review of the Mental Health Act, chaired by Professor Sir Simon Wessely, President of the Royal Society of Medicine, and commissioned by former Prime Minister Theresa May in 2017, found rising rates of detention under the Act, racial disparities, poor patient experience especially for autistic people and those with a learning disability.    

For those with a learning disability or autistic people, the Act will be amended to place a limit of 28 days for which they can be detained unless they have a co-occuring mental health condition.

Professor Sir Simon Wessely, Chair of the Independent Review of the Mental Health Act, said:

I am delighted that at long last a new Mental Health Act bill is to go before Parliament. No one doubts that it is time to modernise our legislation, in order to achieve the goal of reducing coercion and increasing choice for those who suffer from the most severe mental illnesses.

Our reforms will achieve that by ensuring better treatment and discharge planning with more family involvement, replacing outdated Victorian rules, and by reforming community treatment orders tackle unacceptable ethnic differences. Most of all ensuring that more attention is given to patient preferences will improve compliance with essential treatment, reduce coercion, whilst still protecting the public where necessary.

Reforms in the Mental Health Bill aim to improve patient experiences, choice and autonomy as well as tackling racial discrimination and better supporting those with learning disabilities.

This includes:

• Increase the frequency of clinical reviews, to better ensure that the treatment patients receive is appropriate

• Update the use of Community Treatment Orders, so that they are only used when appropriate and proportionate

• Limit the length of time that people with a learning disability and/or autistic people can be detained under the Act, if they do not have a co-occurring mental disorder that needs hospital treatment and have not committed a criminal offence

• End the use of police and prison cells for detaining someone experiencing a mental health crisis instead of getting them access to a facility where they can get the proper support, such as a hospital

• Speed up transfers from prison to hospital by limiting the time it can take to transfer prisoners who need treatment in a mental health hospital to a maximum of 28 days

The action follows the introduction of one of the world's first all-hours mental health crisis support service in August through NHS 111. The government also announced £26 million will be invested to open new mental health crisis centres as part of last week's Budget, with extra funding also secured to provide talking therapies to an extra 380,000 patients.

For people who need support at A&E, every emergency department in England now also has a liaison psychiatric team available to offer specialist care. 

A full list of mental health support options is available via the NHS.uk website. The service is also suitable for deaf people, with tailored services available via the NHS 111 website.

Commenting on the announcement, Mark Rowland, Chief Executive at the Mental Health Foundation, said:

These long overdue updates to the Mental Health Act cannot come soon enough. People need support that reflects our modern understanding of how to help and care for people during a mental health crisis – not our understanding four decades ago. The original version of the Act has driven racial disparities, stripped those who are sectioned of their humanity in a wholly unnecessary way, and all too often made crises worse.

We particularly welcome reforms to give greater say to patients, such as granting people with severe mental health problems more control over who makes decisions for them during a crisis, banning the use of police cells as ‘places of safety' for people experiencing a crisis, and addressing the inappropriate use of Community Treatment Orders, which Black people were 11 times more likely to receive. We will look to work with the Department of Health and Social Care over the next weeks and months to help shape the Mental Health Bill and put dignity at the heart of how our public services support people experiencing a mental health crisis.

Mark Winstanley, Chief Executive, Rethink Mental Illness, said:

People tell us that the Mental Health Act has saved their life, but that the experience was horrendous. It is hard to fathom that when people are at their most unwell they are still routinely placed in prison cells, have no say in who is appointed as their nearest relative and have so little involvement in their treatment.

Reform of this vital legislation is long overdue, and today marks another important step towards the reality of a Mental Health Act fit for the 21st century. Reform should help ensure people are with dignity and respect, and help to protect us all.

We hope the Bill is given careful passage through Parliament so it can be swiftly implemented, and bring improvements for the thousands of people who are detained under the act every year.