Lords to consider landmark reforms to mental health care

Long awaited legislation to reform care for mental health patients is one step closer to becoming law, as the Mental Health Bill has Second Reading in the House of Lords today (25th November 2024).  

The Mental Health Bill, introduced earlier this month, will modernise the Mental Health Act, giving patients a greater say in their care, along with bolstered support from family and friends as part of treatment to ensure that their interests are protected and that their voice is heard throughout the treatment process.  

Last year, over 50,000 people were detained under the Mental Health Act, but an independent review of the Mental Health Act, chaired by Professor Sir Simon Wessely, President of the Royal Society of Medicine, found rising rates of detention under the act, along with racial disparities, and poor patient experience especially for autistic people and those with a learning disability, with patients being detained unnecessarily and for longer than needed. 

Alongside making it legal requirement for each patient to have a care and treatment plans, the Bill will also give patients the right to an Advance Choice Document, which can be used by patients to set out what they want their care to look like in the event of a mental health crisis.  

These changes will ensure that care is tailored to individual needs and encourage patients to remain in contact with health services and continue to engage with treatment.  

Police and prison cells will also no longer be used to place people who need care under the Mental Health Act. Instead, patients will be supported to access a suitable healthcare facility that will better support their needs.  

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

“The Mental Health Act is there to protect people when they're at their most vulnerable, and in many cases, it has saved lives. But it is hugely outdated, depriving people of their liberty, especially autistic people and people with a learning disability.  

“We are now one step closer to bringing forward the essential reforms that will transform the care of some of our most vulnerable people, meaning patients receive the right care in the right place. 

“Modernising the act will strengthen the decision-making processes, helping to better support people, and giving them the appropriate and compassionate care they need.” 

The Bill will help deliver the government's commitment to transform mental health care, giving it the same focus and attention as physical health. 

It will also address unnecessary detentions for people with a learning disability or autistic people. At the end of October 2024, 1,880 people with these conditions were detained in hospital under the Mental Health Act, and research suggests that some would be better suited to care in the community. 

If passed, the Act will limit the length of time that they can be detained under the Act if they do not have a co-occurring mental health condition that needs hospital treatment and have not committed a criminal offence. 

Claire Murdoch, NHS national mental health director, said:

“This Mental Health Bill 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 their care and better mental health outcomes.

“This comes alongside the NHS's work to transform mental health services which are treating record numbers with existing resources – 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." 

Dr Layla McCay, director of policy at the NHS Confederation, said:

“This marks another important milestone towards the long overdue reforming and updating of the Mental Health Act to ensure people with severe mental illness are given greater control over their treatment and are not subjected to unnecessary detentions.

“Our members have long called for these reforms to address the unacceptable disparities in rates of detention for people from some ethnic minority backgrounds.

"The Bill should also stop patients with a learning disability and autistic people from being detained long-term, unless they also have a severe mental illness for which detention may be needed.

“This is a welcome step towards these vital reforms, and we look forward to working with the government to ensure there is enough capacity to implement the Bill's plans.”

Mark Winstanley, Chief Executive, Rethink Mental Illness:

“In the depths of a mental health crisis, everyone deserves care that respects their rights and gives them a say in their treatment. Today marks another milestone in the journey to reform the Mental Health Act, bringing us closer to vital legislation that's fit for the 21st century.

 “After years of tireless campaigning, we're determined that this legislation fulfils its potential. We will support efforts to ensure the Bill passes through parliament to deliver meaningful, positive change for the tens of thousands of people detained under the Mental Health Act every year. In tandem, we will look to the new Ten Year Plan for the NHS to provide the resources and support necessary to ensure people receive the right care and treatment at the right time, to prevent people from experiencing a mental health crisis.”

 Measures in the Bill will ensure patients, staff and the general public are better protected, through improved decision making and new processes requiring clinicians to seek a second opinion before discharging a patient. Discharge processes will also be reviewed more broadly and will include a safety management plan for the patient, to keep them and others safe.