Susan Masters reflects on the Draft Mental Health Bill.

Last week, full details of the government’s plans to update the 1983 Mental Health Act were finally revealed.

The Draft Mental Health Bill 2022  is the culmination of a process that started with a comprehensive investigation of the Act carried out in 2018. The  Wesseley Independent Review highlighted weaknesses in the act that had seen huge increases in the use of detention. Coming right up to date, In 2020-21, for example, 53’000 detentions were ordered under the act – almost double the number recorded in its first year.

The review also highlighted and suggested a long list of recommendations to address the racial disparities it had identified in mental health outcomes, disparities that, today, see men from African and Caribbean communities four times more likely to be detained and ten times more likely to receive a community treatment order.

Coming after a period of wide consultation, the resulting bill had been heralded as a modernisation of the Mental Health Act. Core ambitions included increasing personal choice and autonomy; minimising restriction; treating people as individuals and ensuring that therapeutic benefit lay at the heart of care.

Actual changes proposed include allowing patients to record their wishes regarding future treatment. They would also be able to choose their own independent mental health advocates rather than having their nearest relative automatically assigned. It proposes that the frequency with which patients can make appeals to tribunals over their detentions should be increased. Care and treatment plans are proposed for all patients in detention that will be written with the patient and set out a clear pathway to discharge. And detention, itself,  will only be allowed, in the first place,  where there is a clear therapeutic benefit to the patient.

The bill does strengthen the rights of some key groups – it will no longer be possible to detain people solely because they have a serious learning disability or autism – and provisions have been improved for people with mental health needs within the criminal justice system.

However, while it is accepted that the draft bill contains many positive changes, its lack of ambition in some crucial areas has already invited criticism. From National charities such as Mind to grassroots, user-led groups including Recovery In The Bin and Liberation, there has been great disappointment expressed at the bill’s lack of measures to directly address the very ethnic disparities highlighted in the Wesseley Review. While it will increase the level of scrutiny around detentions and make it harder to detain people against their wishes over long periods of time,  it does feel as though this is merely treating the symptoms of far deeper problems in the system recognised by many as structural racism. Elsewhere, there are also concerns that some of the bill’s terms will not be applied to under 18s.

As the bill enters its period of parliamentary scrutiny, we can only hope the most fundamental of these concerns, at least, will be promptly addressed and that those affected won’t have to wait another 40 years to have such historic wrongs righted.

Susan Masters – Director of Health Transformation, Policy and Neighbourhoods