Why reforms to the Mental Health Act don’t go far enough in improving mental health outcomes for all

'While the reforms could be a tentative step in the right direction – so long as funding promises are upheld – updating the Mental Health Act alone is nowhere near enough to significantly improve mental health outcomes for all'.

Beauty is a Global Health scholar, currently working as a Policy Advisor in Department of Health and Social Care. In her commitment to achieving universal healthcare coverage for all, Beauty is known for her advocacy work for marginalised communities sitting on several advisory and community boards, working with community and grassroot organisations and co-hosting the renowned podcast, Mind the Health Gap.

In January 2021, the government announced that after 40 years it was looking to reform its 40-year-old 1983 Mental Health Act, with many hailing the move as a true sign in progress in people’s attitudes towards mental health.

The Mental Health Act allows the state to detain people, particularly those experiencing mental health difficulties in crisis. The purpose of reform specifically mentioned ‘tackling racial disparities in mental health services’ and to empower those with mental ill health, choice and autonomy over their mental healthcare. Additionally, these reforms will aim to better meet the needs of people with neurodivergence, learning disabilities and autism and ensure appropriate care for people with serious mental illness within the criminal justice system.

The plans of reform were outlined in the ‘Reforming the Mental Health Act white paper, which builds on the recommendations made by Sir Simon Wessely’s Independent Review of the Mental Health Act in 2018.  It is also expected that reforms would also introduce a new competency framework for NHS trusts, the ‘Patient and Carers Race Equality Framework’; which hopefully will help trusts with protocol they need to ensure the improvement of mental health outcomes for minorities communities.

However, this wouldn’t be done in silos but with the guidance of community members, patients, grassroot organisations and carers to understand their experiences and offer services that respond to their needs.

While the proposals have been welcomed by those with lived experiences of mental ill health, mental health advocates and organisations, many are rightful to be sceptical as to whether these changes will have a tangible impact on mental health outcomes for minority communities particularly due to the persistent negation of adequate funding.

Worryingly, the white paper states that a number of the proposed measures, are “subject to future funding decisions”. Due to the growing austerity measures underpinning government legislation in the last decade, mental health services are merely skeletons of what they should be at present. Mental health trusts continue to suffer real-time funding cuts of eight per cent each year since 2011, high staff turnovers persists almost a third of mental health beds have been lost during this time. So, what is the purpose of the reforms if there’s no money to ensure their implementation?

The anticipated failings of this reform are already being cemented further with the increased rollout of the Serenity Integrated Mentoring (SIM) scheme – the mental health support model, currently being adopted by NHS England which gives mental health professionals and police officers greater powers when assisting those who are deemed as ‘high intensity users’ with more challenging cases.

Whilst it seems like a good idea for collaborative working between the mental health system, emergency services and the police, there are concerns that this reinforces the individualisation of those experiencing mental health issues and ignores the impact of social determinants of health rather normalising state-sanctioned criminalisation of mental illness.

The limits of the reform don’t just stop there. My experiences of working on a low secure adolescent unit as well as being sectioned as a young person, have made me realise that  whilst it’s important for us to change several outdated measures in the Mental Health Act, it is also key that we reform the overall practices that have been normalised within the mental health system as part of our ‘duty of care’. This includes punitive practices often enacted under the guise of patient safety, which like many people who find themselves voluntarily or involuntary in inpatient care, I have brutally experienced. Such practices include the use of restraints and seclusion, unnecessary restrictions of patient autonomy such as cancelling off‐ground privileges, increased observation and surveillance, reduced therapeutic engagement and removal of personal belongings, patients and carers being left to wait for hours without explanation or communication, and the denial of patient liberties such as leave without any clear explanations.

A daunting reality for patients is, the margin of acceptable behaviour remains narrow and continues to shrink, with the inpatient environment characterized by boundaries and rules which are and yet continue to be upheld through fear, stigma and the alleged aim to ensure ‘safety’.

Evidence has been provided from service users such as young people and regulatory organisations such as the CQC in the last few years on the overuse and abuse of some of these punitive practices such as restraint to manage behaviour, even though guidance from government state they should be last resorts. Although we now understand that many of the practices from the era of institutionalisation were unethical, inhumane and have been rightfully discontinued; it’s ironic that many of these punitive practices resemble those from the past. Despite the calls for reform being heralded as a sign of progression, it seems these reforms are still, grounded in fear of individuals with mental illness.

While the reforms could be a tentative step in the right direction – so long as funding promises are upheld – updating the Mental Health Act alone is nowhere near enough to significantly improve mental health outcomes for all, especially those from minoritised communities. It is promising to see how since the white paper’s release, the review has started influencing major decisions the government is taking. One example of this includes getting rid of dormitory provision so that inpatients can have the privacy and dignity of their own bedrooms with en suite bathrooms.

If we are to truly see significant reductions in the number of people, particularly from minority communities, falling foul of the legislation that is supposed to protect and help, the government mustcommit to addressing deeply embedded inequalities within society, from the social determinants of health to the criminal justice system. It must also actively work together with patients, advocates, community members and organisations for a cultural shift within the mental health system that eradicates the normalisation of these punitive practices.  

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