Reforms to mental health legislation were featured in yesterday’s Queen’s Speech, including the introduction of a new form of supervised release from the community.
The Mental Health Act Reform Bill would allow the discharge of restricted patients – offenders subject to special controls in the justice system, such as after a court conviction or transfer from prison – to the community with the care and supervision necessary to adequately and appropriately manage their risk.
The definition of “mental disorder” would be changed so that people can no longer be detained solely because they have learning disabilities or are autistic; and the criteria needed to detain people would be changed so that the law is only used when the person poses a real risk to their own safety or that of others, and when there is a clear therapeutic benefit.
Applying to England and Wales, the bill would also give everyone the option of an independent mental health advocate and allow patients to choose their own ‘nominate person’, rather than see assigning a “nearest relative”.
A 28-day deadline would be introduced for transfers from prison to hospital for seriously ill inmates and would end the temporary use of the prison for those awaiting assessment or treatment.
The frequency with which patients could appeal to the courts about their detention would be increased, and the courts would have the power to recommend the establishment of follow-up services.
A statutory care and treatment plan for all patients in detention would also be introduced, drafted with the patient and setting out a clear path to discharge.
The bill aims to address existing disparities in the use of mental health law for people from ethnic minorities, in particular detentions and community treatment orders. In 2020-21 there were around 53,000 detentions under the law in England, an estimated increase of 4.5% from 2019-20. Blacks were four times more likely than whites to be detained under the law and more than ten times more likely to be subject to a community treatment order.
It comes after NHS England decided to start work on an ‘implementation plan’ for new mental health wait times standards in February.
Long-term plans needed
Director of Policy and Strategy at NHS Providers Miriam Deakin welcomed the proposals, which she said were “long overdue”. However, she stressed that the law alone would not be enough to ensure high-quality mental health services, with services already under “severe pressure” as a result of the pandemic. She said more support was needed, as well as a long-term plan to attract and retain staff.
It is estimated that up to 730,000 additional referrals to mental health services could be made each year by 2024, putting significant additional pressure on general practice.
Deakin added that mental health inequities need to be addressed, particularly to improve outcomes and access to services for Black, Asian and minority ethnic communities.
Dr Jennifer Dixon, chief executive of The Health Foundation, agreed that ‘much bolder action’ was needed, including more funding and social care reform, and urgent action on health risk factors and the social and economic determinants of health in the upcoming health disparities white paper.
“Government still has a role to play in ensuring the health service has the resources it needs over the long term and in addressing any urgent workforce shortages,” Dixon said.
The government is seeking the advice of health professionals to inform its new ten-year mental health plan and has reaffirmed its commitment to expand and transform NHS mental health services to reach two million more people, supported by an increase in £2.3 billion of funding per year. by 2023 to 2024.
Despite this, research has suggested mental health clinical support workers experience more abuse, poorer working conditions and fewer opportunities than other NHS staff.
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