Major UK Mental Health Act reform to give patients more autonomy

Major UK Mental Health Act reform to give patients more autonomy
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Patients in the UK are set to have more control over their mental health treatment in a major overhaul of the country’s Mental Health Act.

The UK’s Mental Health Act has undergone a landmark reform that will give people with mental health issues who are detained under the Mental Health Act more control over their care and treatment.

The new plan also aims to tackle mental health inequalities, including the disproportionate detention of people from black, Asian and minority ethnic (BAME) communities, who are over four times more likely to be detained under the act and over 10 times more likely to be subject to a community treatment order, as well as the use of the act to detain people with learning disabilities and autism, and to improve care for patients within the criminal justice system.

Autonomy under care

Set out in the new Reforming the Mental Health Act white paper, the package of reforms will enable greater choice and autonomy for patients in a mental health crisis, ensuring the act’s powers are used in the least restrictive way, that patients receive the care they need to help them recover, and all patients are viewed and treated as individuals.

Health and Social Care Secretary Matt Hancock said: “I want to ensure our health service works for all, yet the Mental Health Act is now 40 years old. We need to bring mental health laws into the 21st century. Reforming the Mental Health Act is one of our central manifesto commitments, so the law helps get the best possible care to everyone who needs it. These reforms will rightly see people not just as patients, but as individuals, with rights, preferences, and expertise, who are able to rely on a system which supports them and only intervenes proportionately, and which has their health and wellbeing as its centre.

“This is a significant moment in how we support those with serious mental health issues, which will give people more autonomy over their care and will tackle disparities for all who access services, in particular for people from minority ethnic backgrounds.”

Proposed changes

The government will consult on a number of proposed changes, including:

  • The introduction of statutory ‘advance choice documents’ to enable people to express their
  • wishes and preferences on their care when they are well, before the need arises for them to go into hospital
  • Implementing the right for an individual to choose a nominated person who is best placed to look after their interests under the act if they are not able to do so themselves
  • Expanding the role of independent mental health advocates to offer a greater level of support and representation to every patient detained under the act
  • Piloting culturally appropriate advocates so patients from all ethnic backgrounds can be better supported to voice their individual needs
  • Ensuring mental illness is the reason for detention under the act, and that neither autism nor a learning disability are grounds for detention for treatment of themselves
  •  Improving access to community-based mental health support, including crisis care, to prevent avoidable detentions under the act – this is already underway backed by £2.3bn a year as part of the NHS Long Term Plan

The proposal also sets out that neither learning disabilities nor autism should be considered a mental disorder for which someone can be detained for treatment under section 3 of the act. Instead, people with a learning disability or autistic people could only be detained for treatment if a co-occurring mental health condition is identified by clinicians.

Criminal justice system

Those with serious mental illness who are within the criminal justice system will also benefit from the reforms due to a 28-day time limit that is being proposed to speed up the transfer of prisoners to hospital, ending unnecessary delays, and ensuring they get the right treatment at the right time.

Lord Chancellor and Justice Secretary Robert Buckland said: “Prisons should be places where offenders are punished and rehabilitated, not a holding pen for people whose primary issue is their mental health. Keeping people safe must be at the heart of everything this government does, and the reforms announced today will allow us to do this while ensuring offenders still get the treatment their conditions require.

“The government also commits to ending the outdated practice of using prisons as ‘places of safety’ for defendants with acute mental illness. Instead, judges will work with medical professionals to ensure defendants can always be taken directly to a healthcare setting from court. Victims of all mentally disordered offenders will now have the option of being assigned a dedicated victim liaison officer to keep them informed of key developments in the offender’s case, including when the patient is discharged.”

For changes which require legislation, consultations will continue until early spring 2021 to listen to the concerns people have, and a draft Mental Health Bill will be shared next year.

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