Mental Health Act Review

In December 2018 an independent review of the Mental Health Act completed its work and made recommendations for improving this legislation. The UK Government has now published its full response as a White Paper. This is a first step towards changing the law.

The Mental Health Act 1983 is the legislation in England and Wales that sets out when people can be detained and treated for their mental health in hospital against their wishes.

We know that mental health legislation can be complicated and difficult to navigate, so it helps to have all the information you need in one place. We have published some frequently asked questions around the Review, the White Paper, and the Mental Health Act itself.

You can also find information about your rights under the Mental Health Act on our legal pages and in our guide about sectioning.

The UK Government's White Paper

The White Paper contains:

the UK Government's plans for changes to the Mental Health Act and related policy and practice
questions where they still want to hear views
their response to each of the Review's recommendations.

Most of the Review's recommendations have been accepted but there are more important issues that are open for consultation and some areas we think call for more ambitious action.

You can read Mind's initial views in our media response and briefing.

The Government's consultation is open until 21 April 2021 and we encourage everyone with experience of being sectioned or supporting someone with this experience to take part. Also, we will be sending in a response from Mind and will post further analysis and opportunities to feed in to our response during the consultation period.

What happened during the Review?

In October 2017, the Prime Minister Theresa May announced an independent review of the Mental Health Act to address rising detentions, racial disparity in the use of the Act and concerns about human rights and dignity. The Review was chaired by Professor Sir Simon Wessely with three vice chairs including Steven Gilbert, who has lived experience of the Act and is also a trustee at Mind.

Over the course of the year the Review has sought the views of people affected by the Act and the professionals who use it, and explored issues in depth through various topic groups and engagement activities.

Mind promoted opportunities for people to feed in directly, carried out our own engagement activity to help develop our views, and made a written submission to the Review. You can read more about our engagement work here.

We were represented on the Review's advisory panel and helped on its working groups.

An interim report in May updated us on their thinking and now the final report has been published setting out the Review's recommendations to the UK Government.

In an initial response, the Government has committed to introducing legislation to allow people to nominate a person of their choice to be involved in decisions about their care and to introduce statutory 'advance choice' documents so that people can set out their wishes about future care and treatment.

Read about our engagement work

What does the Review recommend?

The changes recommended by the Review set out to give much greater legal weight to people's wishes and preferences and to require stronger, transparent justification for using compulsory powers. They address the needs of particular groups affected by the Act including people from minority ethnic communities, and they call for improvements in services.

The recommendations include:

introducing advance choice documents so that people can set out their wishes about future care and treatment, which would have more weight than they do in the current system
advocates for all mental health inpatients (whether voluntary or detained) without having to ask for one
advocates who are skilled in responding to people's cultural needs
a statutory care and treatment plan to include people's wishes
earlier access to a second opinion and a right to appeal against treatments
more scope for tribunals to respond to people's concerns about their care
choice of which friend or family member has a role in decisions about sectioning and care, by making the current 'nearest relative' role a 'nominated person' that you can choose yourself
a complete end to the use of police cells when initially detained and an end to the use of police vehicles for taking people to hospital
a systematic approach to improving how mental health services respond to their local population's ethnic and cultural background.

You can read the full report and recommendations here.

What does Mind think of the recommendations?

We welcome the Review's recommendations to increase people's choice and dignity when they are subject to the Mental Health Act, and for promoting race equality in mental health services and the use of the Act. In particular, we welcome the recommendation that anybody detained, whether they are sectioned against their will or are a voluntary patient, will have access to an advocate to assist them.

Likewise, we back the promotion of race equality in mental health services and in the use of the Act, but this must come with concrete commitments, including that the NHS builds relationships with local communities.

We were disappointed to see that the Review has not recommended getting rid of Community Treatment Orders (CTOs). These have not reduced hospital readmissions and are often experienced as intrusive and coercive, especially by people from Black or Black British backgrounds, who are more likely to be subjected to CTOs. However, the Review's recommendations would be an improvement on the current position.

In the longer term, we want to see larger, more fundamental shifts in the law, but the Review's recommendations would make significant improvements to people's rights and experience of mental health care.

Check out our Policy and Campaigns Officer Charli's blog on what we were hoping to see in the Review.

Read our news story and our response to the Review.

Mental Health Act expert blogs

Why the Act needed to be reviewed

The 1983 Act is outdated – it was based on earlier legislation and the grounds for detaining people have not changed for many years, even though health care and attitudes towards mental health have changed radically.

Since the Act was last amended ten years ago:

there has been a continued rise in detentions
people from Black and Black British groups are still more subject to coercion than others
research has shown that community treatment orders, introduced in 2008, do not make a difference to whether or not people are readmitted to hospital
there have been important developments in recognising the rights of disabled people, which includes people with mental health problems.

A survey by the Mental Health Alliance found that, while a majority of respondents said there were circumstances when being treated against your will in hospital may be necessary, there were deep concerns that people's dignity, autonomy and human rights were being overlooked.

Read Colin King's blog about his experiences of the Mental Health Act, both as a patient and a practitioner.

Read Colin King's blog