Mental Health Act
On this page, we talk about what the UK government is doing to reform the Mental Health Act.
What is the Mental Health Act?
The Mental Health Act is the law in England and Wales which says when you can be detained (or sectioned) and receive mental health treatment against your will. Someone can be detained for their own safety, or to protect other people.
The Act was created 40 years ago. It desperately needs updating. So, in December 2018, an independent review panel made recommendations for how to improve it.
But it took the UK government 4 years to do anything about the recommendations. In 2022, the government published a draft Mental Health Bill to make changes to the current Act. This Bill was looked at by a committee in parliament. They listened to organisations like Mind, and gave some recommendations for how to improve the Bill.
We’ve now been waiting more than 6 months for the UK government to respond to these recommendations. And we can’t wait any longer. The UK government must deliver a reformed Mental Health Act before the next election. This will strengthen people’s rights, choices, and control while they're in a mental health hospital.
What's wrong with the Mental Health Act?
The Mental Health Act is outdated. It’s not fit for purpose. Mind has been pushing for reform to the Act for many years. And we can’t wait any longer.
Here are just some of the problems with the Act:
- People detained under the Act don’t have enough say in their treatment. They aren’t able to choose the treatment that works for them, and the Act doesn’t offer a way to appeal decisions.
- There are shocking racial disparities in how it's used. Black people are 4 times more likely to be detained under the Act than white people. They're more than 11 times more likely to be subject to a community treatment order.
- Community treatment orders don't work. Community treatment orders are meant to give people supervised treatment in the community. They give someone a set of conditions they have to follow when they're discharged from hospital. They were introduced to stop people repeatedly going back into hospital. But they don’t work. They don’t reduce the number of readmissions. They don’t reduce the amount of time people spend in hospital. They’re intrusive and restrict people’s lives. And people don’t know what they have to do to get off the order.
- It's unfair on people in deprived areas. People living in deprived areas are also more than 3 and a half times more likely to be detained than those in the least deprived areas.
- It doesn't work for young people. Young people are inappropriately put in adult wards and far from home. They're restrained, ignored and left to deal with a confusing system on their own. And when they get back to their communities, support they were promised often never materialises.
What changes do we want to see to the Mental Health Act?
The UK government must deliver a reformed Mental Health Act before the next election. They'll do this through a Mental Health Bill. The new Mental Health Bill needs to strengthen people’s rights, choice, and control while they are in a mental health hospital.
- Community treatment orders to be abolished. They don’t reduce readmissions. And they're disproportionately used on black people.
- People to have an automatic right to assessment and treatment. This means they'll get the support they need, when they need it.
- Advance choice documents for everyone in a mental health hospital. This lets them say how they want to be treated in the future and what treatment they'd refuse. This should make it more likely that care and treatment is based on people's wishes and their knowledge of what helps them.
- People to have a right to appeal decisions they don’t agree with.
- Everyone in a mental health hospital to automatically get an advocate unless they don’t want one. Advocacy is where you get support from another person to help you express your views and wishes. People in mental health hospitals should have a right to culturally appropriate advocacy.
- A test for under 16s to check if they have capacity to make decisions about their treatment. This would make sure young people have their voices heard and get extra safeguards if their choices are refused.
- Young people to be placed in appropriate settings. They shouldn't be in adult wards or hospitals far from home.
How can you help?
We're campaigning to reform the Mental Health Act. Our Raise the Standard campaign is calling on the government to change the Mental Health Act, before the next election.
Learn more about the campaign, and see how you can get involved.
The reform has been a long time coming, with the original Act being created 40 years ago. We were particularly pleased to see measures in the draft bill that would give people receiving care under the Act more say over how they are treated and allow a nominated person to exercise certain rights on their behalf.
But we wanted to see more. More on race equity, the rights of children and young people, and tribunal powers. An end to Community Treatment Orders (CTOs), which are coercive, don't reduce readmissions and are disproportionately applied to Black people.
We are currently reviewing the draft and will provide a more detailed analysis over the upcoming days. Over the next few months, we’ll look to work closely with UK government and the Pre-Legislative Scrutiny Committee to address our concerns.
Read Mind and Race on the Agenda’s joint evidence to the scrutiny committee.
We were really pleased to see so many of our recommendations in the committee’s report - on race equity, CTOs, and children and young people’s rights.
And we support the proposed mental health commissioner role, as long as it has achievable aims, gets the resources it needs, and has lived experience and race equity at its heart.
Read our response to the committee’s report.
But even if all these recommendations were accepted, we’d still need more. Not least, we’re calling for rights to get an assessment when you ask for help and then the support, care and treatment you need.
The UK Government will publish a response to the scrutiny committee, which should tell us what’s likely to go into the bill. Then we hope to see a bill in parliament as soon as possible.
We’ll continue to campaign for the rights of everyone affected by this law.
You can help by signing up to be a campaigner. We will be sending through updates on the campaign and how to be involved.
In December 2018, an independent review of the Mental Health Act completed its work and made recommendations for improving legislation. The UK Government published its full response as a white paper. This is the 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 understand. It helps to have all the information you need in one place, so we published some frequently asked questions about:
- the Review
- the White Paper
- the Mental Health Act itself.
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.
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.
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.
The UK Government completed a public consultation on its white paper outlining plans to change the law about when you can be detained and receive mental health treatment without consent.
The white paper was their response to the 2018 Independent Review of the Mental Health Act. We submitted 2 responses to the white paper:
- a detailed England and Wales response to the UK government
- a response from Mind Cymru on specific issues for Wales, which we want the Welsh Government to address.
We used the experiences and views you shared with us anonymously to help shape our responses.
Overall, the changes set out in the white paper should mean:
- the Act is used less
- those of us in mental health treatment will have more say in our treatment.
The Act would still allow us to be detained in hospital against their will if we are very unwell, but the changes should help make this a last resort.
Although the paper has positives, we're concerned that community treatment orders (CTOs). These orders are 10 times more likely to be used against Black people and will still exist under the new Act.
Colin and Liz talk about their experiences of being sectioned and why the Act needs to change.