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Independent Review of the Mental Health Act - Frequently Asked Questions

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. Following the Mental Health Act Review in 2018, we have published these frequently asked questions around the Review and the Mental Health Act itself.

Remember you can find out more about the Mental Health Act Review on our dedicated webpage.

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

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

The UK Government commissioned Professor Sir Simon Wessely to carry out an independent review of the Mental Health Act. The board looked at:

  • how the legislation is currently used
  • its impact on service users, families and staff
  • make recommendations for improving the legislation and related practices.

You can find the full terms of reference for the independent review on the website.

The review was chaired by Professor Sir Simon Wessely, who is the former President of the Royal College of Psychiatrists.

The review set up a number of groups to help in its work, including a service user and carer group and an African and Caribbean working group. You can find out more about the membership and governance of the review on the website.

A lot has changed in the way we view mental health and how we treat people who are experiencing a mental health problem since the Act was written. This review was an important opportunity to fight for legislation and services which are fit for purpose, and support people when they are in crisis.

You can read more about why the Mental Health Act needed to change and what we were hoped to see in the Review in this blog post from our Policy and Campaigns Officer, Charlotte.

The UK Government commissioned this review and it has already committed to introduce a new mental health bill to make at least two of the changes recommended by the review:

  • If you are detained you will be able to choose which friend or relative can have a role in decisions about your care by making the 'nearest relative' role into a 'nominated person' role.
  • Introducing advance choice documents where you can outline your wishes about future care and treatment, which will be count for more than they do currently.

The UK Government also said it would make a formal response in the New Year before preparing any changes to the legislation.

We will be calling on the UK Government to act urgently to take forward the Review's recommendations and we'll be working with MPs and our campaigners, and through the media, to push it forward.

Other recommendations by the Review that would also lead to improvements in people's rights and experience under the Act include:

  • an end to holding people in police cells when they are first sectioned, and the end of the use of police vehicles being used to take people to hospital when they are in a mental health crisis;
  • advocates for all mental health inpatients (whether or not they are detained) without having to ask for one;
  • a requirement in law for a care and treatment plan, that includes your (or the person's) wishes;
  • an expectation that people's choices about medications and treatments are followed unless these aren't deemed clinically appropriate;
  • more scope for tribunals to respond to people's concerns about their care;
  • rights to appeal against medications and treatments;
  • tighter rules about the use of Community Treatment Orders which impose certain rules or conditions on a person following their discharge from hospital;
  • improvements to the ward environment;
  • a new approach to promoting race equality.

We're not taking anything for granted though, and if the UK Government does not respond positively and urgently on these issues too, we'll be campaigning for them to act.

Whilst the Mental Health Act applies in Wales, mental health services are run by the Welsh Government and operate under a different framework. Some of the Review's recommendations are already law in Wales under the Mental Health Measure. These include better access to advocacy and the right to a care and treatment plan. However, we know from a recent review conducted by the NHS Wales that care and treatment planning is not being used as intended and there is little evidence that it is improving outcomes.

We are calling on the Welsh Government to review the effectiveness of mental health legislation, policy and practice in Wales. We would want this review to hear directly from people with experience of mental health problems in Wales and consider the effectiveness of the Mental Health Measure, the recommendations of the Mental Health Act Review and how the two pieces of legislation interact in a Welsh-context.

Mind, together with the Mental Health Alliance, had been calling for a review of the Mental Health Act and we welcomed the Prime Minister's announcement of the review. We were represented on the Review's advisory panel and we helped with one of its working groups.

We fully support the Review and used our channels to inform people about it and invite people to participate. It was a priority for us to ensure that the voices of people affected by the Mental Health Act, including those with lived experience of mental illness were being heard throughout the review process. We recruited a steering group made up of people with lived experience of the Act who informed our work in this area, and inputted into our policy submissions, our engagement work and our communications around the Act.

As well as carrying out interviews and focus groups, we also ran a workshop with people from BAME backgrounds who shared their experiences of mental health services and sectioning and help us decide which areas to focus on in our work on the review.

Steve Gilbert was part of the Review as a vice chair. He has himself been detained, and had a critical role in bringing that perspective to the Review leadership and ensuring wide engagement across people with experience of detention. We are pleased that he has recently also now joined Mind's trustee board. These roles are of course entirely independent of one another.

Paul Farmer (Mind's Chief Exec) represented Mind on the Review's advisory panel, which had oversight of the Review and its progress. However the Review's recommendations come from the chair and vice chairs and are their responsibility.

Sophie Corlett (Mind's Director of External Relations) was a member of the Review's working group and in this role also took part in some of the topic groups. The working group did a lot of thinking and drafting and helped the Review leadership work through different issues. However the Review's recommendations come from the chair and vice chairs and are their responsibility.

The UK Government has committed to introducing legislation that would implement two of the Review's recommendations and to making a formal response in the new year.

We will be pushing for them to adopt the recommendations as a whole and we will continue to hold the UK Government to account on its promises to reform mental health care.

The UK Government commissioned this review and will need to respond. They have already committed to introduce a new mental health bill to make two of the changes recommended by the Review.

There are more recommendations in the Review's report that would require changes to legislation and others that do not. They may accept some or all of them, and could carry out public consultation for some of the more detailed areas, as recommended by the Review. We will be pushing for them to take up the recommendations as a whole.

You can find out more about how to make a complaint about your mental health treatment in hospital on our legal rights pages.

We want reform of the legislation to work for everyone. People from some BME groups, including young black men, are far more likely to be sectioned and detained in hospital and to be on a community treatment order than white people.

The review itself looked at the high number of detentions of BME people and it had an African and Caribbean working group. At Mind we wanted to make sure that we represented the views and experiences of people from the BME groups that are disproportionately affected by the Act and that whatever is recommended works for them and will promote equality.

Changing the Act won't solve everything. Our work with young black men in Birmingham shows the toll that racism takes and the importance of approaches that help build resilience, reduce risk factors, and enable the wider community to support the mental health needs of their young people more effectively. We need preventive work like this.

The Review is proposing a new, practical approach to promoting race equality in mental health services, with some suggestions to make it happen, and we think the whole NHS and wider public services need to get behind this as a priority.

The Review never set out to design whole new legislation and we think that work still needs to be done, even though it will take longer to achieve.

We also know that we can't look at the Act in isolation, without addressing the ongoing failures in mental health services which result in people ending up in crisis. Any recommendations and changes to the Mental Health Act need to be delivered alongside a plan to transform mental health services.

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