A report by a cross-party committee of MPs and peers on the government’s plans for mental health reform has been described as “seriously flawed and discriminatory” by a user-led organisation.
Disabled people’s organisations (DPOs) told the committee last year that the government’s draft mental health bill fell “well short” of compatibility with the UN Convention on the Rights of Persons with Disabilities (UNCRPD).
But despite taking evidence from DPOs that called for “fundamental changes” to the bill to address the human rights concerns, the committee has failed to push for such an approach.
The draft bill is based on a white paper published in January 2021, which itself was built on recommendations made by Sir Simon Wessely’s independent review of the Mental Health Act in 2018.
His review was criticised for falling “significantly short” of recommending full human rights for people in mental distress.
Disability Rights UK, Inclusion London and Liberation all told the joint committee on the draft mental health bill that the government’s proposed legislation did not go far enough to address human rights concerns on the use of compulsory detention and treatment.
The National Survivor User Network (NSUN) told the committee that, although there was no consensus among user-led groups on the detail of the UN convention, Wessely’s review and the draft bill had both failed to engage with the spirit of the UNCRPD and a rights-based approach.
Wessely told the committee that his review had tried to take “the best bits that are implementable” from the UN convention and “pushed those strongly”.
The committee’s report, published today (Thursday), welcomes the draft bill’s “direction of travel”.
It makes more than 50 recommendations to the government, but it makes no demand for a more rights-based approach to the bill, although it calls for an “ongoing process” of reform in the long-term that leads in the direction of more rights-based mental health legislation.
Dorothy Gould, founder of the user-led, rights-based organisation Liberation, said today: “Despite some recommendations for further improvements to the draft bill, the committee’s report comes across to me as still seriously flawed and discriminatory.”
She said the draft bill was itself “in serious breach of fundamental human rights.
“Because of that, it’s utterly demoralising, but sadly not unexpected, that the joint committee has limited itself to recommending improvements to the bill instead of calling for root and branch reform without further delay.
“Some of the committee’s recommendations are a partial step forward, for example its call for further reform in the long term, comprehensive further training for the workforce, adequate funding of services, good quality alternatives to hospitalisation and enshrining respect for racial equality within the bill.
“However, the committee’s claim that successful enactment of the draft bill should have a ‘transformational impact on mental health services’ seems rather detached from reality.”
She said the committee’s recommendations were “dominated by a medical model approach and deeply flawed assumptions about risk”, and “continue to draw on a mental capacity approach, instead of recognising our legal capacity (the legal rights we should retain, regardless of judgements made about our mental capacity)”.
Gould added: “It’s deeply concerning that the committee is endorsing a continued use of detention in psychiatric hospitals and forced treatment which is not thought ethical for other patients. It’s disability discrimination.
“A fundamental flaw, too, is that the committee’s recommendations fail to give a front-line role to organisations led by people who have used mental health services, people with learning difficulties and neurodiverse people.”
The committee says in its report that there had been a “broadly positive response” to the draft bill, which would introduce “more choice, accountability, and oversight” into the use of the Mental Health Act.
But it says the draft bill “must be strengthened to address rising numbers detained under current legislation and tackle unacceptable and inexcusable failures on racial inequalities”.
It calls on the government to publish a detailed plan on funding and implementing the bill, and to report annually on progress during its implementation period – if it becomes law – as well as creating a new national post of mental health commissioner.
It also calls for all health organisations to appoint a person to collect and publish data on racial and ethnic inequalities, and to oversee policies to address those inequalities.
And it says the draft bill should abolish community treatment orders (CTOs) for patients not involved in the criminal justice system.
CTOs are 11 times more likely to be given to black service-users than white service-users, but evidence give to the committee “suggests they are ineffective for most patients”.
There should also be a review and possible abolition of CTOs for those service-users who are involved with the criminal justice system, says the report.
The committee says there has been “widespread support” for measures in the draft bill that should reduce the number of people with learning difficulties and autistic people in mental health hospitals.
But it calls on the government to review its existing Building the Right Support action plan to ensure there is sufficient support in the community to ensure its proposals do not prove “counterproductive”.
The draft bill aims to reform the Mental Health Act 1983 in England and Wales. The government will now publish a final version of the bill.
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