Rights concerns over major Mental Health Act reforms

User-led grassroots groups have raised serious concerns about the government’s new mental health white paper, particularly its failure to offer the full human rights set out in the UN disability convention.

The white paper, published yesterday (Wednesday), aims to deliver “major reform” of the Mental Health Act (MHA), providing service-users with more control over their care and treatment, and ensure the act’s powers “are used in the least restrictive way”.

Ministers also said that it would address the disproportionate detention of people from black, Asian and minority ethnic communities, and the use of the act to detain people with learning difficulties and autistic people, as well as improving the treatment of people with mental health issues within the criminal justice system.

Among proposed changes are the introduction of new “advance choice documents”, which would allow people to express their wishes for their care when they are well, before they need to go into hospital.

Another proposal is to allow individuals to choose a “nominated person” who is best placed to look after their interests under the act if they cannot do so themselves.

Initial coverage of the white paper in the mainstream media – before it had been published, and based on the government’s press release – was overwhelmingly positive.

But the Reforming the Mental Health Act white paper – which is now out for consultation until 21 April, and will eventually be followed by a new mental health bill – builds on recommendations made by Sir Simon Wessely’s independent review of the Mental Health Act in 2018.

That review was criticised for falling “significantly short” of recommending full human rights for people in mental distress.

Although disabled activists have not yet had time to analyse the white paper in depth, they are already raising similar concerns, while also welcoming aspects of the reforms.

Dorothy Gould, co-founder of the new user-led, rights-based organisation Liberation*, said: “It is undoubtedly true that the MHA white paper is extensive and looks at a large number of much-needed improvements to the current act.

“However, these improvements fall well short of the government’s claim that it is bringing the law ‘into the 21^st century’.

“It is also intensely worrying that Matt Hancock regards the Wessely review, on which the white paper is based, as ‘one of the finest pieces of work on the treatment of mental health that has been done anywhere in the world’.

“It is devastating that, so far from drawing adequately on promising international developments elsewhere and the full human rights set out in the UN Convention on the Rights of Persons with Disabilities, the white paper repeats many major flaws in the Wessely review.”

She said the white paper “retains a dominant medical model focus”, and added: “It aims to reduce, but not bring to an end, the fundamental breach of human rights represented by involuntary detention in psychiatric hospitals and forced treatment.

“It has an inadequate focus on the full range of multiple discrimination that exists. We want so much more than this.”

The grassroots, user-led mental health group Recovery in the Bin (RITB) was also critical in its initial response to the white paper.

An RITB spokesperson said: “We welcome proposed changes in the MHA white paper such as a nominated person and increased right to advocacy, but it falls short of a social justice approach and as with the existing act, in the absence of funding and the continuing hostile environment of the DWP [Department for Work and Pensions] and wider systemic racism, the act is irrelevant to the actual conditions people have to endure.”

POhWER, the UK’s largest advocacy charity, which was founded by disabled people in 1996 and has a majority of disabled people on its board, welcomed “some progress” in reforming the act, “particularly where it strengthens relationships, empowers individuals, further upholds human rights and builds dignity for people supported by public services or in government-run institutions”.

But Helen Moulinos, its chief executive, said there were “still many concerns” about the proposed changes.

Among its concerns are the need for better investigations and regulatory oversight for non-natural deaths in mental health settings; more work on discrimination in how the act is applied, such as the disproportionate use of the act’s powers of detention on black people; more clarity on funding for advocacy; more safeguards for patients being treated informally with their consent; and more thought given to the needs of people with learning difficulties and autistic people.

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.

“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.”

*Liberation can be contacted via email at: [email protected]

Picture: Wessely speaking at the launch of his review in 2018

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