The report that's shaping the UK Mental Health Act

The parliamentary Joint Committee on the draft Mental Health Bill published their final report on 19^th January 2023. After gathering evidence from a range of experts, the committee’s report makes a series of recommendations about the law which needs to be changed to improve mental health services.

Lily Huggins, Head of Advocacy for Gaddum provided evidence to the Parliamentary Joint Committee in October 2022, highlighting the findings of Gaddum’s pilot as well as the issues affecting the advocacy sector more widely. Lily states:

“We welcome the findings of this report and I am so pleased that Gaddum Advocacy was invited to speak as an expert panellist as part of this process. We agree with the report that racial disparities in mental health services are ‘inexcusable’ and ‘unacceptable’. The recommendations go some way to addressing the racist application of the Mental Health Act, but more must be done.

We must see the legislated adequate resourcing of Advocacy services, including culturally appropriate advocacy as well as more community mental health and preventative services to ensure everyone with mental health needs gets the support they deserve. I hope that appropriate funding can be provided to ensure these positive changes can be implemented in practice.”

You can watch the full evidence session here.

What is the Mental Health Act and why is it being reformed?

The Mental Health Act is a law that outlines how people should receive care and support for their mental health. It also contains important information about how and when someone can be detained (often known as “sectioned”) for compulsory mental health treatment in hospital or in the community.

There are lots of problems with the current legislation. One of them being that people from minoritised racial groups, especially Black people are much more likely to be detained (“sectioned”).

Shamefully, Black people are 10 times more likely than white people to be placed on a ‘Community Treatment Order’ which stipulate conditions under which people must live when discharged from hospital. Increasing amounts of evidence indicate that CTOs are simply not effective in reducing the chance of someone being readmitted to hospital.

The law describes people with Learning Disabilities and/or Autism as having ‘mental disorders’. This is not appropriate or accurate and means that many people do not get the right care they need when in hospital.

Another problem is that the Law does not provide enough opportunities for patients to have a say in their care and treatment and does not allow for certain patients to have access to Independent Mental Health Advocacy (IMHA). This means patients get less say in their care and treatment, which means they are less likely to recover.

Gaddum welcomes the following recommendations from the report:

Advocacy to be provided as an ‘opt out’ service –psychiatric inpatients will be referred automatically to Advocacy services as standard and can ‘opt out’ if they want.
Introduction of Advance Care Documents – this will mean that people can make proactive decisions about their care that can be implemented if they experience a period of mental health crisis. This centres individual’s choice, voice and autonomy and will ensure patients’ needs are enacted swiftly.
The statutory provision of culturally appropriate advocacy – Advocates must ensure they meet the cultural needs of people accessing their services and be aware of and able to challenge racism.
Removal of Community Treatment Orders (CTOs) for part ii patients – this means there will be no CTOs for most patients, apart from those being released from prison. CTOs place conditions on people when they have been discharged from hospital.
Advocacy for ‘informal’ or ‘voluntary’ patients – this will mean people who are in a psychiatric ward, but not detained under the Mental Health Act, will also get access to Advocacy services. This is especially supportive for people that would like help to plan their discharge, as well as for Children and Young People who are often voluntary patients.

Whilst Gaddum welcomes many of the changes to the law, we feel the law could go further in the following areas:

We want the abolition of CTOs for all patients, regardless of their involvement in the criminal justice system.
We want the legislation to include firm and robust requirements to ensure the adequate resourcing of advocacy services to all people with mental health needs that need Advocacy support.
We want there to be more focus on community wraparound and preventative support including step down, group work and peer-led wellbeing services.

The Bill will now be updated based on the recommendations of the Joint Committee report before it heads to the House of Commons to be voted on by MPs.

How have we been involved?

Gaddum was invited by the Joint Committee to attend parliament to provide expert evidence about Advocacy and specifically culturally appropriate advocacy. Gaddum delivered the Department of Health and Social Care’s (DHSC) Culturally Appropriate Advocacy Pilot alongside long-standing partners, African & Caribbean Mental Health Services.

The pilot provided Advocacy services to People of Colour in Manchester accessing mental health services. You can read more about this here.