Matt Hancock – 2021 Statement on the Reform of the Mental Health Act

The statement made by Matt Hancock, the Secretary of State for Health and Social Care, in the House of Commons on 13 January 2021.

With permission, I would like to make a statement on reforming the Mental Health Act. Even amidst the pandemic, I am enormously grateful for the work that my team and the NHS have done, led by Sir Simon Wessely and Claire Murdoch and my hon. Friend the Minister for mental health, to deliver this White Paper, which we published today, to bring mental health legislation into the 21st century.

We are committed as a Government, and as a nation, to see mental health treated on a par with physical health. We are increasing funding for mental health services to record levels, with £2.3 billion extra each year being invested through the NHS long-term plan, and an immediate £0.5 billion in place to support mental health services with the very significant pressures they are under. Our mental health services are now helping more people than ever before. Services are there for the most serious mental illnesses, although those, of course, are under significant pressure. Services are there for better community support through 24/7 crisis services and establishing liaison in A&E, and supporting people to manage their own mental health.

This programme of transformation is ambitious, and as we support mental health services now, so we must bring up to date the legislative framework for the long term. The Mental Health Act 1983 was created so that people who have severe mental illness and present a risk to themselves or others can be detained and treated for their protection and the protection of those around them, but so much has changed since the Act was put into place, nearly 40 years ago. We now understand a lot more about mental health. Public attitudes around mental health have changed significantly for the better. We now have a better understanding and practice of how we can best support people with learning disabilities and/or autism. We are also concerned by the growing number of people being detained, inequalities among those who are detained, and the length of time that people are spending detained under the Act.

So, after a generation, we must bring the Mental Health Act into the 21st century. The previous Prime Minister, my right hon. Friend the Member for Maidenhead (Mrs May), asked Professor Sir Simon Wessely to lead a review into what a modern mental health Act should look like. I thank her for her work, and I am so grateful to Sir Simon and his vice-chairs for their dedication. As I said to the House last year on its publication, the Wessely review is one of the finest pieces of work on the treatment of mental health that has been done anywhere in the world. I know that the review was welcomed across the House. We committed in our manifesto to deliver the required changes, and I am grateful to the Prime Minister for his emphatic support.

Sir Simon’s review compellingly shows that the Mental Health Act does not work as well as it should for patients or their loved ones—that the Act goes too far in removing people’s autonomy and does not give people enough control over their care. I am delighted to set out our full response to that review in our White Paper, which, together with my right hon. and learned Friend the Lord Chancellor, we have laid before the House.

The White Paper sets out plans for a landmark new mental health Act. The new Act will ensure that patients are put at the centre of decisions about their own care; that everyone is treated with respect; and that the law is only used to compel treatment where absolutely necessary. The White Paper has been developed in close consultation with those with the greatest expertise—the Royal College of Psychiatrists, Rethink Mental Illness, Mind, the Centre for Mental Health and countless practitioners on the frontline—and I thank them all.

There are four pillars to this work; I should like to take a moment to update the House on all of them. First, we will give patients a voice in their own care, which we know leads to better engagement in treatment. We will put care and treatment plans and advance choice documents in statute for the first time, so that patients are more closely involved in the development of their care, and so that they can have confidence that if they lose capacity because of illness, their preferences will be properly considered. We are making it easier for patients to challenge decisions about their care, creating a new right to choose a nominated person who is best placed to look after their interests, and increasing patients’ access to the independent tribunal to provide vital independent scrutiny of detention. In his report, Sir Simon recommended that one of the best ways to ensure dignified care is to ensure that patients can expect the privacy of their own en-suite room. We have already committed £400 million of funding to deliver that, and we are building new mental health hospitals, with two schemes already approved and with more to come.

Secondly, we will address the disparities that currently exist within the application of the Mental Health Act. Black people are currently four times more likely to be detained under the Mental Health Act than white people, and black people are 10 times more likely to be placed on a community treatment order. We also know that people from black and minority ethnic backgrounds can often engage with services later, and our plans to enhance patient choice, increase scrutiny of decisions and improve a patient’s right to challenge will help us to improve service provision for all. On top of that, we have already announced our new patient and carer race equality framework, as recommended by the review, and we are developing the use of culturally appropriate advocates, so that patients from all backgrounds can be supported in making their voice heard.

Thirdly, it is important that the Act supports patients within the criminal justice system. We will make sure that, where people in prison require treatment in a mental health hospital, they are transferred in a timely way, and we will support rapid diversion from custody to care where appropriate so that people in our criminal justice system can get the right care in the right place at the right time, while we fulfil our fundamental duty to keep the public safe.

Finally, in our manifesto, we committed to improving how people with learning disabilities and autistic people are treated under the Act. Until now, the use of powers in the Act did not distinguish between people with mental illness on the one hand, and people with learning disabilities and/or autism on the other. That is wrong. Needs are different and the law should be different, too. That is all part of treating everyone with respect. We therefore propose reforms to limit the scope to detain people under the Act where their needs are due to their learning disability or autism alone. In future, there will be a limit of 28 days for these detentions, which would be used to assess clinical need, and, wherever possible, we will work to ensure that appropriate support is available in the community rather than in institutional settings. I thank Baroness Hollins, Ian Birrell, Mencap and the National Autistic Society for their advocacy and for their support for these reforms.

This Act is there for us all and we want to hear as many views as possible on these plans, so we will consult widely on this White Paper and will respond later this year before we bring forward a new mental health Bill. I believe that everyone in our society has a contribution to make and that everyone should be respected for the value that they bring. It is the role of Government to support people to reach their potential, even at the most difficult of times, and to protect people when they are at their most vulnerable. That is what I believe, and I believe these reforms will help put those values into action and help give patients the dignified treatment that they deserve. I commend this statement and the White Paper to the House.