Reforming the Mental Health Act – Government proposals and consultation

The Government has published details of a ‘Reforming the Mental Health Act’ White Paper.

The paper is intended to build on the recommendations of the 2018 Independent Review and emphasise principles of choice and autonomy, least restriction, therapeutic benefit and recognition of the person as an individual. The aim is to increase parity between physical and mental health.

The paper sets out the government’s proposed changes including:

  • The introduction of statutory “advance choices documents” to require decision makers to consider patient views when deciding on medical treatment under Part 4 of the MHA.
  • A revision of criteria for treatment under Part 4 MHA.
  • The implementation of statutory care and treatment plans to be maintained by RC.
  • The ability of individuals to nominate a person best placed to look after their interests, such nominated person to have the right to appeal clinical decisions at tribunal, have increased consultation in relation to care and treatment, transfers, detention and CTO.
  • The expansion of the role of independent MH advocates to enable greater support and representation for detailed patients.
  • An increased recognition of the disproportionate number of black, Asian and ethnic minority individuals detained under the MHA. To be addressed by the piloting of a scheme for culturally appropriate advocates for patients of ethnic backgrounds to ensure they are better supported. A National organisation competency framework for MH trusts will be introduced, the ‘Patient and Carers Race Equality Framework (PCREF), to enable Trusts to understand the steps needed to improve black, Asian and minority ethnic communities’ mental health outcomes. An aim to reduce the number of CTO’s and improve mental health transport vehicles.
  • Ensuring that autism or LD are not grounds for detention under MHA themselves and where people with those conditions are detained, proposal of statutory care and treatment reviews to address inappropriately long inpatient stays.
  • The implementation of a duty on local commissioners to ensure provision of community services for people with LD or autism.
  • Improving access to community-based support, included crisis care to prevent avoidable detentions.
  • Revision of criteria for CTO’s and introduction of requirement for a community supervising clinician to be involved in decision to implement a CTO
  • An increased ability for patients to challenge treatment by access to the First Tier Tribunal, including enabling an IMHA or nominated person to bring a challenge.
  • A planned revision of the MHA/ MCA interface, to take into account LPS due to be implemented by April 2022.
  • Reform to the interface between mental health and criminal justice system including the introduction of statutory time limit of 28 days to speed up transfer from prison to mental health settings, increased support and new supervised discharge process of restricted patients.
  • An extension to the s5 MHA powers to enable hospitals to hold individuals with capacity for the purpose of life sustaining treatment.
  • New Commission for Mental Health with responsibility for monitoring use of formal powers, assuring the quality of statutory training for practitioners and specialist advocacy services.

It is intended that consultation will continue until 21 April 2021 with the intention to publish a draft Mental Health Bill in 2022. The proposals are potentially wide ranging and may have a significant impact on the way mental health services are delivered. However, the details of the proposed changes are not yet available and whether the resources for the necessary investment will be provided remains to be seen.

Further information and training will be provided by Hempsons as more information is available.

The White paper can be found at: