‘Reforming the Mental Health Act’ white paper

In December 2018, the Department of Health and Social Care published an independent review of the Mental Health Act. The act – introduced in 1983 and amended in 2007 – gave the state powers to detain, assess and treat people with severe mental health problems in England and Wales. The independent review focused on rising rates of detention under the act and the disproportionate number of people detained from minority ethnic backgrounds. It concluded that the act was not suitable for a modern mental health system. This led the government to develop plans for reform.

White paper

On 13 January 2021, the government published a white paper on reforming the Mental Health Act. It outlined proposals to improve patient experience of detention and treatment under the act. The white paper included the government’s response to the independent review, accepting most of its proposals.

Government put forward several measures in its white paper, including to:

• Improve criteria for detention so that people were only detained when most appropriate.
• Give patients more rights to challenge detention, including greater access to the mental health tribunal.
• Introduce advanced choice documents to allow people to outline and consent to their preferred treatment in the event they are detained.
• Change the person with ‘rights and powers in relation to the patient’ from the nearest relative, which the patient has no control over, to a person nominated by the patient.
• Strengthen the decision-making process for applying community treatment orders (CTOs) to enable conditional discharge into the community with continued supervision and support. Evidence had shown that CTOs could lead to readmission and had been applied disproportionately to black people.

The Secretary of Health and Social Care, Matt Hancock, made a speech to parliamentarians on the publication of the white paper. He stated that ‘the Mental Health Act does not work as well as it should, for patients or for their loved ones’ and that it should be brought into the 21st century.

Further developments

The consultation on the white paper ran until 21 April 2021. The government published its response to the consultation on 24 August 2021. It concluded that the proposals had received an ‘overwhelmingly positive response’ but highlighted concerns among some stakeholders, for example regarding how these reforms would affect children and young people. On 27 June 2022, the Department of Health and Social Care and the Ministry of Justice published a draft mental health bill.