Proposed reforms to the Mental Health Act risk worsening racial inequalities and criminalising those with autism, experts have said, as ministers are warned the plans will be “meaningless” without funding.
The government has introduced the Mental Health Bill, which will make long-awaited changes to the Act, seven years after the previous Conservative administration first announced a review of the legislation.
However, leading experts have warned Labour it must commit to a funding plan for mental health amid fears ministers are rowing back on investment commitments made under the Tories.
In 2015 the Mental Health Investment Standard was introduced to the NHS, which committed to increasing investment in mental health to the same level as investment in physical health, and was met under the Tory government.
But when asked by The Independent whether it could continue to commit to this standard, the Department for Health and Social Care declined to comment.
Dr Sarah Hughes, chief executive of Mind, told The Independent: “Legislation alone cannot fix the mental health crisis. The new Mental Health Bill has to go hand-in-hand with adequate funding if we’re to see the wholesale change that is so desperately needed.
“This was also the view of the Joint Committee on the Draft Mental Health Bill, which made clear that community care and preventative services will need significant long-term investment, or the reforms risk failing the very same people they set out to help in the first place.”
“To help unlock the potential, we need the government to ensure an ongoing commitment to the Mental Health Investment Standard [MHIS], which safeguards mental health spending.”
Worsening inequalities
Under the current law, people who police believe are suffering from a mental disorder and are in “immediate need of care or control” can be detained so that they can be examined for possible treatment.
The new Mental Health Bill, published on Wednesday, will introduce a 28-day limit on how long autistic people and those with learning disabilities can be detained. This is a move to address the more than 2,000 people with learning disabilities and autism who are in hospitals inappropriately.
Health secretary Wes Streeting, writing in the Independent about the changes, said the reforms would “tackle racial discrimination and better support those with learning disabilities”.
The new Act will also only allow community treatment orders (CTOs), which are used to treat sectioned patients in the community, only when appropriate and proportionate. Research has shown CTOs have been disproportionately used on Black and minority ethnic patients.
However, the Independent understands the changes to the Mental Health Act are not being applied to the legislation used to detain people through a criminal route, through which a higher proportion of black and minority ethnic people are detained.
Dr Lade Smith, the president of the Royal College of Psychiatrists who worked on the Mental Health Act review, warned: “Distinguishing between the criteria for detention for different parts of the Act will only serve to introduce a disparity that will disproportionately affect Black people, one that did not exist in the Act before.”
Dr Smith also said taking away the Act’s use for “treatment” for those with learning disabilities and autism could have the unintended consequences of leading to additional A&E admissions and arrests of those with neurodiversity who are experiencing a crisis.
In a statement to The Independent, Julie Newcombe, Alexis Quinn, and Dawn Cavanagh, from the campaign groups Rightful Lives and Stolen Lives, said: “What the Mental Health Act is currently doing is creating a safety net, so that when there is that imminent risk of harm people have a place to go that’s not a prison or not a police cell.
“We’re not saying it’s okay to lock people in hospital. We support those calling for the right community care to stop people from getting distressed and needing to go to hospital.
“What we’re not supporting is the removal of a safety net, which is going to make things worse.”
The group pointed out that under the proposed changes, which take away the use of Section 3 for those with autism and learning disabilities, people detained in hospital would have no legal right to state-funded care after a short discharge.
Meaningless
Following the announcement, concerns by those in the sector have also been raised over an absence of new funding promised by the government to mental health services.
One senior leader said the reforms around be “will be meaningless because we will still end up detaining people in crisis and slowing down discharge because of proper alternatives”.
They said: “We are worried the new Mental Health Act and claims of improvement will not be backed by investment, growth and reduction in waiting lists, adequate access...Therefore the new MHA will be lip service to choice and control.”
Dr Smith also called for mental health hospitals to have their fair share of capital spend to address the “unfit” state of buildings.
She said: “Urgent investment in the mental health estate is needed. The government should allocate and ring-fence £44m to promptly address this high-risk maintenance backlog. It should also explore the introduction of a ‘mental health investment standard’ for capital spending.”
Mark Winstanley, executive of Rethink Mental Illness, said: “To truly deliver on its potential, funding is needed to ensure new legislation is effectively implemented.
”Alongside this, the government should sustain and reaffirm commitment to the Mental Health Investment Standard to ensure funds are protected and not at risk of being diverted to other cash-strapped parts of the NHS.”
He warned with NHS services under pressure without the MHIS safeguard the charity is concerned the government’s commitment to parity for mental health will not be delivered.
Andy Bell, chief executive for the Centre for Mental Health, said: “The Mental Health Investment Standard offers vital protection for mental health services locally to retain their share of NHS funding. A government commitment to retain this minimum standard is essential, but with a commitment to ensuring fairer funding for mental health services longer term to address the shortcomings of the current system.”
What DHSC say
A DHSC spokesperson said: “Our outdated mental health system is letting down some of the most vulnerable people in our society, and is in urgent need of reform.
“The Mental Health Bill includes measures to help ensure people with a learning disability and autistic people get the support they need in the community, improving care and keeping people out of hospitals.
“By bringing the Mental Health Act in line with the 21st Century, we will make sure patients are treated with dignity and respect and the public are kept safe.”
