The 1983 Mental Health Act provides for some extraordinarily coercive powers. A person with acute mental illness can be detained without their consent and sometimes forcibly removed from their home for that purpose. This is necessary when someone poses a danger to themselves or others, but that imperative must always be applied with clinical sensitivity and regard for fundamental rights. Mental illness is not a criminal offence.
Too often, the boundary between medical intervention and arbitrary detention has been blurred. In 2017, Theresa May, then prime minister, established an independent review to consider why increasing numbers of people were being sectioned and why some groups were affected more than others. The most draconian powers were being disproportionately applied to black people – three times more likely to be detained than white people – and also patients with learning disabilities and autism. Prejudice, compounded by inadequate resourcing of mental health services, has engendered systemic injustice.
There followed a draft reform bill to bolster patients’ rights and, in the words of the review, “shift the dial” away from coercion and towards choice. But Ms May’s interest in this area was not shared by her Tory successors. The law was not changed.
That can now finally happen, since Labour introduced a revised version of the bill to parliament on Wednesday. The new law will give patients more power over their care and how their interests are represented, whether by a family member or some other nominated person. There will be clearer obligations on clinicians to include relatives in decisions about patients’ care. There will be shorter limits on the amount of time people with learning difficulties or autism can be detained.
It will no longer be possible to use police or prison cells as designated holding “places of safety” in cases of acute mental health crisis. That practice represents one of the more egregious affronts to patients’ dignity. It often fails on the basic test of keeping vulnerable people from harm, while giving expression to an old and stubborn prejudice that associates mental illness with public menace. Jails should not be used as hospital wards. Thankfully, those attitudes are shifting. The cultural discourse around mental health is more enlightened and compassionate than it was when the Mental Health Act was first passed.
How far statutory reform can shift the dial in recognition of that evolution in attitudes will ultimately depend on resources. Out of last week’s budget boost for the NHS, £26m is to be allocated for new mental health crisis centres, although demand for hospital care will continue to outstrip supply. A single reform act cannot undo generations of neglect, but it is a necessary condition for restoring humanity and justice to a system that has too often forgotten those qualities.
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• This article was amended on 7 November 2024. Police cells as well as prison cells will no longer be designated holding “places of safety” in cases of acute mental health crisis.
