Mental health reform needs to come with enhanced funding for community services
Mental Health Act reform should mean fewer people being held in secure inpatient units and more people getting support to continue to live in their communities.
On Wednesday the government published its long awaited response to the Independent Review of the Mental Health Act.
Three and a half years after the Review was first announced and two years after it was published, this sets the stage for a generational overhaul of the laws which govern mental health detention.
And these laws need an overhaul. Written in the 1980s, they promote a medicalised, top-down model of mental health care which sees thousands of people detained for long periods of time with no realistic prospect of release.
The laws are discriminatory, with black men far more likely than their peers to be detained under the Act and they allow the use of restrictive practices to carry on with little oversight. When it comes to mental health law, the question is not ‘why are we acting’ but ‘why did we not act sooner’.
One of the most significant changes is the removal of autism and learning disabilities as grounds for long term detention
The announcement from the government about the reforms contains a number of technical changes, but most important is their decision to adopt the principles recommended in the Independent Review led by Professor Sir Simon Wessely. These four principles – choice and autonomy, least restriction, therapeutic benefit and the person as an individual – can easily be summed up as shifting mental health from services done to a person by doctors to keep them ‘safe’ to ones which are done with a person in order to promote their wellbeing.
Perhaps one of the most significant changes is the removal of autism and learning disabilities as grounds for long term detention. It has always been an aberration that an autistic person can be detained in order to ‘treat’ autism, which is not a health condition but a form of neurodivergence. By removing these from the Act, we can ensure that the only people detained in mental health units are those with mental health conditions and a genuine need for treatment.
These reforms should mean fewer people being held in secure inpatient units and more people getting support to continue to live in their communities.
Unfortunately, Ministers have often found such commitments easier to make than to keep. Since 2011, various governments have promised to do something about the scandal of autistic people and people with learning disabilities being held in inappropriate and outdated institutions.
However, since data started to be collected in 2015, the number of people in such units has fallen from 2,395 to 2,075 – far below the promised rate of change.
There are many reasons for this, but one of the most important is funding. Placements in secure units are paid for through the NHS, while community support – although often cheaper – is paid for by local authority social care departments. After years of cuts to council budgets, they simply don’t have the funding to provide this community support.
Until this changes, legislative reform simply won’t lead to better outcomes for people currently in mental health units. Alongside the new Mental Health Act, we need comprehensive funding for community services, from talking therapies to catch problems early to 24/7 support for people with learning disabilities.
This is a big commitment, but it would provide a parity of esteem between physical and mental health services. GPs surgeries are a significant expense for the government, but they are rightly seen as worth it because they help keep people out of hospital. We need to start seeing community mental health services in the same way.
Barbara Keeley is the Labour MP for Worsley and Eccles South and Member of the Health and Social Care Select Committee.