Reforming the Mental Health Act - GOV.UK

1 Reforming the Mental Health Act January 2021 CP 355 Reforming the Mental Health Act Presented to Parliament by the Secretary of State for Health and Social Care and the Lord Chancellor and Secretary of State for Justice by Command of Her Majesty January 2021 CP 355 .. Crown copyright 2021 This publication is licensed under the terms of the Open Government Licence except where otherwise stated. To view this licence, visit we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. This publication is available at enquiries regarding this publication should be sent to us at 978- 1-5286-2324-7 CCS1220704008 01/21 Printed on paper containing 75% recycled fibre content minimum Printed in the UK by the APS Group on behalf of the Controller of Her Majesty s Stationery Office Reforming the Mental Health Act 3 Contents Joint foreword from the Secretary of State for Health and Social Care and the Secretary of State for Justice and Lord Chancellor.

2 5 Executive summary .. 8 Unprecedented transformation - making Mental Health services fit for the future .. 8 Responding to the Independent Review of the Mental Health Act.. 9 Next 15 Introduction .. 17 Scope of the White Paper .. 18 PART 1: Proposals for reform of the Mental Health Act .. 20 1. New guiding principles .. 20 2. Clearer, stronger detention criteria .. 23 3. Giving patients more rights to challenge detention .. 28 4. Strengthening the patient s right to choose and refuse 35 5. Improving the support for people who are detained .. 49 6. Community Treatment Orders (CTOs) .. 56 7. The interface between the Mental Health Act and the Mental Capacity Act .. 61 8. Caring for patients in the Criminal Justice System .. 68 9. People with a learning disability and autistic people .. 80 10. Children and Young People.

3 87 11. The experiences of people from black, Asian and minority ethnic 90 PART 2: Reforming Policy and Practice Around the New Act to Improve Patient Experience .. 96 Transforming Mental Health services - The NHS Long Term Plan .. 96 Quality Improvement Programme .. 97 Inpatient safety and risk .. 97 Restrictive Practice .. 98 Suicide .. 98 The physical ward environment .. 99 The role of the Care Quality Commission .. 100 Supporting people in the community .. 102 Care planning in the community .. 103 Section 117 national 104 Supporting people in a Mental Health crisis .. 104 Reforming the Mental Health Act 4 Use of police custody .. 106 Ambulance conveyance .. 107 The Mental Health workforce .. 107 Diversity of the Workforce .. 108 Improving Staff Morale .. 110 Data and digital .. 111 Impact Assessment .. 113 PART 3: The Government s Response to The Independent Review of The Mental Health 124 References.

4 181 Reforming the Mental Health Act 5 Joint foreword from the Secretary of State for Health and Social Care and the Secretary of State for Justice and Lord Chancellor It is two years since Professor Sir Simon Wessely delivered his landmark Independent Review of the Mental Health Act. This set out what needs to change in both law and practice in order to deliver a modern Mental Health service that respects the patient s voice and empowers individuals to shape their own care and treatment. It also made recommendations on how to address the disparities in how the Act affects people from black, Asian and minority ethnic backgrounds. We are grateful to Sir Simon, and to his Vice Chairs, Sir Mark Hedley, Baroness Julia Neuberger and Steve Gilbert OBE for their report and for their continued advice and support. We welcome the considered work and in-depth engagement undertaken by Sir Simon Wessely s Independent Review.

5 We accept, and we will take forward, the vast majority of its recommendations for change. The Government has not been able to bring forward this White Paper as early as originally planned because of the unprecedented battle we are waging with the COVID-19 pandemic. We have all made it our priority to fight this virus, which has already claimed so many lives and is affecting the Mental Health and wellbeing of the nation. This is a challenging time. But we are confident that people who are or who have been users of inpatient Mental Health services, their families and carers, and those who work for these services will all recognise the critical importance of taking the next steps in this process of reform. The Review is already influencing the major decisions and actions the Government is making to improve Mental Health care.

6 We have already taken steps to introduce significant new investment to transform the Mental Health estate so that inpatients can have the privacy and dignity of their own bedrooms with en suite bathrooms. We are investing over 400 million to rid the Mental Health estate of dormitory provision, just as the Review recommended. We will build new Mental Health hospitals with two schemes already approved and with more to come and will tackle the maintenance work needed in the Mental Health facilities where patients are treated. Reforming the Mental Health Act 6 Fortunately, NHS Mental Health services did not need to use the emergency provisions contained in the Coronavirus Act 2020 designed to be deployed if severe staff shortages due to the pandemic disrupted vital care and assessment under the Act. Instead, steps have successfully been taken to innovate in order to adapt and manage the pandemic within wards.

7 As a result, the emergency provisions within the Coronavirus Act have been expired. Some of these approaches point to new ways of doing things such as remote video consultations, when appropriate, as part of the Care Quality Commission s Second Opinion Appointed Doctors service. The Department of Health and Social Care has also followed suit - removing regulatory barriers to the electronic transmission of the Act s statutory forms. This has allowed more flexible and remote working to take place and represents a crucial first step in our work towards digitising the clinical pathways under the Act. This Government believes firmly in increasing the liberty of its citizens. And so we will seek to implement reforms which see people not just as patients, but as individuals, with rights, preferences, and expertise, who are able to rely on a system which supports them and only intervenes proportionately, and which has their Health and wellbeing as its central organising principle.

8 Mental Health services must be improved for people of black, Asian and minority ethnic backgrounds. The Government asked the Independent Review to take a close look at the disparities that exist and to make proposals to address them. This White Paper reflects on the progress that has been made in response to the Review to enable organisations to take the steps they need to make improvements in access, experience and outcomes for individuals from different ethnic backgrounds. It also sets out future plans, including work to develop and support a more diverse and representative workforce and to launch a programme of culturally appropriate advocates, in order to better help patients from all ethnic backgrounds voice their individual needs. We have seen high profile cases of quality failings in the care of people with a learning disability and autistic people in inpatient settings such as the abuse uncovered at Whorlton Hall in May 2019.

9 Too often people have been detained without sufficient therapeutic input and without their rights being upheld. We propose changes to reduce reliance on inpatient services for people with a learning disability and autistic people and to further ensure the availability of community alternatives. We will also deliver on our commitment to improve how people with a learning disability and autistic people are treated in law, with a separate legal approach more suited to their needs. This acts on our manifesto pledge and on our commitment earlier last year to the Joint Committee on Human Rights (JCHR) that individuals within this group should only be in inpatient care for as short a time, as close to home and in the least restrictive setting possible, with a clear, therapeutic benefit, not as a last resort due to lack of appropriate community support.

10 Reforming the Mental Health Act 7 This White Paper marks the next step on this journey. We urge you to take part in the consultation that will take place over the next three months to help shape future legislation, service approaches, and modernise the Act s principles and values. Reforming the Mental Health Act 8 Executive summary Unprecedented transformation - making Mental Health services fit for the future The Government and NHS England and Improvement (NHSEI) are delivering the most ambitious programme for the transformation of Mental Health care England has ever known. This expansion of support, central to our NHS Long Term Plan and backed with record levels of investment, will see two million more people receive high quality Mental Health services by 2023/24 from primary care and specialist community teams, in some schools and colleges, in accident and emergency departments, when in crisis, and in inpatient settings.