Reform of the Mental Health Act must be properly funded

Proposed changes to the mental health system must be properly funded to be effective, the Law Society of England and Wales warned following publication of the Mental Health Act White Paper.

Law Society president David Greene said:

“It is clear the current system means that all too often compulsory detention and treatment is, or feels like, a first and not a last resort.”

“Every person who has mental health issues should be treated in the least restrictive way possible and should only be detained against their will as the very last option if their health, safety or public protection depends on this.

“In October 2020, there were nearly 15,000 people detained in hospital under the Mental Health Act. Anyone who is formally detained under the Mental Health Act – often referred to as being sectioned – must be effectively safeguarded and have greater involvement in decisions about their care and treatment.

“Reform must be backed up by proper funding to meet the rising pressure on services and to address the poor state of infrastructure in many hospitals. This is vital to ensure the safeguards for people detained under the Act are sustainable, effective, and enforceable.

“Without adequate investment into the mechanisms upholding the law, such as the mental health workforce, public health and social care, community-based support and the tribunals, these changes will result in exponential demand that cannot be met, and consequentially, collapse.

“These services are already under severe strain due to the Covid-19 pandemic, and it is important that they are regarded as a priority by the government if there is to be sustainable, long-term change.”

Many of the proposed reforms would need a substantial injection of resources to succeed:

• Reducing compulsory detention depends upon more accessible and responsive crisis and community-based services
• Transferring prisoners to secure hospitals within a 28-day time limit may require extra beds within the secure estate
• Extending tribunals’ powers and increasing opportunities to appeal would require more hearings, and so more judges, panel members and tribunal staff
• Increasing the role of independent mental health advocates to support patients throughout their journey will require funding
• There will be a greater demand for aftercare services, with an emphasis on enhanced provision for community-based support and treatment, together with statutory care plans
• Hospital environments will need to be modernised and refurbished to provide truly therapeutic environments for patients

David Greene said:

“As well as facing higher rates of detention, black British people experience poorer outcomes.

“Data indicate that black patients are subject to a level of restraint that is three times higher than white British patients. The Law Society welcomes the commitment to develop culturally appropriate advocacy for people of all ethnic backgrounds and communities. The steps proposed to address the significant under-representation of people of black African and Caribbean descent across the mental health professions at more senior levels are also positive, although this is unlikely to be a quick fix.

“The plan to reduce the number of community treatment orders (CTOs) overall is promising, but as black or black British people are at least ten times more likely to be placed on a CTO than white British people, it will be important to monitor whether any reduction in their use does in fact result in a reduction in this disparity.”
“There are also devolved issues, which means that the White Paper will be need to be considered by the Welsh government for application there, but it is important that the changes link up, given the high number of cross-border matters.”

Louise Lawrence, Partner at Winckworth Sherwood, commented:

“The ongoing COVID-19 pandemic has shone a spotlight on mental health and wellbeing in the workplace. Employers in particular are worried about the long term impact of working from home on their employees’ health. In our recent survey involving 500 HR decision makers, concerns about the negative impact on employee wellbeing came up in the top four challenges that businesses face if employees work from home either, all, or most of the time.

“In our experience, the pandemic has pushed employers to offer more mental health support to their workforce. A study carried out by the Reward and Benefits Association (REBA) between 4 May and 11 May 2020, in association with Unmind, supports this with nine in 10 respondents stating they were offering more mental health support as a result of COVID-19 along with 70% stating they would be increasing investment in mental health support over the next 12 months.

“Particular attention has been paid to their virtual wellbeing offering with more employees working from home than ever before. This support comes in many forms and has included sessions on resilience and mindfulness, exercise classes and online yoga, along with access to wellbeing apps, digital GP appointments and free counselling sessions. In addition, employers have reassessed how they engage with their employees who now find themselves working remotely and have been holding virtual coffee breaks, team socials and organising buddy systems. Successful engagement is crucial while employees are working remotely as it is harder for their employers to spot signs of mental ill-health.

“As many businesses look to increase flexibility around working from home in the long term, it has never been more important that businesses continue to offer structured wellbeing support whilst creating an open culture where employees feel able to share mental health issues at an early stage.”