'Discriminatory' mental health system overhauled

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Plans have been announced to overhaul the mental health system – with the aim of making it less discriminatory towards black people.

Ministers say changes to how people are sectioned in England and Wales will see them treated “as individuals, with rights, preferences, and expertise”.

Black people are over four times more likely to be detained under the Mental Health Act, relative to population.

The mental health charity Mind said the changes “cannot come soon enough.”

People are detained under the mental health act – or sectioned – for their own safety, or the safety of others.

How long they are detained for varies – but once detained, they are immediately considered to be “sectioned”.

Use of the Mental Health Act has increased markedly – from 2005/6 to 2015/16, the number of people detained in hospital increased by 40%.

NHS data for England shows there were at least 50,893 new detentions under the Mental Health Act in 2019/20 – but the overall total will be higher as not all providers submitted data.

Of those detentions, 5,336 people were black or black British.

The data also shows that in 2019/20 there were 321 detentions per 100,000 population for people who were black or black British – while there were 73 detentions per 100,000 for white people.

With the act disproportionately used against black people, the reforms will see a Patient and Carers Race Equality Framework introduced across all NHS mental health trusts – which the government describes as a practical tool to improve the outcome for BAME communities.

What ministers call “culturally appropriate advocates” will also be developed, so patients from all ethnic backgrounds can be supported.

“We need to bring mental health laws into the 21st Century,” said Health Secretary Matt Hancock.

“I want to ensure our health service works for all, yet the Mental Health Act is now 40 years old.

“This is a significant moment in how we support those with serious mental health issues, which will give people more autonomy over their care and will tackle disparities for all who access services – in particular for people from minority ethnic backgrounds.”

The reforms will also ensure that autism or a learning disability cannot be a reason for detaining someone under the act.

In future, a clinician will have to identify another psychiatric condition to order their detention.

The current Mental Health Act dates from 1983 and the aim of these reforms, which are widely supported, is to give people greater say over their care and to rebalance the system between the state and the individual.

Among the recommendations are plans to introduce statutory advance choice documents which will allow people to express their preferred treatment before they reach a crisis and need hospitalisation.

“This is just the beginning of what is now a long overdue process,” said Sophie Corlett, director of external relations at the mental health charity Mind.

“At the moment, thousands of people are still subjected to poor, sometimes appalling, treatment, and many will live with the consequences far into the future. 

“Our understanding of mental health has moved on significantly in recent decades but our laws are rooted in the 19th Century.”

The recommendations, set out in a government White Paper, build on the proposals from an independent review of the act, which was ordered by then prime minister Theresa May in October 2017 and which published its conclusions in December 2018.

Ministers intend to publish a Mental Health Bill in 2022, following a consultation on their plans.