The 1983 Mental Health Act provides for a number of extremely coercive powers. A person with an acute mental illness may be detained without their consent and sometimes removed from their home for that purpose. This is necessary when someone poses a danger to themselves or others, but this obligation must always be applied with clinical sensitivity and with respect for fundamental rights. Mental illness is not a criminal offense.
Too often the line between medical intervention and arbitrary detention is blurred. In 2017, Theresa May, the then Prime Minister, set up a independent assessment to consider why more and more people were sectioned and why some groups were more affected than others. The most draconian powers were disproportionately applied to black people – three times more likely to be detained than white people – as well as patients with learning disabilities and autism. Biases, exacerbated by inadequate mental health resources, have led to systemic injustice.
One followed draft reform law to strengthen patients’ rights and, in the words of the review, “move the dial” from coercion to choice. But Mrs May’s interest in this area was not shared by her Tory successors. The law was not changed.
That may finally happen, as Labor presented 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 another nominated person. There will be clearer obligations for doctors to involve family members in decisions about patient care. There will be shorter limits for the duration of detention for people with learning difficulties or autism.
It will no longer be possible to use prison cells as ‘safe places’ in the event of an acute mental health crisis. This practice represents one of the most egregious insults to patients’ dignity. It often fails the fundamental test of protecting vulnerable people from harm, while expressing an old and persistent prejudice that associates mental illness with public threat. Prisons should not be used as hospital wards. Fortunately, those views are changing. The cultural discourse around mental health is more enlightened and compassionate than when the Mental Health Act was first passed.
The extent to which legal reforms can shift the dial in realizing that evolution in attitudes will ultimately depend on the means. From last week’s budget increase for the NHS, £26 million will be allocated to new mental health crisis centres, although demand for hospital care will continue to outstrip supply. A single act of reform cannot undo generations of neglect, but it is a necessary condition for restoring humanity and justice to a system that has too often forgotten these qualities.
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