Today is the second reading in Parliament of a new bill to reform the Mental Health Act for England and Wales, thus hopefully concluding a process that started seven years ago, when I was asked to chair an independent review of the existing legislation.
Mental health acts have a tricky history, because they have to balance two opposing principles. First, that people should be free to make their own decisions, even if they are bad ones. Second, society’s duty to protect the most vulnerable – children and the elderly, but also those with severe mental illnesses.
How to strike this balance needs periodic reviews, in the past often triggered by terrible tragedies, but more recently by increasing understanding and tolerance of mental illness.
To avoid the rancour that accompanied previous reviews, we began with extensive engagement with patients and families, and detailed work with health professionals, the judiciary, police, social workers and more, assisted by a splendid team of civil servants.
Our final 2018 report gained widespread support and the majority of our recommendations accepted.
That was not the end of the matter. Brexit, Covid and general elections slowed the process of converting a report into legislation, whilst the 2023 dreadful killings of Grace O’Malley-Kumar, Barnaby Webber and Ian Coates by Valdo Calocane, suffering from severe schizophrenia, rightly led to further scrutiny.
There is no avoiding the fact that these killings could have been prevented, and serious errors were made by mental health services and police. But this was not because of failings in current legislation, but failures to implement the powers that already existed, and which are retained in the new legislation.
The case for change is as compelling after the Nottingham tragedy as it was before. Unacceptable differences in rates of detention between ethnic groups, outdated Victorian rules, people with severe mental illness, autism or learning disability being detained long beyond any therapeutic benefit and families feeling overlooked in decisions around discharge.
And too often when people were being deprived of their liberty they were also being deprived of any say in how they should be treated. As one service user told me: “I am sure being detained saved my life, but did it have to be such a terrible experience?” Why indeed?
Now saying that people should have more say in how they are treated is not proposing a right to refuse all treatment. This would inevitably lead to people with treatable conditions being indefinitely detained because of continued unacceptable risk, which benefits no one.
But increasing choice is different. The more say anyone has in how they are treated, the more likely they are to cooperate with that treatment. So by giving more weight to advance directives , where a person can say that if I need to be detained again, which sadly is not uncommon, this is how I would like to be treated.
Our reforms will mean that their views will be considered, implemented if possible, or reasons given if it is not. Because someone co operating with their treatment is more likely to improve and less likely to require coercion, which benefits them, their family, the NHS staff caring for them, and the public.
This Bill, unlike its predecessors, now enters Parliament with a broad agreement from all the political parties, professionals, media, the charitable sector, service user groups, and in particular stakeholders representing ethnic minority communities.
This is the right time to modernise the act, and to do so without jeopardising the safety of the public.
