The Government has set out sweeping proposals to tackle mental health inequalities including the disproportionate detention of people from black, Asian and minority ethnic (BAME) backgrounds.
Plans to reform and modernise the Mental Health Act will give patients in a mental health crisis “greater choice and autonomy” over their care, the Department of Health and Social Care (DHSC) said.
The proposals aim to ensure powers under the 40-year-old Act are used in the least restrictive way, and bring parity between mental and physical health services.
They will also aim to better meet the needs of people with learning disabilities and autism, and prisoners with serious mental illness.
The Government is proposing to introduce “advance choice documents” so people can express their care preferences before falling ill, and implement the right for a patient to nominate a person to look after their interests.
The DHSC said decisive action is needed to tackle racial disparities, with black people more than four times more likely to be detained under the Act and more than 10 times more likely to receive a Community Treatment Order.
The Government is planning to introduce a “Patient and Carers Race Equality Framework” to help NHS Mental Health Trusts better understand what they need to do to improve outcomes for patients of different ethnicities.
And it will consult on piloting culturally appropriate advocacy services in areas that could benefit.
The proposed reforms also aim to address concerns about people with learning disabilities and autism detained in mental health hospitals.
They have been put forward in recognition that a mental health inpatient setting is often not the best place to meet the needs of these people, the Government said.
Neither conditions should be considered as justification for detaining someone under the Act; instead people with learning disabilities or autism should only be detained if they have a co-occurring mental illness.
The Government will also consult on how to improve access to community-based mental health support, including crisis care, to prevent avoidable detentions.
Health Secretary Matt Hancock said: “These reforms will rightly 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 centre.
“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.”
A 28-day time limit is being proposed to speed up the transfer of prisoners with serious mental health illnesses to hospital, ending unnecessary delays and ensuring they get timely, appropriate treatment.
The Government also wants to end the “outdated practice” of using prisons as “places of safety” for defendants, with plans for judges to work with medical professionals to ensure they are taken directly to a healthcare setting from court.
Justice Secretary Robert Buckland said: “Prisons should be places where offenders are punished and rehabilitated, not a holding pen for people whose primary issue is their mental health.
“Keeping people safe must be at the heart of everything this Government does, and the reforms announced today will allow us to do this while ensuring offenders still get the treatment their conditions require.”
The Government’s white paper, published on Wednesday, builds on recommendations made by Sir Simon Wessely’s independent review of the Mental Health Act in 2018.
Consultations on areas that require legislation will run until early spring, and a draft Mental Health Bill will be shared next year.
Claire Murdoch, mental health director for NHS England, said: “The proposed reforms are a welcome step towards ensuring that people with mental health needs, a learning disability or autism, remain at the centre of decisions about their care, and that longstanding inequalities in experience and outcomes are addressed.”
Sarah Hughes, chief executive at the Centre for Mental Health, said the need to modernise the Act “could not be clearer”.
She added: “Every year, the number of people who are sectioned grows. While we know this can save lives, the use of coercion can also cause lasting trauma and distress.
“And we have known for too long that black people are subjected to much higher levels of coercion at every stage of the system. It is time for this to change.”
Sophie Corlett, director of external relations at Mind, added that the Government must consult with people from BAME groups if it is to tackle “underlying and systemic racism that results in disproportionate detentions and use of force”.