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The Mental Health Act Review: Reflecting on 5 Years of Advocacy and Calls to Reform

December 2023 marks 5 years since Sir Professor Simon Wessley’s Independent Review of the Mental Health Act. The initial aims of this Independent Review were to confront racial inequalities faced by Black and Ethnic minority communities detained under the Mental Health Act, address the sharp rates in detention and modernise mental health-related processes, with the goal of creating responsive and modern mental health services, fit for purpose in the 21st century. 

In the years following this review, service providers and communities have faced considerable challenges, dealing with deep-seated structural inequalities worsened by the pandemic, an ongoing cost-of-living crisis, and a renewed emphasis on tackling racial injustice, provoked by the tragic murder of George Floyd in 2020. Recent developments highlight the impact of systemic inequalities on the existence of service gaps and barriers within mental health services, disproportionately affecting marginalised groups and Black and Ethnic Minority Communities. 

As we look back, it’s clear that the recommendations from the Independent Review remain as relevant today as they were then – if not more so. While the mental health landscape has seen notable developments, including the launch of a Mental Health White Paper in 2021 and a Draft Mental Health Bill in 2022 which faced pre-legislative scrutiny in January 2023, the recent King’s Speech omitted any mention of the Mental Health Act Reform, prompting a reflection not just the roadblocks in achieving reform but on the progress made and the continued need to push for transformative change within mental health legislation, systems and services. 

To generate momentum and discussion on the importance of Mental Health Act reform and to mark the anniversary of the Independent Review of the Mental Health Act, the Association of Mental Health Providers hosted a panel event on this topic, on 5 December 2023. Panel members included Co-Chair of the Review, Lived Experience and Anti-Racism Consultant, and Trustee of The Association, Steve Gilbert; Head of Legal at Mind, Rheian Davies; Senior Policy and Public Affairs Officer, Stephen Hinchley from Voiceability; as well as Marsha Mcadam, Expert by Experience, Member of the Maximising Autonomy of people with lived experience Topic Group of the Review, and a current Churchill Fellow researching social injustices and inequity faced by individuals diagnosed with Borderline Personality Disorder (BPD). 

The focus of this panel event was to capture the impact of the Independent Review of the Mental Health Act, emphasise why reform was crucial to deliver improved services and care to communities, and lastly, to reflect on the role organisations must continue to play, to demand action and change when it comes to the Mental Health Act.  

Steve Gilbert, a key advisor on the Independent Review of the Mental Health Act in 2018, shared that there was a continued need to challenge detention rates and racial inequalities across mental health services. Steve emphasised that Mental Health Act reform must place communities and service users at the forefront of the reform process. He reiterated that implementing the recommendations from the 2018 independent review and continuing to fight for the reform of the Mental Health Act, would require everyone to play a role, and would deliver access to services, outcomes and experiences which meet the needs of the most marginalised communities.  

Marsha, drawing from her extensive background in suicide intervention and postvention work, provided a unique perspective. Her insights, shaped by a Churchill Fellowship visit to Orygen in Australia, emphasised the critical need for culturally appropriate care and holistic approaches in mental health. Marsha shared that legislative reform would be important, as it would transcend beyond rhetoric, and would allow the creation of a future where culturally sensitive services become the norm rather than the exception. Marsha highlighted her personal belief that legislative reform can serve as the catalyst for ensuring culturally appropriate services and mental health care are not just a promise, but a reality and become easily accessible to communities. 

Stephen Hinchley from Voiceability echoed the importance of Wessley’s independent review of the Mental Health Act, and the need for legislative reform, on the grounds that it would genuinely support empowering and uplifting an individual’s voice. He stressed the importance of advocacy in achieving person-centred care and treatment, pointing out that, unfortunately, what’s legislated doesn’t always align with everyday practice in some wards, where a lot of people are not aware they can access an Independent Mental Health Advocate and are unaware of their rights. Stephen argued for further meaningful engagement and consultation with communities, to shape the future of advocacy services. He emphasised that legislative reform is essential to ensure culturally appropriate advocacy becomes the standard rather than the exception. 

Rheian Davies, representing Mind, delved into the legal landscape surrounding mental health, highlighting outdated provisions within the Mental Health Act of 1983. She pointed out provisions of the 1983 legislation, such as treating individuals with mental health issues bringing legal challenges as vexatious litigants, perpetuates stigma towards mental health within legal systems. Rheian emphasised the urgent need for mental health reform and the necessity of rewriting the law to eliminate systemic inequalities, particularly racial barriers. She provided examples where hospitals utilised legal tactics to thin out resources or disempower individuals with mental health challenges. Rheian stressed the imperative to address racism within the mental health system and advocated for the appointment of a suitable Mental Health Commissioner. This commissioner, she argued, should play a pivotal role in delivering and spearheading the much-needed reform of the Mental Health Act, shaping sustained and groundbreaking improvements for people facing mental health challenges. 

As chair of the panel event, Kathy Roberts, CEO of the Association of Mental Health Providers, who also chaired the Advocacy Topic Group of the Review, shared that delays in reforming the Mental Health Act were taking place against a backdrop of an ongoing mental health crisis, where mental health needs within communities are growing, but this demand is not being met by current mental health services, with service providers in the VCSE sector fulfilling this service need and gap. She shared that the tireless efforts of those in mental health and social care pushing for change could not be ignored, and all must continue to play a part in securing reform of the Mental Health Act, to seek the change that could improve systems and services.  

As we look back on the 5-year journey since the Mental Health Act Review, it’s evident that significant work lies ahead. The unified voices of advocates, professionals, and communities echo a resounding call for timely and substantive reform. It is crucial for the government not only to hear but to genuinely commit and take tangible actions, moving beyond mere promises. The mental health landscape necessitates a paradigm shift, and the moment for transformative change is upon us. 

In the pursuit of Mental Health Act reform, it is essential to persist in amplifying voices, challenge existing norms, and advocate for a system that prioritizes the wellbeing of all, with a particular emphasis on marginalised communities.