The Mental Health Act

The Mental Health Act 1983 (MHA) is a piece of legislation in England and Wales setting out when people can be detained and hospitalised for mental health treatment against their wishes. 

This page outlines NSUN’s work relating to the MHA (from oldest to newest), namely around the White Paper (2021) which followed the Independent Review of the Act (announced in 2017), and the resulting Draft Mental Health Bill (the first version of which was published 2022) and its scrutiny.

NSUN response to the Mental Health Bill announcement, 2024

In November 2024, the Government announced plans to introduce changes to the Mental Health Act via a new Mental Health Bill. The press release, published on November 6th, concentrated on measures we previously saw in the 2022 Draft Bill under the Conservative government, the headline changes of which included an end to the use of police and prisons as ‘places of safety’ for people in crisis, removing more autistic people and people with learning disabilities from the scope of the Act, and introducing statutory care and treatment plans.

While some of the proposals being put forward do have the potential to improve the experiences of people who are detained under certain circumstances, the announcement did not provide detail or elaborate on plans to challenge the structural issues present in the mental health system that it identifies. You can read our full response to the development here.

The Bill will now go through Parliament, firstly through the House of Lords, and then the House of Commons. NSUN will continue to engage with the passage of the Bill and we will keep members updated on the progress of the reforms.

Inclusion of Mental Health Act reforms in the King’s Speech, 2024

In July 2024, at the State Opening of Parliament, the King’s Speech contained confirmation that the Government will legislate to modernise the Mental Health Act. This is the next step in the long-awaited reform of the Act.

As we outlined in our response to the omission of the Bill from the King’s Speech in November 2023 (below), the last before the general election, we know that many regarded the reforms outlined by the previous Government as a step in the right direction towards addressing some key issues in the Act.

However, the reforms on offer in that draft Bill – which we assume will be brought forward, but may be subject to change – were considered by many not to go far enough, and would have had to be backed by significant additional funding. We reiterate that we urgently need to see a commitment to transformative change beyond the scope of the reforms in addressing a culture of abuse, neglect, iatrogenic harm and exclusion in the mental health system as a whole. The decimation of community care and alternatives to detention under austerity for both those in crisis and those living with long-term distress remains an urgent crisis. You can read our full response to the development here.

NSUN’s response to the omission of the Mental Health Act reforms from the King’s Speech, 2023

In November 2023, the final King’s Speech before the next general election took place without mention of a Mental Health Bill, which would have been the next step in the long-awaited reform of the Mental Health Act. This means it is now extremely unlikely that any changes under the Bill will be passed before the next general election. You can read NSUN’s response to this news here.

Alongside 25 other mental health organisations, NSUN wrote to the Prime Minister, Secretary of State for Health and Social Care, and the Parliamentary Under-Secretary for the Department of Health and Social Care to express our concern about the King’s Speech not including a mental health bill. We reiterated that on top of legislative change, we also need resources to improve mental health care and community support with a focus on preventing crisis and inappropriate detention under the Mental Health Act.

Final report of the Joint Committee on the draft Mental Health Bill, 2022

In January 2023 we published our response to the final report of the Joint Committee on the draft Mental Health Bill. We reiterate our concerns that the recommendations depend on proper funding and a commitment to transformative change in what care looks like, in communities and inpatient settings.

The draft Mental Health Bill, 2022

The Draft Mental Health Bill was published in June 2022 and “takes forward the vast majority of the Independent Review’s recommendations”.

In October 2022 NSUN gave oral evidence at the Formal Meeting (oral evidence session) held by the Joint Committee on the Draft Mental Health Bill. You can read the transcript of the session or watch the recording here.

In November 2022 we published an update on the Draft Mental Health Bill, which you can read here. We feel that the proposed reforms are not driven by a rights-based approach, though they do contain the potential to make changes to the experiences of some people who are detained, if properly resourced and implemented. 

Institutional racism within Mental Health Act Reform, 2021

In December 2021, NSUN, as part of the Mental Health Alliance, wrote to the Secretary of State for Health and Social Care, Sajid Javid, on institutional racism in Mental Health Act reform.

Black people are four times more likely to be detained under the Mental Health Act and ten times more likely to be discharged from hospital under a Community Treatment Order. However, the Government’s response to the public consultation only mentions racism once, in passing. There were no consultation questions specifically addressing the impact of MHA reform on people from racialised communities (“individuals who identify as BAME”). Many members of the Mental Health Alliance raised institutional racism in their responses to the public consultation. We did not see these contributions adequately reflected or responded to within the Government’s response.

Proposed initiatives such as culturally appropriate Independent Mental Health Advocates, the introduction of a Patient Carer Race Equality Framework (PCREF), and a small number of new research projects do not go far enough and do not all have clear long-term resourcing. Only by acknowledging and addressing structural factors and providing significant investment in alternatives are we going to be able to improve access, experience and outcomes for mental health care. The dial will not shift on tackling racial disparities in mental health services until the existence and impact of structural and institutional racism are acknowledged and challenged.

We asked the Government to commit to the following:

1. Publically acknowledge institutional racism in the use of Mental Health Act.
2. Commit to concretely improving disparities in detention rate by ethnicity, with publishing of clear annual targets to progressively reduce disparities by 2025.
3. Commit to long-term resourcing of all the recommendations pertaining to racialised groups outlined in the MHA Review.

NSUN’s work on the MHA Independent Review and the White Paper, 2017-2021

Background – the Independent Review

The Mental Health Act 1983 is a piece of legislation in England and Wales setting out when people can be detained and hospitalised for mental health treatment against their wishes. 

In 2017, an independent review of the Mental Health Act was announced with the intention of addressing concerns about issues such as rising detentions and the disproportionate number of people from Black and minority ethnic groups detained under the Act. You can read about the background here. It was chaired by Simon Wessely and concluded at the end of 2018.

NSUN worked throughout the process to consult with our membership and represent your views. NSUN also responded to the interim report. You can view the final report and recommendations here, which NSUN also analysed. 

The White Paper – NSUN’s response

In January 2021 the government’s White Paper (a policy document that sets out their proposals for future legislation, based on the Independent Review of the Mental Health Act) was released. The White Paper broadly followed the recommendations in the Independent Review. It was open to a public, online consultation until the 21^st April 2021. 

Our starting position was that real change in how people experience detention is not just down to legislation, but will also be contingent on changes in practice and culture, and on the funding which follows. We worked to consult members in order to help us formulate a response but also to support people respond to the consultation directly. You can find out more about our work in the consultation process in the section below.

You can read our initial response (January 2021) here and our official response to the consultation (April 2021) here.

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What did NSUN do in the White Paper consultation period (March/April 2021)?

We ran a member consultation exercise on the Mental Health Act:

NSUN ran a series of short surveys on the Mental Health Act White Paper. Responses helped us form the NSUN response to the White Paper consultation. Our surveys focussed on: discharge from hospital, the role of Independent Mental Health Advocates, racial disparities, and the newly proposed “guiding principles”.

We published a members’ blog series exploring experiences of detention under the Act:

We published Card Games & Colouring Books: an Inpatient Perspective on being Sectioned by Jennifer Reese, Autism and colour in a monochrome anti-neurodivergent psychiatric setting by Zaynab Sohawon, and My experience of being sectioned by Emily Katy

We held Mental Health Act webinars with BIHR:

For people who are accessing, have accessed or are trying to access mental health services, we held a webinar with the British Institute of Human Rights on the reforms to the Mental Health Act and what they mean for human rights. We also held a similar session for those working in or with mental health services.

We took part in a Mental Capacity Law and Policy “Shedinar” Episode on the reforms

“In this ‘in conversation with’ Akiko Hart, Chief Executive of NSUN, we discuss the challenges of responding to reform proposals in relation to mental health law and practice as a membership organisation, and also get into some of the thorny issues around mental health reform more generally. This ‘in conversation with’ is audio only, and you can most easily access it by the podcast link here.”

We held a ‘Mental Health Act Q&A Webinar’:

We held a Q&A webinar on the 6th April 2021 on the proposed changes to the Mental Health Act. We explored the changes to the Act set out in the recent White Paper. We wanted to delve into the detail of the proposed changes to enable more people to understand the White Paper and respond to the consultation.

Chairing the discussion was Mark Brown, Development Director of Social Spider and a well-recognised writer and tweeter on mental health, social innovation and social media. Our panellists were:

• Jabeer Butt, the CEO of the Race Equality Foundation. 
• Joanna Dean, a lawyer specialising in prison and mental health.
• Neil Allen, a Barrister and Senior Lecturer at the University of Manchester. With particular interests in human rights, mental health and incapacity law.
• Jayne Gardner, an Approved Mental Health Professional.