Reform of the Mental Health Act: White Paper

Helen Hayes Excerpts

Wednesday 16th June 2021 Westminster Hall

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I beg to move,

That this House has considered the “Reforming the Mental Health Act” White Paper.

It is a pleasure to see you in the Chair today, Ms Nokes. I am grateful for this opportunity to bring to the Minister the concerns and aspirations of my constituents about the “Reforming the Mental Health Act” White Paper.

I appreciate that the consultation on the White Paper closed only recently and that the Government will be considering their response ahead of bringing forward legislation. My intention in securing this debate is to emphasise many of the concerns and priorities of my constituents on reform of the Mental Health Act 1983, to put those concerns on record and to seek assurances from the Minister that they will be addressed in the Government’s response and in forthcoming legislation. Although I draw on the experience of my constituents, I am confident that these issues apply equally to communities up and down the country.

I am grateful to Lambeth and Southwark Mind for the work it has done to engage with local residents in Lambeth and Southwark, including many with lived experience of accessing mental health services. That work has informed its submission to the consultation, which I will draw on today. I am also grateful to national Mind, for its research and analysis of the experiences of black, Asian and minority ethnic residents of mental health services.

Being sectioned is one of the most serious things that can happen to somebody experiencing a mental health problem. It involves the deprivation of liberty, removal to an institutional facility, multiple interactions with professionals, who are most likely to be strangers, and medical interventions, sometimes involving the use of chemical or physical restraint. For far too many people, the experience of being sectioned is itself an additional trauma.

That reality was brought home to me when, as a teenager, I had a regular summer job in a firm of legal aid solicitors in Liverpool who represented people at the mental health review tribunal. It was my job to open the post and, day after day, I read handwritten accounts of the pain and distress suffered by people detained due to their mental health. The overall impression from the weight of correspondence over many weeks and months was of desperation and a system that was so often not listening to the patients in its care. Reform of the Mental Health Act is long overdue. Many of the proposals for reform set out in the review chaired by Sir Simon Wessely are very welcome.

The boroughs that my constituency covers, Lambeth and Southwark, have among the highest rates of mental ill health anywhere in the country. They are also among the most diverse communities in the country, with a significant proportion of residents from black, Asian and minority ethnic backgrounds. It is therefore a top priority for me and my constituents to ensure that the forthcoming reform of the Mental Health Act delivers services that work for our diverse communities, in terms of both sustaining good mental health and delivering equitable access to services that are culturally appropriate and free from racial discrimination.

Mental health research points to a relationship between the experience of racism and mental ill health and to racial inequality within mental health services. There is ethnic disparity in the diagnosis of mental illness. For example, for every one white person diagnosed with schizophrenia, 4.7 black people and 2.4 Asian people are diagnosed with the disorder. Incidence is highest among UK residents of black Caribbean heritage, but that disparity is particular to the UK and is not replicated in the Caribbean, which points strongly to social determinants of mental ill health, including poverty, unemployment, poor housing and school exclusion.

Growing evidence, cited by Mind, suggests that discrimination and, in particular, experiences of racism, both personal and institutional, contribute to increased likelihood of developing mental health problems. Experiences of racism have been linked to an increased likelihood of developing depression, hallucinations and delusions and post-traumatic stress. Routine experiences of racism and discrimination, and the associated prolonged exposure to stress and distress, have been found to have a toxic wear-and-tear effect on the body over time.

There is also evidence of some racial discrimination within mental health services, particularly with regard to racial stereotyping and the perceived risk of violence contributing to increased rates of detention. That translates into significant racial inequalities in the use of the Mental Health Act. Black people are more likely than white people to be referred to mental health services through the criminal justice route, four times more likely to be sectioned, more likely to be detained more than once, three times more likely to be the subject of physical restraint, and eight times more likely to be given a community treatment order.

The Government’s support for the Sewell report, with its denial of institutional racism, gives rise to grave concerns among many of my constituents about whether the reforms will address racial inequality in mental health. It is absolutely vital that reform of the Mental Health Act addresses those stark and unacceptable inequalities. I hope the Minister will understand why I am anxious to emphasise this matter before the Government publish a response to the consultation.

Lambeth and Southwark Mind has identified three ways in which racial and ethnic disparity and discrimination can be addressed in mental health services. The first is greater community engagement directly with black, Asian and minority ethnic communities, working with existing, often dynamic, community structures, rather than expecting communities to engage proactively with NHS structures. Such structures can seem distant and opaque and which often reflect services that have been the source of painful experiences in the past, and in which trust is sometimes low. There are many grassroots organisations and NHS services that engage very well with communities. It is vital that best practice is understood and embedded across all services as part of those reforms.

The second is investment to support more culturally focused peer support groups and counselling as part of much wider investment in improved community care. There is concern that, although increasing the threshold for sectioning is the right thing to do, without a step change in the level of investment in community-based mental health services—specifically those that are culturally appropriate and competent—some people could experience a delay in accessing services until they are much more unwell.

Thirdly, Lambeth and Southwark Mind recommends a significant change in language to reduce stigma and improve access to mental health services. That type of change is modelled exceptionally well by organisations such as Black Thrive, whose language focuses not on the stigma of illness but on the changes that are required to keep people well and thriving. Lambeth and Southwark Mind also emphasises the need for practical changes, including the introduction of discreet mental health vehicles to transport people suffering a mental health crisis, which are more appropriate, less traumatising and less stigmatising than ambulances and police cars.

There is widespread support for the proposal to move to an opt-out system for mental health advocacy services. It is important that training and funding are put in place to ensure that advocacy services are always delivered in a culturally appropriate way. The introduction of a nominated person is a significant improvement over the current nearest relative provision, but in a consultation meeting held by Lambeth and Southwark Mind, which I attended, some of the contributors flagged concerns that there should be robust safeguards against coercion and exploitation, since it is possible for people to be subject to abuse and exploitation from non-relatives, which may result in pressure to designate them a nominated person.

Lambeth and Southwark Mind raises some questions about the lack of clarity in the White Paper on the time limit for temporary detention. As it stands, section 5 of the Act places a 72-hour time limit for an in-patient to be temporarily detained in hospital pending assessment. It is unclear whether the limit extends to out-patients in A&E. Provision of a 72-hour time limit for temporary detention in A&E reflects the horrific experience of far too many mental health patients in A&E departments across the country, due to the acute shortage of in-patient beds. Long wait times in A&E are unacceptable. They should not be enshrined in law; rather, investment should be made in services to ensure that they are available in a timely manner.

Nationally, Mind has raised particular concerns about community treatment orders, given the appalling racial disparity in their use. Black people are 10 times more likely to be put on a CTO than white people. CTOs can involve very significant coercion and intrusion, and there is no evidence that they reduce the number of black people being sectioned. The Government have committed to ensure that any reduction in the use and duration of CTOs is matched by a reduction in disparities surrounding their application, but that is not a sufficient response to the level of racial disparity in the use of CTOs, and will not help to build trust and confidence of black communities in mental health services. I urge the Minister to look again and to ensure that reforms are fit for purpose, by removing racial disparity from the use of CTOs in mental health services.

I commend my hon. Friend the Member for Croydon North (Steve Reed) for his work to introduce the Mental Health Units (Use of Force) Act 2018 known as Seni’s law, in honour of Seni Lewis, who died while being restrained. It was passed in 2018 but has not yet been implemented. Will the Minister commit to expedite the implementation of Seni’s law, which is so important in reducing the use of restraint?

Finally, I want to raise two important issues on the reform of the Mental Health Act for children and young people. First, the Children and Young People’s Mental Health Coalition raised important concerns about the lack of data on children and young people admitted informally to inpatient facilities. There is currently no legal requirement for advocacy for informal patients. Although the White Paper recognises the importance of extending that right to them, it also states that

“this will create an additional burden for local authorities, and advocacy providers”,

and will

“therefore be subject to future funding decisions.”

Advocacy is rightly recognised as important enough to make it a statutory requirement. It is surely therefore important enough for the Government to fund it properly. Will the Minister make a commitment today to fund advocacy services for children and young people who are admitted as mental health in-patients, whether by a formal or informal route?

Secondly, it is absolutely vital that these reforms remove the routine use of out-of-area placements and placements in private hospitals for children and young people. Out-of-area placements are distressing for young patients and their families, limit access to vital support networks, make services less transparent, and are not conducive to good outcomes. Will the Minister confirm that there is a commitment to ensure that children and young people who need to be admitted to hospital for their mental health will be able to access a bed close to home?

These reforms are vital and long overdue. They are also complex and far reaching, and it is vital that the Government get this right. Reform of the Mental Health Act must work for everyone in our diverse communities, and it must work for children and young people. Involving and engaging a wide range of community stakeholders and people with lived experience of in-patient treatment and care in developing the reforms further and in the future design of services will help to ensure that these reforms are fit for purpose.