The King’s speech yesterday did not include any mention of the reform of the mental health act, despite this being a key manifesto commitment from the Conservative party. So how has the mental health sector responded?
Delivered every year, a ceremonial address takes place in the Lords Chamber in the Palace of Westminster. This speech, delivered by the monarch, is part of the state opening of Parliament. The speech, which despite its name, is not actually written by the King, sets out the programme of legislation that the government intend to pursue over the next year.
This year’s speech was particularly notable, not just because it was the first King’s speech delivered in over 70 years, but because it laid out the priorities that Prime Minister Rishi Sunak intends to fight the next general election with.
So why have so many mental health charities and leaders in the mental health sector reacted with dismay at the speech?
It’s about what was left out, not what was kept in.
Despite making reform of the mental health act a manifesto commitment in both 2017 and 2019, the Draft Mental Health Bill has stalled on its way through Parliament. The King’s speech would have been a chance for the Conservative government to reaffirm its commitment to improving mental health care in the UK. Instead, by leaving it out, the government has effectively reneged on its manifesto promise.
This is especially frustrating as much of the work to reform the bill has already been done. The reforms that are outlined in the draft mental health bill (The legislation which has to be passed by Parliament in order to reform the existing Mental Health Act) include:
- Improving choice and autonomy for service users, including introducing Advance Choice Documents.
- Treating people as individuals including respecting wishes and preferences.
- Ensuring that detainment, or sectioning, is considered a last resort with an emphasis on therapeutic benefit.
- Improving care for autistic individuals or people with learning disabilities.
Anger, dismay and demand for change
Charities and leaders in the mental health sector have reacted strongly to the government’s de-prioritisation of mental health.
The Children and Young Peoples Mental Health Coalition are a coalition of leading organisations from across England who speak as on on behalf of children and young people's mental health.
The CYPMHC published a statement, signed by 61 leaders, including MQ.
For too long, the Mental Health Act has failed people who require mental health care and reforms are long overdue. Inequalities in the disproportionate use of detentions, high levels of restraint – particularly experienced by children and young people – and the removal of patient autonomy are just some of the problems with the Act in its current form.
As a sector, we are increasingly concerned that mental health is no longer a political priority. With the loss of the ten-year mental health plan earlier this year, the promise to reform the Mental Health Act is yet another commitment abandoned by this Government. Sadly, it is children, young people and their families that are most impacted by these failed promises.
You can read the full statement here.
The Centre for Mental health are a charity challenging policies, systems and society, so that everyone can have better mental health.
They do this by building research evidence to create fairer mental health policy and driving forward sustainable policy change, to pursue equality, social justice and good mental health for all.
Andy Bell, Chief Executive for the Centre for Mental Health, said that abandoning the mental health act reform is a government breach of public trust.
““It is now seven years since the Government committed to modernising the Mental Health Act. Despite a comprehensive review of the Act published back in 2018, and the Government’s 2019 manifesto pledge to reform it, it is now clear that vital legislative changes will not happen in this Parliament. This represents a major breach of trust to the many people who have experienced the Act first-hand and campaigned for essential reforms.”
You can read the full statement on the Centre for Mental Health’s website here.
The charity Mind published a statement on their website and Mind’s chief executive, Dr Sarah Hughes, said:
“The long overdue Mental Health Bill is a chance to overhaul the way the system works when people are in a mental health crisis. It is an opportunity to address the deep racial injustices in the use of the Act, with Black people being four times more likely to be detained. It is also a crucial chance to prevent people being stripped of their dignity, voice and independence when they are sectioned.
That chance has now been missed, and the UK government has broken its promise to thousands of people, their loved ones and the nation as a whole to reform the Act.
“This is further evidence of how little regard the current UK government has for mental health. More than 50,000 people were held under the Mental Health Act last year, so it is incomprehensible that legislation which would help people at their most unwell has been de-prioritised.
There could not be a worse time to abandon this bill, especially given the recent string of exposés revealing unsafe mental health care across the country.”
The Race Equality Foundation is a national charity tackling racial inequality in public services to improve the lives of Black, Asian and minority ethnic communities.
Jabeer Butt, the Chief Executive for the Race Equality Foundation reiterated exactly why the reform was needed.
“Reforming outdated mental health laws should have been a top priority. Inadequate healthcare disproportionately affects Black, Asian and ethnic minority people. This is a real lost opportunity to have significantly improved millions of people’s lives and reduced inequality.”
The current mental health act has led to disproportionate involuntary detention of black and ethnic minority people, which is why the long-awaited reforms have been so imperative.
You can read their full statement here.
The proposed reforms to the bill would not just have improved care and mental health outcomes for ethnic minorities but for neurodiverse people with mental illnesses too.
The National Autistic Society is a charity working to transform lives and change attitudes to help create a society that works for autistic people.
Tim Nicholls, Head of Influencing and Research at the National Autistic Society said in a statement on their website:
“The Government has ignored the thousands of us calling for reform, so our mental health laws are fit for the 21st century. We do not understand why it is not worth parliamentary time to change the law so that autism can no longer be a reason to section someone.
"There are 2,045 autistic people and people with learning disabilities in mental health hospitals in England - and 65% are autistic people. Hospitals are often miles away from families and the average length of stay is more than five years. We hear alarming reports of people being overmedicated, pinned down and shut away in isolation in these settings, often with devastating consequences.
Reforming the Mental Health Act needed to be a key step towards ending this crisis.”
Rethink Mental Illness’s Chief Executive Mark Winstanley said in a statement on Rethink’s website:
“The failure to introduce a Mental Health Bill is a profound betrayal to people that have been detained under the Mental Health Act and everyone who has campaigned for decades to reform it. It is difficult not to conclude that the march of progress to prioritise the nation’s mental health and challenge the stigma of mental illness has stalled. What makes this decision even harder to swallow is that reform had been mapped out and agreed in draft legislation and has cross-party support.
Now forty years old, the legislation has failed to keep pace with the world we live in, and the need to protect people while respecting their wishes and dignity."
Dr Lade Smith CBE, president of the Royal College of Psychiatrists said in a statement on the RCP website:
"As feared, reform of the Mental Health Act was not included in the King’s speech – which means it will not be achieved before the next General Election, despite being promised by this Government in its last manifesto.
"We have seen no action from Government to tackle the underlying causes of rising detentions under the Mental Health Act. These continue to rise at an unacceptable rate, with people from Black and racialised communities facing hugely disproportionate rates of detention.
“In the absence of this vital reform, the College will continue to work with Government, NHS and patient groups to promote the dignity, autonomy and human rights of people subject to the Act, while also pushing for the legislation to be introduced at the earliest opportunity.
Government has also failed to move forward any plans to ban conversion practices for LGBTQ+ people. Conversion practices can cause severe physical and psychological suffering and violate the human rights of LGBTQ+ people. Legislation must be introduced to address this as a matter of urgency.”
Dr Smith did however note that despite the disappointment of the exclusion of the reform of the mental health act, there were some positives for mental health in the speech.
“Given the enormous negative impact on mental health, we welcome the focus on easing the cost-of-living crisis, increasing economic growth and safeguarding the health and security of the British people.
“There are 1.35million people out of work with a mental illness and a record 1.4 million people are now on waiting lists for NHS mental health services. Seventy-five percent of mental illness arise before the age of 24-years. Much of this is avoidable and can be effectively treated if caught early.”
So why wasn’t the reform of the mental health act included in the speech?
The simple answer is the current Government do not view improving mental health care as a key priority. This de-prioritisation of mental health is reflected not only in allowing the progress of the Draft Mental Health bill (The law which will reform the existing mental health act) to stall on its way through Parliament and not including any mention of it in the King’s speech. But also in a policy change made earlier this year.
In January, the government announced that the long awaited 10-year mental health strategy was being abandoned and instead replaced with a broader ‘Major conditions strategy’. This new strategy, which has yet to be implemented, included ‘mental illness’ as a broad term alongside other more specific physical health issues such as cancer, heart disease and respiratory issues.
It is also likely that with only a year or so left of his current term in office, Rishi Sunak has wanted to focus on ‘quick wins’. On legislation and policies that he knows he can implement quickly before the election. But not pushing forward the reform of the mental health act, which has cross party support, and for which all of the hard work has already been done, he and his government are missing an opportunity to create real, tangible change for the 1 in 4 people impacted by mental illness.
This is why MQ is joining the call from the Centre for Mental Health and 35 other charities for all political parties to include mental health as a key priority in their election manifestos to create a mentally healthier nation. Read more here.
