Review of the Mental Health Act 1983

The announcement by Theresa May that there would be a review of the Mental Health Act 1983 (MHA) was somewhat unexpected. The review was chaired by Professor Sir Simon Wessely and completed in December 2018 (DHSC, 2018). The review process included a series of stakeholder events and examining literature and other research to explore key themes that emerged. Theresa May was explicit in identifying the crisis in mental health care as an issue of social injustice – while at the same time not making any links between broader social policy developments and their impacts (Cummins, 2018).

In his foreword to the final report, Simon Wessely outlines the case for change. One of the fundamental drivers of the review was the increasing rate of detentions under the MHA. Within mental health services there have been long-standing concerns about the processes of admission under the MHA and patients’ experiences on inpatient units. The review notes that the patient's voice is often lost or ignored within mental health services and services being experienced as bureaucratic, uncaring and coercive. The review was also charged with addressing the long-standing over-representation of people from black and minority ethnic groups who are detained under the MHA. The experiences of people with learning disabilities and or autism within mental health services were also examined. Finally, there were concerns that the current mental health legislation in England and Wales did not comply with international standards on human rights. None of these issues is new. There are several echoes from New Labour's review of mental health law 20 years previously.

The review reports that there were 49,551 detentions under the MHA in 2017/18, excluding short-term orders such as Section 5(2) (DHSC, 2018: 44). There was a 40% increase in detentions in the period 2005/06 to 2015/16. Black people were four times more likely than white people to be detained under the MHA. The risks of black patients, particularly young men, of being subject to community treatment orders (CTOs) were also noted. Black people were eight time more likely to be subject to a CTO than their white fellow citizens.