Theresa May pledges mental health revolution will reduce detentions

Theresa May will pledge to scrap the “flawed” Mental Health Act, warning that it has allowed the unnecessary detention of thousands of people and failed to deal with discrimination against ethnic minority patients.

In an attempt to meet her pledge to prioritise mental illness during her premiership, she will commit to ripping up the 30-year-old legislation and replace it with new laws designed to halt a steep rise in the number of people being detained. Increased thresholds for detention would be drawn up in a new mental health treatment bill to be unveiled soon after a Conservative victory. Mental health charities, clinicians and patients would be consulted on the new legislation.

While the announcement is likely to be welcomed by mental health campaigners, there will be warnings that a lack of resources, rather than badly drafted laws, has been the real driver of the increase in detention.

The overhaul is being described by the Conservatives as the biggest change to the law on mental health treatment in more than three decades.

“On my first day in Downing Street last July, I described shortfalls in mental health services as one of the burning injustices in our country,” May said. “It is abundantly clear to me that the discriminatory use of a law passed more than three decades ago is a key part of the reason for this.

“So today I am pledging to rip up the 1983 act and introduce in its place a new law which finally confronts the discrimination and unnecessary detention that takes place too often. We are going to roll out mental health support to every school in the country, ensure that mental health is taken far more seriously in the workplace, and raise standards of care.”

More than 63,000 people were detained under the Mental Health Act in 2014-15, an increase of 43% compared with 2005-06. Black people are also disproportionately affected – with a detention rate of 56.9 per 100 patients who spent time in hospital for mental illness. It compares with a rate of 37.5 per 100 among white patients.

In its last report on the act, the Care Quality Commission, the independent regulator of healthcare services, said it had “failings that may disempower patients, prevent people from exercising legal rights, and ultimately impede recovery or even amount to unlawful and unethical practice”.

The new legislation would include a code of practice aimed at reducing the disproportionate use of mental health detention for minority groups and countering “unconscious bias”. Safeguards would be introduced to end rules that mean those who are detained can be treated against their will. Those with the capacity to give or refuse consent would be able to do so.

The new bill would form part of a series of measures designed to improve mental health in schools and the workplace. However, ministers would face immediate questions over whether they were providing sufficient funding for their plans.

The Tories would commit to hiring 10,000 staff in the NHS by 2020. An insider said the plan would be funded from existing budgets, because mental health service funding will be up by £1.4bn in real terms by 2020.

The Equalities Act would also be altered to prevent workplace discrimination. Currently patients who have conditions such as depression, anxiety and bipolar disorder are only protected from discrimination if their condition is continuous for 12 months. That would be altered to take account of the fact that the conditions are often intermittent.

Every primary and secondary school in England and Wales would have staff trained in mental health first aid and be given a single point of contact with local mental health services. Children would be taught more about mental health, including keeping safe online and cyber-bullying.

Large companies would be required to train mental health first responders alongside traditional first aiders.

Theresa May pledges mental health revolution will reduce detentions

CQC to investigate as mental health detentions hit 10-year high

The health and social care watchdog is to launch an investigation after government figures revealed the number of detentions for mental health treatment had risen to its highest level in at least a decade.

Patients were detained in England for treatment under the provisions of the Mental Health Act 63,622 times in the year to April 2016, the statistics from NHS Digital showed, a rise of 47% since 2006, the year comparable records began, when there were 43,361 detentions.

Dr Paul Lelliott, the deputy chief inspector of hospitals and lead for mental health at the Care Quality Commission, said the figures were concerning, particularly given a national commitment to reduce the number of mental health detentions.

“The causes of the rise in the use of the act are likely to be complex, but the increase in detentions needs to be examined carefully,” he said. “We do not know, for example, the extent to which the rise is due to repeated detentions, it could signal a lack of support in the community for people with serious mental health problems or if people are being detained repeatedly, it could be a sign that some services are operating ‘revolving door’ admissions.

“To get to the bottom of this, we are launching an investigation into the reasons why detentions under the Mental Health Act in England continue to rise. We expect to publish our findings from this next year.”

Much of the rise in detentions came recently, with a 31% increase in the past five years, the statistics showed. Detentions under section two of the Mental Health Act, which allows for people to be held against their will for up to 28 days for diagnosis and treatment, were up 36% over that period. Detentions under section three, which allows for patients to be held for up to six months of compulsory treatment, were up 7%.

Marjorie Wallace of Sane says doctors are being forced to use the act to obtain an inpatient bed for treatment. Photograph: Richard Saker for the Observer

A snapshot figure, taken on 31 March, found 20,151 people were being detained under the act, 30% of whom were being held in private hospitals.

Peter Kinderman, the president of the British Psychology Society, said the figures were “tragic and shocking, but not terribly surprising”. Cuts to health budgets, combined with widening inequality, social turmoil and economic austerity were leading to an ever tighter squeeze on the poor, he said.

“If there are pressures on the service from cutting community support, various forms of psychotherapeutic support or social support for people, you could see how the pressures would build up and the people who are on the edge of coping might be pushed into feeling as if there was no support for them and feeling as if they might want to take their own lives,” said Kinderman.

“It doesn’t take much of a threat to social support for people in crisis for them to feel like there’s no point in carrying on living, and at that point you need to step in and take quite drastic action to help them.”

Marjorie Wallace, the chief executive of the mental health charity Sane, speculated that the rise could be the result of situations where patients or their doctors felt detention was the only way to get proper mental health treatment. “We know that community mental health services are overstretched and in many cases unable to provide the early treatment that could prevent people becoming so desperately ill,” she said.

“Moreover, without available local psychiatric beds, doctors are being forced to use the act in order to obtain an inpatient bed for treatment, which may involve sending patients to unfamiliar hospitals where they cannot be easily visited by professionals they know, let alone their friends and family. It is a scandal that you have to be sectioned in order to get treatment. What we need is more rather than fewer beds, so that those who need sanctuary and healing can receive help without having to be deprived of their liberty.”

A Department of Health spokesperson said: “People with mental illness need the best possible care and local areas are investing £693m more to make sure the right services are in place. Decisions about detention under the Mental Health Act are clinically led but the Care Quality Commission will be looking into the rise in cases.”

CQC to investigate as mental health detentions hit 10-year high