A commissioner should be appointed to oversee reforms to mental health and monitor their implementation and impact, parliamentarians said.
MPs and peers called for the Government to strengthen its draft Mental Health Bill to address rising numbers of people being detained under the current law, and tackle "unacceptable and inexcusable" failures on racial inequalities.
Proposed legislation was published in June 2022 in response to an independent review of the 1983 Mental Health Act. Chaired by Professor Sir Simon Wessely, the review found a rise in the number of detentions under the Act, a disproportionate increase in the number of detainees from Black backgrounds, and a tendency to treat people detained as criminals.
The Joint Committee on the Draft Mental Health Bill welcomed planned reforms but after "extensive hearings" called for further changes to bolster patients' rights. Some of the "starkest" examples of racial disparity involved community treatment orders, where use was around 11 times higher for black and ethnic minority patients compared with white individuals, and Committee members recommended early abolition for people detained under part II of the Act and a statutory review after 3 years of their use under part III, for people involved in criminal proceedings or under sentence.
The Joint Committee welcomed plans to end the "inappropriate" long-term detention of people with learning disabilities or autism but called for stronger safeguards and duties on commissioning bodies to prevent more detentions under legal powers outside the scope of the Mental Health Act.
Community Care Shortage
Members of the Committee also warned that shortages in community care provision had the potential to derail reforms and could lead to worse outcomes for people with autism and learning disabilities.
Baroness Buscombe, who chaired the Committee, said: "To drive reform, we urge the creation of a new Mental Health Commissioner to monitor the implementation of the Bill and to speak up for patients, families, and carers."
She added: "We believe stronger measures are needed to bring about change, in particular to tackle racial disparity in the use of the Mental Health Act. The failure to date is unacceptable and inexcusable. The Government should strengthen its proposal on advanced choice and give patients a statutory right to request an advance choice document setting out their preferences for future care and treatment, thereby strengthening both patient choice and their voice."
Additionally, the Government should publish a comprehensive implementation and workforce plan alongside the Bill with clear actions and milestones, and pledge to report annually to Parliament on progress, the Committee report said.
Reaction to the Findings
Responding to the report, Sarah Hughes, chief Executive of Mind, welcomed the proposal for a commissioner who could act as "a powerful advocate for patients' rights". She said: "For decades, people sectioned under the Mental Health Act 1983 have been at the back of the queue when it comes to effective planning and funding. In recent months, we've seen a wave of whistleblowing stories raising the alarm on alleged abuse and neglect of people living on mental health wards around the country. These accounts demonstrate the urgent need for wholesale reform to the Mental Health Act and crisis care settings."
Mencap noted that currently around 2000 people with a learning disability or autism were in detention because of inadequate community care. Dan Scorer, head of policy and public affairs at the charity, said: "We need adequate funding and accountability for local authorities and Integrated Care Boards to build the community services that are so urgently needed."
A Department of Health and Social Care spokesperson said: "We welcome the Committee's support for the aims of the Government's draft Mental Health Bill to bring about long overdue mental health reform. We are taking action to address the unequal treatment of people from Black and other ethnic minority backgrounds with mental illness – including by tightening the criteria under which people can be detained and subject to Community Treatment Orders.
"The government will now review the Committee's recommendations and respond in due course."
