The long-awaited Mental Health Bill aims to modernise mental health legislation, ensuring that patients receive more dignified and respectful treatment. Recent amendments have considerable implications for people with learning disabilities and autistic people.
According to the National Autistic Society there are approximately 2,035 people with learning disabilities and autistic people detained in inpatient mental health hospitals in England (June 2023). Of these, 64% are autistic. Among under 18s in inpatient units, autistic people represent 93%.
The average length of stay for these groups is around 5.4 years, with some detained for over 20 years.
Proposed changes seek to address long-standing issues of inappropriate detention and inadequate care. They should ensure that these groups of people receive the support they need in a more suitable environment.
Key changes in the bill
- Exclusion from Section 3 detention: People with learning disabilities or autistic people can no longer be detained under Section 3 of the Mental Health Act solely based on their condition. It will now require a co-occurring mental health condition.
- Community-based support: The bill emphasises the need for robust community-based services to prevent crises that lead to detention. With provision of early intervention and appropriate support within the community, the need for hospital admissions should be reduced.
- Care and Treatment Reviews: Statutory Care and Treatment Reviews (CTRs) are to be introduced so that people with learning disabilities and autistic people receive the right support and are not detained unnecessarily. CTRs will be mandatory and enforceable, helping to facilitate timely discharges from hospitals.
Co-occurring conditions
Under the proposed amendments people with learning disabilities or autistic people can be detained under Section 2 of the Mental Health Act if they have a co-occurring psychiatric disorder that requires hospital treatment.
This detention would be for up to 28 days, intended for assessment and short-term treatment. For longer-term treatment, they can be detained under Section 3 for up to six months, which can be renewed.
Personal stories
Achieve together is supporting many autistic people previously detained under the Mental Health Act to thrive. Their discharge from hospital follows the Transforming Care Programme and Building the Right Support.
This has been achieved with oversight from our Positive Behaviour Support (PBS) Practitioner Team, a focus on skill development and minimising restrictions on the person’s life.
Read some of their Success Stories.
Timeline
The bill is currently being considered by the House of Lords. It will likely move to the House of Commons in early- to mid-2025. The Act will become law once Royal Assent is given which could be from the middle to the end of next year.
Implementation will be phased while services prepare for the changes for example training and creating new guidelines. A timeline of 5 -10 years for this is possible for effective delivery.
Sector feedback
National Autistic Society: Head of Influencing and Research, Tim Nicholls, stated: “This is one of the greatest human rights crises of our generation – and it must end now. Autism is not a mental health condition, and mental health hospitals are not the right place for the vast majority of autistic people. The trauma caused to those who are wrongly detained in hospitals is unimaginable.”
Mencap: Dan Scorer, Head of Policy and Public Affairs, emphasised: “It is unacceptable that in the 21st century, the law allows for people with a learning disability and autistic people to be locked up in mental health hospitals for years on end when they don’t have a mental health condition. We need to see investment in early intervention and better community support to prevent admission in the first place.”
Community support
Director of Wellbeing, Strategy and Collaboration, Michael Fullerton, commented: “This bill should offer greater protection to people with learning disabilities and autistic people, and ensure fewer people are detained inappropriately and for lengthy periods of time.
“Critical to success will be the strength and capacity of community support across the country. Social care as it stands is underfunded. Sadly, there is no indication of when the government intends to look at reform. The changes proposed are reliant on community services being strong to support people well, reducing hospital admissions and making discharge possible.
“With the budget announcement of additional National Insurance Contributions and other costs to social care providers community support could be at risk. Therefore, the Mental Health Act reforms may suggest greater protection for people with learning disabilities and autistic people but if social care itself is vulnerable, that will maintain vulnerability for those that rely on it.”
