Mental Health Act reform - impacts on autistic people and people with a learning disability

DOI: https://doi.org/10.58248/PN722

The Mental Health Act 1983 legislates for the compulsory detention and treatment of people with a mental disorder in England and Wales. The legislation is undergoing a process of reform to reduce the disproportionate detention of people from ethnic minorities, improve patient choice and autonomy, and modernise the Act. A timeline of the main events in the reform process is presented below, and a more detailed summary is available in the Commons Library briefing on Reforming the Mental Health Act.

The Government commissioned an Independent Review of the Mental Health Act, which reported in 2018. Its recommendations centred on four principles: choice and autonomy; least restriction; therapeutic benefit; and the person as an individual.

A Joint Committee on the draft Mental Health Bill was established in July 2022 to scrutinise the draft Bill. The Committee published a report with its recommendations to Government in January 2023. The Government published its response in March 2024.

This POSTnote highlights research evidence and stakeholder perspectives on how autistic people and people with a learning disability may be affected by proposed reforms. It complements three other POSTnotes which deal with other aspects of reform: Mental Health Act Reform – Approaches to Improve Patient Choice, Mental Health Act Reform – Race and Ethnic Inequalities, and Mental Health Act Reform – Impacts on Children and Young People.

As healthcare policy is devolved, the reforms described here apply only to England and Wales.

• Under the Mental Health Act 1983 (England and Wales) people can be detained if they are at risk of harming themselves or others due to a “mental disorder”. This term is currently defined to include learning disability and autism, although these are not mental health conditions.
• Some people with these conditions detained under the Act have experienced inappropriate care, a lack of specialised services tailored to their needs, overuse of restraints, over-medication, and extended periods of detention.
• After an independent review of the Act in 2018, the Government introduced a draft Mental Health Bill in 2022 to modernise the Act and reduce detentions. The Bill proposed to remove autism and learning disability as criteria for Section 3 detention in the absence of a co-occurring mental health condition.
• Pre-legislative scrutiny of the draft Bill identified potential unintended consequences of this change without extra investment in community support, including the risk of increased rates of detention under different legal powers.
• Stakeholders have raised concerns over the current shortage of community-based services which would otherwise help autistic people and people with learning disability to avoid crisis, and detention under the Act.
• International comparisons demonstrate substantial variation in legal provisions for autism and learning disability.
• In March 2024 the Government stated that it would introduce a revised Bill "when parliamentary time allows".

September 1998 - November 1999: The Government commissions a review of the Mental Health Act 1983 led by Professor Genevra Richardson, to examine how treatment under compulsion can be provided in the least restrictive environment.

July 2007: The Mental Health Act 2007 receives Royal Assent, amending the 1983 Act but preserving most of the existing law. Mental disorder is redefined to include a wider group of people.

October 2017 - December 2018: In response to rising detention rates and disproportionate detention of people from minority ethnic groups, the Government commissions the Independent Review of the Mental Health Act, chaired by Professor Sir Simon Wessely. The review publishes a report examining the causes of rising and unequal detention rates, and recommending ways to modernise the mental health care system.

January - August 2021: The Government publishes a white paper, ‘Reforming the Mental Health Act’, which includes most of the recommendations from the Independent Review. The Government runs a 14-week consultation to determine the likely impact of these reforms and to canvass recommendations for their implementation.

June - July 2022: The Government publishes the draft Mental Health Bill, and a Joint Committee is established for pre-legislative scrutiny.

July - January 2023: The Joint Committee on the Draft Mental Health Bill takes evidence, and publishes its report with additional recommendations for strengthening the Bill.

November 2023: The King’s Speech does not include a mental health bill, effectively halting the legislative reform process until the next parliament.

March 2024: The Government publishes its response to the Joint Committee report. The Government states its intention to introduce a revised bill “when Parliamentary time allows”.

POST is grateful to Dr Dugald Foster for researching this briefing, to the Nuffield Foundation for funding his parliamentary fellowship, to Carl Baker for creating the figure, and to all contributors and reviewers. For further information on this subject, please contact the co-author, Dr Sarah Bunn.

POSTnotes are based on literature reviews and interviews with a range of stakeholders and are externally peer-reviewed. POST would like to thank interviewees and peer reviewers for kindly giving up their time during the preparation of this briefing, including:

• Members of the POST Board*
• Professor Regi Alexander, University of Hertfordshire and Royal Society of Medicine
• Professor Clare Allely, University of Salford
• Andy Bell, Centre for Mental Health*
• The Challenging Behaviour Foundation*
• Professor Gavin Davidson, Queen's University Belfast*
• Department of Health and Social Care*
• Dr Helen Gilburt, The King’s Fund
• Professor Angela Hassiotis, University College London*
• Stephen Hinchley, VoiceAbility*
• Elaine James, Bradford Metropolitan District Council
• Professor Judith Laing, University of Bristol*
• Professor Peter Langdon, University of Warwick*
• Mencap*
• NHS England*
• Dr Gareth Owen, King’s College London and Royal College of Psychiatrists*
• Alex Ruck Keene KC, 39 Essex Chambers and King’s College London*
• Dr Lucy Series, University of Bristol*
• Professor Jill Stavert, Edinburgh Napier University
• Professor Vaso Totsika, University College London*

*denotes people and organisations who acted as external reviewers of the briefing.