As many of the most mainstream mental health, autism, and learning disability charities praise the new Mental Health Bill – reforming the 1983 Mental Health Act – going to the House of Lords this week, it feels like there should be true cause for celebration in a way that many psychiatric survivors may not be experiencing.
Of course, there are aspects of the proposed reforms that are extremely important changes if they are done well – people in mental health crises should not be held in cells, and families and carers should have more rights and greater involvement. Most of the reform bill looks good on paper – but does it begin to go far enough?
Should the Mental Health Act reforms be celebrated?
There are currently 2,020 Autistic people and people with learning disabilities in inpatient mental health hospitals in England, with the average stay at 4.8 years (via National Autistic Society & NHS Digital). Many will be held unnecessarily or in inappropriate settings, and it is severely evident that something needs to be done.
However, it is also clear that the Mental Health Act reforms are likely not going to fix the issues at hand.
As an Autistic ex-inpatient, I should in theory be celebrating the changes to the reasons and ways Autistic people and people with a learning disability can be detained.
But is it right to celebrate that we will not be able to be detained long-term on the basis of our autism or learning disability, when we can be if we have a co-occurring mental health condition?
Why is it that it is still seen as appropriate to detain in inappropriate settings if someone has other mental health needs? And what about the thousands of people whose autism has gone undiagnosed (and often stays so throughout an inpatient stay), or who are misdiagnosed with a personality disorder?
It is extremely difficult to agree that this reform actually changes much for Autistic people or people with a learning disability when psychiatric spaces are so extremely hostile as a sensory and social environment – and even a 28 day section (section 2) can be a cause of severe trauma, let alone considering those who will still be held long-term.
Most units are extremely bright, loud, and do not have enough staff training on autism or learning disabilities to support us. We are more likely to experience physical or chemical restraint and seclusion due to biases and misunderstandings about our needs and communication.
Ignoring the real issues, here
Jon Sparkes, the Chief Executive of Mencap, said in their press release that the reforms are key to “placing new duties on commissioners to ensure the right community support is developed” – but there is little to no mention of community support in the release from the Department of Health and Social Care, especially concerning autism and learning disabilities.
Many reach crisis point because they have been consistently failed and unsupported, and there feels like there are no moves being made to change these inequalities in the home, in schools, or in communities.
Psychiatric units are not not set up to be spaces for proper recovery, they are for holding and policing. Incarceration often causes trauma and iatrogenic harm (harm experienced by patients during medical care) is rife, seen by many as part and parcel of the experience.
Many psychiatric units in the UK have little to no therapies or recovery-focused support in them, showing the lack of care for real recovery over simply holding people – and there’s no real notion that this would change under the reforms.
These are spaces with huge power structure issues, where levels of restraint, seclusion, and overmedication are extremely high, particularly amongst marginalised communities including Black people and Autistic people.
Although inequalities Black people face have been mentioned as an issue – being over three times more likely to be detained and 11 times more likely to receive Community Treatment Orders – there has been little to no discussion of what is actually being done around this as part of the reforms.
Little on community-based care
The way that the Mental Health Act and its potential reforms are about detainment and psychiatric inpatient care means changes are being made in a bubble not accounting for the significant lacking we see in community care.
Although there has been some commitment to crisis care in the budget, the National Survivor User Network notes how little notion we have of how this would look, and there is still little to no attention to preventative care, recovery-based support, or long-term community needs.
How do we truly change how mental health care looks when someone has to fall into crisis to get anywhere?
As an ex-inpatient I have spent years advocating for people to stop being unnecessarily detained or placed in psychiatric settings, but I have learnt that there are so few alternatives set up, and if hospital is inappropriate, people are abandoned and left to fall further into crisis.
We often see imprisonment, deaths by suicide, and families struggling to cope, ultimately begging for something, anything that would give them some support. Keeping people out of hospital is only the beginning, but it is seen by much of the system as the job complete.
We can pretend the Mental Health Act reforms will be enough, if you want
You cannot make it part of the law that all patients must have a proper care and treatment plan without committing to significant new levels of funding, nor can you when you are not doing anything to change the staffing crisis.
You cannot say that mental health patients will not be held in police cells when so many biases around addiction, psychosis, and ‘suspicious behaviour’ exist.
You cannot stop detaining Autistic people but not increase funding for sensory support, bespoke care, or neurodiversity-affirming supported living.
In the official press release about the reforms, Claire Murdoch, NHS national mental health director, said that this reform is a “once in a generation opportunity”.
If that is the case, it must go further and do more for psychiatric patients and survivors.
There must be a proper commitment to funding the changes, or this will be another set of reforms that never manifest themselves, with inequalities perpetuated for decades to come.
We can pretend that the reforms will be enough – but where is the true care for dignity or human rights?
Where is the real commitment to not leaving people locked up?
Featured image via the Canary
