Mental health detention – UK Government assessment

The UK Government has committed to introducing a new Mental Health Bill and implementing new laws to prevent the use of force in mental health units. However, detention rates remain high, particularly for Black people, and the use of restraint is widespread. The UK Government has repeatedly missed targets to reduce the use of inpatient care for people with autism and those with learning disabilities, and there is evidence of poor treatment and abuse in these settings. The coronavirus (COVID-19) pandemic has exacerbated the overall rates of poor mental health and reduced important safeguards in mental health detention.

• Overall detentions under the Mental Health Act (MHA) continue to rise. There were almost 51,000 recorded detentions under the MHA in England in 2019–20, higher than the previous two years, although the actual total will be higher as not all providers submit data.
• Evidence shows that Black people are more than four times as likely to be detained under the MHA than White people, and more than 10 times as likely to be subject to a community treatment order. People living in the most deprived areas are approximately three and a half times more likely to be detained than those in the least deprived areas.
• Evidence suggests many people in mental health detention are unaware of their rights, and are not involved in planning their own care.
• The UK Government’s white paper on reforming the MHA includes a number of proposals to improve choice and control, which, if properly implemented and resourced, could lead to a significantly more human-rights focused approach.
• The UK Government has failed to meet targets to reduce the use of inpatient care for people with autism and those with learning disabilities. In August 2021, there were still at least 2,040 people in inpatient units in England and 56% of them had been detained for over two years, often far from home. The UK Government has established a minister-led delivery board to oversee progress and committed to publishing a detailed action plan.
• The House of Commons Health and Social Care Committee and Joint Committee on Human Rights have both criticised the UK Government regarding the poor treatment of people with learning disabilities and/or autism in inpatient settings. An independent review published in July 2021 concluded that there are “several systemic barriers delaying discharge”.
• The use of restraint in mental health detention remains high, particularly on people with learning disabilities and/or autism, and disproportionately affects people from Black and other ethnic minority groups and women and girls.
• The Care Quality Commission’s report on the use of restraint, seclusion and segregation found evidence of blanket restrictions and inappropriate restrictive practices.
• The Mental Health Units (Use of Force) Act 2018, which includes measures intended to reduce the use of restraint and improve accountability in mental health settings, has not yet been commenced, though the UK Government has announced it will be implemented in November 2021.
• Emergency legislation and guidance during the COVID-19 pandemic allowed for the possibility of reduced safeguards on detention. A suggestion in the guidance that people could be detained on the basis of remote assessments was held to be unlawful and the relevant section was then withdrawn.
• At the start of the COVID-19 pandemic, the drive to reduce inpatient numbers sometimes led to people being discharged with unsafe or incomplete care plans.