Poulter: My disappointment at Government on mental health

It’s an undeniably complex, emotive topic which has for decades challenged Governments, and last month, a full year after I published a report together with other MPs into how the mental health system could be improved, the Government gave their response. 

As a practising NHS consultant psychiatrist who has served on committees holding the government to account over this issue, I have long stated publicly that our mental health laws need to be updated.

So much more needs to be done to help mental health patients, says Dr Dan Poulter

A glance at the Mental Health Act 1983, which as its title suggests is now over 40 years old, highlights some of the challenges we face.

Given the big changes during those decades, not to mention the societal shifts in attitudes to mental health over the same period, it is plain for all to see that mental health legislation is in urgent need of modernisation.

It was with great optimism in 2022 that I joined the Joint House of Commons and House of Lords Committee on the Draft Mental Health Bill, established to unite parliamentarians with relevant expertise to investigate how much-needed changes to mental health lawmaking could be shaped and implemented. 

The process was collaborative and gathered evidence from a wide array of clinical experts alongside individuals and organisations operating throughout the healthcare sector.

Once all information was collated and absorbed, the committee published its proposals in pursuit of wide-reaching alterations that were only ever intended to be a starting point for continued updates in the years ahead.

The motivation behind this was never ideological; it has always been rooted in the fact that patients are too often denied the standard of care they deserve, in addition to the recognition of long-running inequalities woven into an outdated policy framework. 

Among the committee’s key recommendations were measures to address the unfairness experienced in the mental health care system by certain groups in our communities. 

For example, we need to understand why Black people are four times more likely to be detained under the Mental Health Act than white people, and 11 times more likely to be given a community treatment order.

It is unacceptable that currently, too many autistic people and those with learning disabilities are detained in inappropriate mental health facilities and for excessively long periods of time. 

Our committee also sought to introduce amendments to existing legislation to improve patient choices regarding their care and to safeguard individuals from criminalisation as a result of a severe mental illness. 

When considering the timing of this review, it is important to note that the urgency with which legislative advancements are required has ramped up significantly since the Covid-19 pandemic.

The number of children and young people experiencing mental distress since the lockdowns earlier this decade is a particular cause for concern, especially when this can mean they end up on adult wards or in hospitals far from home due to the lack of appropriate care placements. 

What our committee called for was extensive, urgent modernisation. 

55 recommendations were put forward for government consideration and the responses to each and every proposal have now been returned. What was delivered – nothing of substance to date – has, in truth, left me very disappointed. 

What I worry about is the idea that some recommendations may now end up debated again for months and years ahead, when we as a nation do not have the luxury of time to mull over these critical issues.

It is not just time being wasted.

Government projections suggest mental health expenditure this year will be around £14.8 billion. As people working in or using any part of the NHS will tell you, throwing money at the health service will not instantly solve its problems and we need to reform and transform the services that we deliver to patients. 

Ensuring public money is spent wisely is always of paramount importance in delivering our public services, especially in healthcare. Fundamentals of this have to be the consistent, unbiased prioritisation of patient care and a commitment to taking onboard feedback from experts in their field regarding how to shape future policy.

While I fear a partial acceptance of our committee’s recommendations, without meaningful delivery of proposed reforms, represents an opportunity missed for this government to achieve something truly transformative on mental health.

Nevertheless, it is undoubtedly most distressing for those requiring mental health care right now who are all too often contending with a system which needs to modernise and transform its care for patients.