Mental Health Act 1983 document image on purple background

Important changes to the Mental Health Act in England and Wales have been recommended today, with the publication of the Independent Review of the Mental Health Act

The recommendations to the Government include the introduction of new rights to challenge detention and a new duty on decision-makers to have the right services locally. These changes, if implemented, could help many autistic people get better mental health support. And they could mean that fewer autistic people are admitted to inappropriate mental health hospitals. 

But we are disappointed that these changes don’t go further, to stop autistic people being inappropriately detained under the Mental Health Act.

In autumn 2017, the Prime Minister announced that she was appointing Professor Simon Wessely to lead an independent review of the Mental Health Act. We welcomed this move. For many years, our charity has been calling for changes to be made to the Act (including in this recent blog), to make it better reflect the needs of autistic people. Today, the review has published, setting out recommendations to change the Act.

Our main concern is the Act’s definition of “mental disorder”, which includes autism. We are clear about this: autism is not a mental health condition and it is inappropriate for autism to be included in the definition in this way. In 2015, the Government committed to looking at this. We are bitterly disappointed that the review published today has not recommended a change. 

It does say that the Government should keep this under review. We strongly believe that the Government should complete a review urgently, because of the increasing numbers of autistic people reported in mental health hospitals.

What else is recommended?

There are a lot of good things in the review too, many of which we and other organisations and individuals have been campaigning for, including:

- Introducing a specific duty on health and social care commissioners to ensure there is community based support for autistic people and people with a learning disability. This is really important, because it is often a lack of community services that lead to autistic people hitting crisis and being detained. This duty would mean those community services have to be available.

- A change to the “detention criteria”. This means that for someone to be detained, there will need to be a “substantial risk” of “significant harm”. This would need to be documented and there would need to be evidence of it. We hope that this would lead to fewer autistic people being detained and the report highlights that this could in particular stop the “warehousing” of autistic patients.

- Requiring clinicians to follow National Institute for Health and Care Excellence (NICE) guidelines more closely. Again, this specifically mentions autism. This is important, because NICE guidelines include important information about adapting mental health therapies and avoiding psychotropic medication.

- Making Care and Treatment Reviews (CTRs) part of the Mental Health Act. CTRs are held by clinicians, other professionals responsible for people’s care and can help autistic people in mental health hospitals get discharged sooner. But too often recommendations from CTRs aren’t followed. If given statutory force, Mental Health Tribunals would be able to rely on them more. This could help people get out of hospital sooner.

- Improving data collection about why an autistic person has been detained under the Act. This will help identify what is happening, so that national and local commissioners can identify what changes need to be made to mental health services to ensure autistic people get the care and treatment they need and that they are not detained or treated inappropriately.

What happens next?

At this stage, these are just recommendations. To become the law, the Government needs to propose specific changes to the Mental Health Act and they would need to be voted for by Parliament. There are many recommendations in the report and we strongly believe that the Government should adopt them. But they must show leadership by looking at the definition of “mental disorder”. This is a very complex subject and a decision should be properly considered. So we believe the Government should bring together autistic people, professionals, and organisations to specifically decide what changes should be made on this issue. This shouldn’t be kicked into the long grass again. 

Jane Harris, Director of External Affairs at the National Autistic Society, said: "We welcome the review's recommendations to: strengthen people's right to challenge their detention; put care and treatment reviews on a statutory footing; give people greater rights to choose who in their personal life they want involved in their care; and set out the NHS and local councils' duties to create more community-based services for autistic people. These changes will improve autistic people's chances of getting out of inappropriate inpatient care more quickly.

“But we and many autistic people and their families are bitterly disappointed by the review's failure to recommend changing the definition of mental disorder. It is absolutely wrong that this includes autism as fundamentally autism isn't a mental disorder, it is a lifelong disability. 

“The Government promised to review the definition in November 2015 and it needs to fulfil this promise urgently. Until this changes autistic people will continue to suffer from inappropriate treatment by professionals who don't understand them and the kind of support they need."

What you can do

Please sign this petition on the Parliament website that we are supporting, calling for an end to the detention of people who are autistic or have a learning disability in mental health hospitals.

Further information

  • For information about what to do if an autistic family member is at risk or has been admitted to or discharged from a mental health hospital, visit our page on autism and mental health.
  • Bringing us Together have produced this very useful Survival Guide for care and treatment reviews.
  • Read our Transforming Care: our stories and Beyond Transforming Care reports, which explore the scandal of autistic people being left behind in mental health hospitals.
  • Please sign this petition on the Parliament website, calling for an end to the detention of people who are autistic or have a learning disability in mental health hospitals.
  • Read our recent blog, setting out what’s wrong with mental health hospitals and what we can all do to support the vital campaigns to change this unacceptable situation.