Connecting the dots: tackling mental health inequalities in Wales
This is the eighth chapter of the Health and Social Care Committee ‘Connecting the dots: tackling mental health inequalities in Wales’ report.
On this page:
— Reform of the Mental Health Act 1983
— Our View
Reform of the Mental Health Act 1983
153. Evidence suggests the number of people from ethnic minority groups detained under the Mental Health Act 1983 (“the 1983 Act”) is disproportionate, and that their experience and outcomes of detention are worse. Autistic people and people with a learning disability have also been inappropriately detained. This can prevent some marginalised or racialised communities seeking mental health support:
“Marginalised young people express fears that health professionals are no different to the police and they won’t be safe if they engage. Mental health services need to be actively anti-racist—taking proactive steps to combat and reverse ingrained patterns of oppression and injustice towards racialised communities”.
154. Andy Bell said different approaches may be taken to policing different groups or communities on the basis of age or ethnic background. He noted increases in detentions under the 1983 Act and the potential exacerbation of existing trauma and inequalities:
“…the more we see the use of coercion in the mental health system, the more people are detained under the Mental Health Act 1983, which sadly is rising year after year after year, we know that can do harm long term. It may be necessary to save a life, but potentially those experiences of coercion can reinforce some of those traumatic experiences people have been through, and we know that's used unequally. So, if you are from an African or Caribbean background, you're something like four times more likely than a white person to be subject to the mental health Act, and there's something deeply, deeply wrong about that”.
155. Llamau described an incident in which a number of police officers and several vehicles had responded to a young person who was suicidal, which they said “frightened the young person and didn’t help with their mental health crisis”. Similarly, Life Warriors, a peer-led therapeutic support group for people with a diagnosis of (or who identify with the characteristics of) ‘personality disorder’, told us:
“[The police] are most often first responders to someone in mental health crisis, so do need those specialist skills to remain person centred at times where people need help the most. “In moments of crisis, I am vulnerable and frightened, yet I am thrown in the back of a van and treated like a criminal, not explaining where we are or where we are going”. “If they understood us, they would be much kinder than they are””.
156. Others also highlighted the need for police officers to be trained to deal appropriately with people (including children and young people) experiencing mental health issues or crises, including training in mental health awareness and suicide prevention.
Plans for reform
157. Following an independent review of the 1983 Act in 2018, the UK Government published a White Paper in 2021 and a draft Mental Health Bill in June 2022. The proposed reforms include:
- Ensuring greater choice and autonomy for patients in a mental health crisis.
- Tackling racial disparities in mental health services.
- Better meeting the needs of people with a learning disability and autistic people.
- Ensuring appropriate care for people with serious mental illness within the criminal justice system.
158. The UK Parliament has established a joint committee to scrutinise the draft Bill. We wrote to the joint committee to highlight the evidence we have gathered, and to emphasise the importance of ensuring that the different legislative and policy contexts in respect of mental health in Wales and England are taken into account in the development and scrutiny of the legislation, and in its implementation, to ensure that any changes complement rather than complicate the current legislative and policy framework in Wales.
159. It is unacceptable that anyone is being inappropriately detained under mental health legislation, and even more so that some groups and communities are disproportionately at risk. It harms and traumatises the individuals who experience inappropriate detention, damages trust and confidence in public services, and deters others from the same groups or communities from seeking help and support.
The Welsh Government should work with the police and crime commissioners and the police forces in Wales to identify opportunities to improve access for police officers to ongoing training in mental health awareness, suicide prevention, neurodiversity awareness, learning disability awareness, and cultural competence. In line with our recommendation 22, the Welsh Government should provide us with an update on this work in December 2023.
160. We note that the Explanatory Notes published with the draft Bill say the UK and Welsh Governments are discussing the legislative proposals, the majority of which would apply to Wales and would therefore engage the legislative consent process if the Bill were to be introduced in its current form. We would anticipate that any legislative consent memorandum would be referred to us for scrutiny.
In its response to our report, the Welsh Government should provide an update on its discussions with the UK Government on the draft Mental Health Bill. This should include information about whether the Welsh Government has reached a view on whether it supports the UK Government’s intention to legislate in the devolved area of mental health, details of the analysis and consultation undertaken by the Welsh Government to inform its view on this matter, and information about the actions taken by the Welsh Government to ensure that the different legislative and policy contexts in Wales and England are being taken into account in the development of the legislation and planning for its implementation.
Table of Contents
— Mental health is 'made' in communities
— Coordinated cross-government action
— Reform of the Mental Health Act 1983
— Annex: Mental health and emotional support
 MHI80 Centre for Mental Health
 RoP [paras 162 and 176], 24 March 2022
 MHI56 Llamau
 MHI17 Life Warriors
 For example, MHI35 Barnardo’s Cymru, MHI75 DPJ Foundation
 UK Government, Independent report: Modernising the Mental Health Act – final report from the independent review, December 2018
 UK Government, Consultation outcome: Reforming the Mental Health Act, 24 August 2021
 UK Government, Policy paper: Draft Mental Health Bill, 27 June 2022
 Letter to the Joint Committee on the Draft Mental Health Bill, 11 October 2022
 UK Government, Draft Mental Health Bill: explanatory notes, July 2022