What does the Independent Review of the Mental Health Act mean for autistic people?

The Independent Review of the Mental Health Act was published last week and recommended welcome and far reaching proposals to improve mental health care in England and Wales.

“Autism is not a mental health condition and it is inappropriate for autism to be included in the definition in this way”.

The recommendations, if taken forward by the Government, could help a lot of autistic people get better mental health support – and mean that fewer autistic people end up being admitted to inappropriate mental health hospitals.

But, we believe the review could and should have gone further.

Background

Autism is, of course, not a mental health condition. But research shows that many autistic people struggle with poor mental health, like anxiety and depression. This can be devastating and have a lifelong impact. However, far too many autistic people have to wait far too long for support – or are given support that simply won’t work for autistic people – and end up falling into crisis.

In some tragic cases, which we and other campaigners and organisations have been highlighting, autistic people in crisis are admitted into mental health hospitals and become stuck there, in large part because there aren’t appropriate mental health services in communities. As we point out in our new report, NHS data suggests the number of autistic people in mental health hospitals is rising, despite Government and NHS England recognising the problem and promising to address it. This is unacceptable; autistic people deserve to have the support they need near their family and friends.

Last year the Prime Minister announced an independent review of the Mental Health Act 1983 and appointed Professor Simon Wessely to lead this. We and many other organisations and campaigners welcomed this move and the opportunity it offered to make sure the Act better reflects the needs of autistic people.

Following many months of consultation, which our charity fed into, the review’s report was published last week. The Government is currently considering the recommendations and is set to issue a formal response in the New Year, before introducing a new Mental Health Bill.

We need this Bill to fix the broken mental health system for autistic people.

• See more: Mental Health Act changes could see 10,000 fewer individuals face compulsory detention
• See more: Independent review of the Mental Health Act: charities’ responses

What the review means for autistic people

The review recommends a number of very welcome changes which would strengthen people’s right to challenge detention and help make sure the right preventative and crisis services are available in communities. These include:

• introducing a specific duty on health and social care to make sure autistic people and people with learning disabilities can access care in their own communities. 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.
• changing the ‘detention criteria’. This would mean that an individual needs to be at ‘substantial risk’ of ‘significant harm’ to be detained – and that there is evidence to prove this. We hope that this would lead to fewer autistic people being detained.
• introducing a new requirement for clinicians to follow National Institute for Health and Care Excellence (NICE) guidelines more closely. This is important because NICE guidelines include vital autism-specific information about adapting mental health therapies and avoiding psychotropic medication.
• changing Care and Treatment Reviews (CTRs), so they’re part of the Mental Health Act. CTRs are held by clinicians and 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 CTRs have statutory force, Mental Health Tribunals would be able to rely on them more and many autistic people could 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, so they are less likely to be detained in hospital.

What’s missing

These recommendations could make a real difference, and are things that we and our supporters have been calling for. But we’re really disappointed they don’t include removing autism from the Act’s definition of ‘mental disorder’. 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.

Because autism is part of the definition, autistic people can be detained in a mental health hospital, even if they don’t have an accompanying mental health condition. And this can happen simply as a result of there not being enough community-based to meet autistic people’s needs in the time of crisis. The review itself admits as much, acknowledging that detention can often be “the only relief available for those experiencing a crisis because there is no alternative option available to support them.”

This is not good enough. We should not be allowing people’s human right to liberty to be overridden because of a lack of services. We believe this is, quite simply, discriminatory and has to change.

There’s no denying that this is a complex issue – and there are concerns that getting it wrong could mean that some autistic people might end up in the criminal justice system if there was no community support and they could no longer be ‘sectioned’ to a hospital setting. The removal of autism from the definition of ‘mental disorder’ therefore must go hand in hand with making sure there are the right community-based mental health services for autistic people. The NHS has the opportunity to make this happen with its Long Term Plan, and we firmly believe that it needs to.

The review does say that the Government should keep the current definition under review. We strongly believe that the Government should finally grasp this issue and complete a review now. We’ve already waited since 2015 when they last promised to keep this under review. In fact, latest data suggests increasing numbers of autistic people are subject to detention. This cannot and must not be ignored.

• See more: CQC to review the use of restraint, prolonged seclusion, and segregation
• See more: Can cognitive behavioural therapy (CBT) work for those with learning disabilities?

What happens next

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 urge the Government should to adopt them.

But they must also show leadership by looking at the definition of ‘mental disorder’. We believe the Government should bring together autistic people, professionals, and organisations to decide what changes need to be made.

Tim Nicholls is Head of Policy at the National Autistic Society.

Read more about the National Autistic Society and find information and advice about autism at www.autism.org.uk