The Government has published promising new proposals to change mental health law in England and Wales which could result in fewer autistic people being wrongly sent to mental health hospitals. This is a huge step forward. We and hundreds of thousands of campaigners have been calling for changes to mental health law for years, so it respects autistic people’s rights. At the moment, it allows people to be sectioned because they’re autistic – even though autism isn’t a mental health problem. The proposals will change this in some really important ways.

It’s right that the Government has listened and is taking action. But it’s important to remember that these changes will take years to come into force and, crucially, won’t end the scandal of autistic people being stuck in mental health hospitals alone. The Government and NHS need to stop autistic people reaching crisis in the first place, by investing in better social care and mental health services that work for autistic children and adults.

Background

The proposals are part of the Government’s ‘White Paper’ on the Mental Health Act. White Papers are documents that set out what governments plan to do about certain issues. The Government is consulting on its proposals, so you can have your say on how to make sure the Mental Health Act works better for autistic people who have mental health problems.
Because the proposals need changes to the law, they will take around two years to come into force. During that time, the Government and the NHS need to continue to work to stop autistic people reaching crisis in the first place. This can be done by better investing in social care and mental health services and making sure that these actually work for autistic adults and children.

In 2019, we and autistic activist Alexis Quinn launched a petition calling on the Government to stop autistic people being inappropriately detained in mental health hospitals, get them discharged sooner and improve support in the community. Over 217,828 of you signed our petition, thank you. The Government heard your voices and today’s White Paper includes many important things that will help make this happen.

Here are some of the main changes in the White Paper that will affect autistic people:

• The definition of “mental disorder” in the Mental Health Act. This definition currently includes autism, which means you can be sectioned for being autistic, even if you don’t have a mental health condition. The White Paper proposes to change this for one important type of ’section’, sometimes called a ’section 3’. This would mean that autistic people couldn’t be sectioned for longer than 28 days unless it is to treat another mental health condition. Autistic people could still be detained in two circumstances:
  • For “assessment” for up to 28 days (sometimes called a ‘section 2’). If during this time the assessment does not find a mental health condition, then there would no longer be grounds to detain the autistic person.
  • In cases where otherwise it would mean someone would go to prison (sometimes called “criminal justice” or “Part 3” sections). This would mean that autistic people could still be diverted away from prison to get more support. 

This is a very big and welcome change. We hope that it will mean that fewer autistic people are sectioned because they’re autistic or because of misunderstandings about their actions or needs. 

• Making Care and Treatment Review actions enforceable. Care and Treatment Reviews (CTRs) are held by clinicians and other professionals responsible for people’s care and can help autistic people get discharged sooner. But too often their recommendations and actions aren’t followed. The proposals in the White Paper mean that actions agreed in CTRs would be included in new statutory care and treatment plans, which would be looked at by mental health tribunals and could be enforced. 
  • We have been calling for legal backing behind the actions in CTRs to make sure they are actually followed. 

This proposal is positive because Mental Health Tribunals will now be able to make sure CTR actions are followed, which we hope means many autistic people get out of hospital sooner.

• The introduction of a duty to provide adequate community services. Too many autistic people get stuck in mental health hospitals because there aren’t the right services to support them in their homes. In the White Paper, the Government says there will be a duty for councils, NHS England and local health decision makers to provide enough services for autistic people in their area.
  • These services could include: enough mental health services, better supported housing or more social groups to stop people becoming lonely and developing mental health problems.

We have called for many years for stronger duties to provide community services. We hope that with more community support, this can prevent autistic people reaching crisis in the first place and that no autistic person will have to stay in an institution because there is nowhere else to go. But we need to know more about how this duty will be monitored to make sure it’s working. And it is important to remember that many of these services will need more investment in social care, which is desperately needed. 

• Changes to “detention criteria”. When someone is sectioned, they have to meet the “detention criteria”, which means as well as professionals agreeing that you have a “mental disorder”, they must also agree that you are at risk of harm, or harming other people. The White paper sets out some key changes to this criteria, the Government says for someone to be sectioned it must be demonstrated that:
  • The purpose of the care and treatment has a clear “therapeutic benefit” to the person
  • The same treatment cannot be done in the community
  • That there is a “substantial likelihood” of harm – they will be revising the act so it is clear how serious this harm must be or how likely it is that the harm will occur in order to justify someone being sectioned. 

These important changes to the detention criteria could make a big difference in the number of autistic people who are sectioned.

In addition to this, other key proposals mentioned in the paper include, more frequent reviews of the decision to be detained, more choices available to people over their treatment and improved support for those who are sectioned with better access to help from advocates.

Have your say

You can have your say in this consultation by responding to the Government's survey.

Some additional things you might want to consider are:

• Do you think the changes for autistic people are good?
• What should be included in training for mental health professionals?
• What community services are needed to stop autistic people going into hospital?
• Why it’s important that mental health law recognises that autism is not a mental health condition and cannot be “treated”.
• Anything from your own experience that you think is relevant and you are comfortable to share with the Government. 

FAQs

What is the Mental Health Act and what does it do?

The Mental Health Act is the law which sets out when you can be admitted, detained and treated in a mental health hospital. It is also known as being ‘sectioned’. For this to happen, certain people must agree that you have a ‘mental disorder’. They also need to think you are putting your own safety or someone else’s at risk.

Being sectioned can mean that you are treated even if you don’t want the treatment. However, you have certain rights under the Mental Health Act, including the right to appeal and the right to get help from an advocate.

Mental health and autism

Autism is not a mental health condition, but often, due to a lack of recognition of their autism and because of inappropriate support, many children and adults on the autism spectrum develop mental health problems. You can find out more about autism and mental health on our website and you can read more about what we are doing to support autistic people’s mental health in our blog.

What happens next? 

The Government will be gathering feedback on these changes which is a great opportunity to have your say on what the changes in the Act will mean for autistic people.

They will gather feedback until 21 April 2021. After this time, depending on the feedback they may make changes to the White paper before it becomes the final Bill. The Bill is then taken to Parliament for them to debate and vote on it before it becomes law. This means it will take some time for these changes to come into force.

The Government’s proposed timings for this are:

• A 12-week consultation gathering responses to the White Paper 
• Final policy decisions and the publication of their response to the consultation
• Draft Bill ready for pre-legislative scrutiny
• Then it will go through a number of Parliamentary sessions to be debated by both the House of Commons and the House of Lords
• It will then be formally Introduced in Parliament 
• Starting to implement new laws introduced in the bill
• Full implementation

Further information

• For confidential support and advice, including our Autism Inpatient Mental Health Service casework service, visit the Help and Support section of our website.
• Bringing us Together have produced this very useful Survival Guide for care and treatment reviews. 
• Read about our campaign to stop the scandal of autistic people being wrongly admitted to hospital.
• The All Party Parliamentary Group on Autism, with support from our charity, held an inquiry into the state of support and services for autistic people in England – 10 years on from the Autism Act. Find out more by reading about out Not Enough campaign.
• Read Alexis’ story about being “locked inside” various mental health hospitals for three years.
• If you’re a professional looking to build your knowledge of autism and mental health, look out for our conference 11 March 2021.