The LGA continues to speak with the Government to help shape the reforms.
We welcome the Government’s acceptance of the large majority of the independent reviews' recommendations. For the Act to be successful there needs to be an improvement in the care that is provided to some of the most vulnerable people in our society. Along with changes we support the balance of appropriate safeguards but enable greater individual rights and liberties, with individuals having a more active role in care planning with a recovery focus.
Successful implementation will be heavily reliant on additional funding and workforce for mental health services and local authorities. Throughout the process, we will raise the necessity of additional resources to support to implement the new legislation.
The Government has undertaken an impact assessment; it addresses two main areas of new burdens for councils; the reforms/workforce pressures of approved mental health professionals and the increased demand on Independent Mental Health Services commissioned by councils; however, the impact of the policy and costs of the reform related to people with a learning disability and autistic people needs further clarification.
We have highlighted the need for the provision of appropriate post-discharge care and support, especially given the number of people with a learning disability and autistic people currently in inpatient services (of whom there are approximately 2,600 nationally) and those in the community at risk of being admitted to hospital without the right support (of whom there are an estimated 24,000 nationally.
There were 2,035 people with learning disabilities and/or autism detained in inpatient units at the end of March 2021. The average length of stay was more than five and half years, and 735 people had been detained for five years or more. NHS Digital (April 2021), ‘Learning Disability Services Monthly Statistics AT: March 2021, MHSDS: January 2021’, see LDA monthly statistics from AT data sheet, table 8.
The proposed reforms align with the national plan ‘Building the Right Support’ and the NHS Long Term Plan to develop community services and close inpatient facilities for people with a learning disability and autistic people who display ‘behaviour that challenges’, including those with a mental health condition.
We support specific interventions to reduce the use of the Mental Health Act for people with a learning disability and autistic people, which are lifelong conditions.
Evidence suggests people in these groups are typically detained because they demonstrate behaviour’ that challenges possibly due to the persons communication, distress or the impact of the environment not being recognised and responded to by the people around the person. We strongly support the proposal to clarify the criteria for detention so that learning disability and autism are no longer grounds for detention on their own, without a co-occurring mental health condition. We are concerned this proposal in isolation will not lead to a meaningful reduction in the number of people detained. In our view, it is primarily the lack of community support rather than the legislative framework that has resulted in continued detentions of people.
The white paper proposes that the detention of people with learning disabilities and autism will remain possible for assessment and where a co-occurring mental health condition is diagnosed. Implementation will need to ensure that that behaviour associated with a learning disability or autism, including coping strategies, is not misinterpreted as a mental health condition and used to justify detention.
A reform of this size will naturally require further expansion of the mental health workforce with an understanding and expertise in supporting individuals with learning disabilities and autism needs. We look forward to the opportunity to influence training on the changes to the Act and supporting meaningful co-production and the development of expert-by-experience leadership roles.