LGA submission to the Reforming the Mental Health Act White Paper

1. The Local Government Association (LGA) is the national voice of local government. We are a politically led, cross party membership organisation, representing councils from England and Wales.

2. Our role is to support, promote and improve local government, and raise national awareness of the work of councils. Our ultimate ambition is to support councils to deliver local solutions to national problems.

3. The LGA strongly supports the reform of the Mental Health Act (MHA) and the four principles that will underpin the new Act. Local government has a long and proud history of leading a person-centred approach to joining-up services around the needs of individuals, their families, and carers. We welcome the ambition to achieve meaningful change for people living with severe mental illness, and the central role of local government in supporting this.

4. We support the emphasis on treating people as individuals as a fundamental principle. We welcome the intention of the Act to address the rising rates of detention and experiences of people from Black, Caribbean, and African backgrounds. It is important that the Act reflects the needs of people with lived experience of mental health needs.

5. It is essential that the new Act clearly recognises the local leadership role of councils and identifies the roles and responsibilities of councils in respect of both statutory and non-statutory mental health duties, working in partnership with the NHS and local voluntary and community services. At implementation, it needs to reflect the impact of the pandemic which is predicted to cause an increase in new or additional mental health support (COVID-19 and the nation’s mental health).

6. We strongly support the proposals to revise the detention criteria to be clearer that autism and learning disabilities are not considered to be mental disorders for this purpose, and the requirement that there must be a probable mental health cause to their behaviour that warrants assessment in hospital. We want to see people with learning disabilities and/or autism receiving personalised care in the community whenever possible. To achieve this, it is important that there is additional funding for councils and clinical commissioning groups to support the development of alternative resources for people with autism and learning disabilities in the community.

7. The Act will have significant resource implications for councils which need to be fully funded on a long-term basis. The Act needs to reflect the operational needs and resource pressures on local government, and partners, who will need to be resourced to support effective implementation. For many years mental health services at all levels have been reduced despite rising demand.

8. The new Section 117 guidance needs to be developed in partnership with councils, the LGA and ADASS. It should clearly identify the responsibilities of the NHS and councils in meeting health and social care aftercare. It needs to align with Ordinary Residence guidance and to focus on ensuring positive outcomes for the person receiving support, and clearly highlight any areas of increased responsibilities for local councils that may lead to additional burdens.

9. For councils to plan and introduce the Act successfully, they will need a clear timetable in advance of implementation, for all duties arising from the Act.

10. We support the changes to the current act to increase choice and improve autonomy. The extension of choice must be supported through investment in the funding for partners to develop a broader range of appropriate specialised mental health support in the community.

11. We welcome the recognition of the role of councils in the commissioning of culturally appropriate advocacy services and the intent to work with ADASS, the LGA and the Association of Mental Health Providers to develop this.

12. Any future commissioning arrangements should follow sector led improvement principles, an approach agreed between councils and central government. Commissioning of mental health services should reflect local needs and knowledge; the process should not be overly prescribed by central government. We support improved quality in service delivery, but it is important that the proposed Quality Improvement programme makes links the mental health role of councils, not just the NHS, and reflects sector led improvement principles.

13. The new Mental Health Act should also outline on how it will interact with the Care Act, the Human Rights Act, the Mental Capacity Act, the Equality Act, and the Children Act 2004. There also needs to be clear links with the new Health and Care Bill, the forthcoming National Strategy for Disabled people, the Autism Strategy and the Liberty Protection Safeguards. All these policies have an impact on how mental health care and support is delivered and should be referenced in any supporting guidance.

14. Achieving a reduction in detentions is not solely about legislative change. There also needs to be alternative treatments and services available commissioned by councils in the community as well as NHS services. There needs to be a system-wide shift in policy and resources away from medicalisation and treating mental ill health, to early intervention, prevention, and support for recovery through integrated community-based services.

15. The success of the new Act will require the NHS and councils working in partnership. More needs to be done to fully embed mental health into integrated care teams, primary care, urgent and emergency care pathways (Mental health and new models of care: lessons from the vanguards). The recent Health and Social Care white paper provides a promising base on which to build a more collaborative culture. It sets out a clear direction of travel for enabling NHS organisations to work more effectively together, and for the NHS to work as an equal partner with local government

16. Councils have several existing statutory duties under the Mental Health Act 1983 and will continue to have responsibilities under the new Act . The current existing responsibilities for councils are:

15.1 Councils have statutory duties to provide social care to support people experiencing mental health problems. Section 117 of the MHA requires councils, along with the NHS, to provide after-care services and support to people moving out of hospitals.

15.2 They employ Approved Mental Health Practitioners (AMHPs) who undertake statutory mental health assessments and have a critical role in treatment.

15.3 Councils are responsible for commissioning advocates to help people express their views and to represent their interests. This includes specialist advocates to help people subject to the MHA (independent mental health advocacy – IMHA) and those under the MCA (independent mental capacity advocacy – IMCA).

15.4 Councils have duties to authorise deprivation of liberty under the current Deprivations of Liberty Safeguards (DOLS) scheme and the forthcoming Liberty Protection Safeguards (LPS) scheme. Important to note that following the Supreme Court judgement on the Cheshire West case, between 2014 - 2015, councils received 137,540 DoLS applications – significantly more than the 13,700 made in 2013-14. DoLS applications have continued to rise since.

16 It is also important to note that poor mental health is anticipated to rise significantly because of the impact of the pandemic (COVID-19 and the nation’s mental health). The increase in need was reflected in the recent mental health recovery plan (COVID-19 mental health and

wellbeing recovery action plan) announced by the government. The forthcoming Act will need to consider the additional pressures in the implementation stage.

17 The government proposes to include four principles “up front” in the new Act:

17.1 choice and autonomy – ensuring service users’ views and choices are respected

17.2 least restriction – ensuring the MHA’s powers are used in the least restrictive way

17.3 therapeutic benefit – ensuring patients are supported to get better, so they can be discharged from the MHA

17.4 the person as an individual – ensuring patients are viewed and treated as individuals

18 We respond to each of these principles below.

19 The LGA strongly supports the principle for increased choice and autonomy for service users. However, to enable genuine choice and autonomy, there will need to be a broader range of appropriate specialised mental health support in the community. Mental health support services in the community are often commissioned by councils, a key commissioning partner is the NHS. This will require increased investment in evidence-based community mental health services co designed and co-commissioned with the NHS. Some of these services already exist, but some will need to be established to meet specific needs or communities.

20 Not being able to access the right care at the right time can lead to people reaching crisis point and ending up in hospital. In the annual CQC State of Care 2020 report (The state of health care and adult social care in England 2020/21) on the care for people with mental health needs in acute hospitals, they identify that, once in hospital, people are not receiving the care that they need, with poor co-ordination and joint working between acute and mental health services and delays in assessments and securing beds. These delays can then be made worse if there is a lack of availability of mental health beds, with people in distress having to stay in inappropriate and sometimes unsafe environments.

21 A lack of access to local community services can also lead to people being placed in hospital far from home. Such placements can isolate people from friends and families. The CQC in 2020 found that this also increases the risk of closed cultures developing (The state of health care and adult social care in England 2020/21). A closed culture is a poor culture in a health or care service that increases the risk of harm. This includes abuse and human rights breaches. They expressed concerns that the risk of closed cultures has increased during the pandemic, with restrictions on people’s movements and services having to restrict or stop families from visiting their loved ones.

22 We support the changes to the current act to increase choice, such as Advanced Choice Documents and input into Care and Treatment Plans, and improved autonomy, such as enhanced opportunities to challenge decisions. These changes must be supported through investment in the AMHP workforce, where there are increasing problems of recruitment and retention (Briefing: Mental Health Act – Approved Mental Health Professional services), and in services that are able to provide appropriate alternative support.

23 We welcome the opportunity for the new Act to support councils to grow the capacity and capability of voluntary sector providers, such as Independent Mental Health Advocacy (IMHA) services. We recognise that these are operating in an increasingly fragile market. We are concerned that the White Paper Impact Assessment does not reflect the increase in use of advocacy services which will occur with an ‘opt-out’ model. The Impact assessment assumes a 40 per cent uptake, however it may be that where contracts currently provide for an opt-out model, referrals are likely to be higher.

24 The White Paper recommends that as a minimum an annual report should be prepared by advocacy service providers, with the opportunity for quarterly exception reporting as required. Many advocacy providers already report to local authorities and CQC inspects access to advocacy as part of its emphasis on ensuring the rights of detained patients. Any further reporting requirements should be proportionate to the provider organisation capacity and should be person centred and not unduly bureaucratic.

25 An additional complexity is advocacy for people who are detained or assessed outside of their normal area of residence. Advocacy costs may need to be borne by the council in which a mental health or detention facility is located. It may also require additional funding to ensure that the person receives an advocacy service familiar with their local originating community or needs. Furthermore, a person may decide to stay in the local area after discharge from hospital, which may have an additional demand on advocacy services where the hospital is based.

26 The current White Paper Impact Assessment does not address the costs or benefits of additional community services. Councils have a lead role in commissioning a range of specific services for adults, such as supported housing, home care and enablement, employment, and day/activity services, including specific services for young people and those with autism. Social work services are also responsible for the effective preparation for adulthood for young people moving to adult services and joint working with children’s services and Child and Adolescent Mental Health Services.

27 The White Paper recommends that commissioning by councils should be strengthened. We would welcome further discussions on this point. Local government works according to sector led improvement principles (What is sector-led improvement?) ; an approach agreed with MHCLG. Local health and council partners are best placed to identify service needs and responses in consultation with local communities and voluntary providers. We want to ensure that any future commissioning arrangements reflect local needs and knowledge and the process is not overly prescribed by central government.

28 The White Paper outlines a Quality Improvement (QI) programme – it identifies specific reforms to the act which are most likely to benefit from a QI approach; improved care planning, reducing inequalities, improved partnership working, improved assessment processes, greater levels of safety, and the dignity and respect experienced by service users. We support improved quality in service delivery, but it is important that the QI programme makes links to councils’ mental health role and importantly reflects sector led improvement principles.

29 The White Paper also proposes to look at how any expansion of the CQC monitoring role could make a positive impact and aid the quality and safety of care. It proposes working with Local Authorities and others to consider how best to extend these powers, and then publish proposals for consultation at a later stage. The LGA would be keen to be kept informed of this work prior to the consultation. 30 However, our is that improvement is first and foremost a local endeavour. It is local councils, working alongside commissioner partners in health, as well as other partners from the provider sector, the voluntary and community sector, people with lived experience and others, who lead and support an area’s local improvement journey. Sector-led improvement is the sector’s national programme of activity to support and enhance that journey.

31 A constant pursuit of improvement should underpin what drives all parts of the health and social care sectors so that people of all ages are able to live their best lives. We support the emphasis on collaboration, action, encouraging innovation, and the importance of sound evidence. As the regulator for health and care services, CQC is clearly an important agent of improvement. However, we believe CQC’s regulatory role may be compromised if it steps into the role of convenor of local improvement.

32 The NHS and councils working in partnership is a key theme that needs to be reflected in the new Act. The LGA see integration as a means to deliver better health and wellbeing outcomes through effective, streamlined and coordinated care and support. Whether working at national, regional, system, place or neighbourhood level, effective partnership working on health, care and wellbeing should have the following elements:

32.1 collaborative leadership

32.2 subsidiarity - decision-making as close to communities as possible

32.3 building on existing, successful local arrangements

32.4 a person-centred and co-productive approach

32.5 a preventative, assets-based and population-health management approach

32.6 achieving best value (Six principles to achieve integrated care).

33 For mental health services to be sustainable in the long term, local government and the NHS need to work together in equal partnership. At the implementation stage and going forward, the Act should recognise and encourage the need for the NHS to join up with councils and other partners, including the voluntary sector, in delivering place based person-centred and preventative mental health support.

34 The NHS leads on the diagnosis and treatment of mental health conditions, whilst councils provide the support to individuals and carers to remain independent, cope, adapt and rebuild; so, they can live fulfilling lives beyond diagnosis and treatment. Mental health, which depends on both statutory NHS and council services and the wider support offered by councils and others should be a key area for partnership and information sharing between councils and the NHS. Indeed, in many places' council statutory functions and NHS functions have been brought together in community-based teams.

35 For example, many local authorities have integrated their mental health social workers with NHS staff in community-based teams and they play an important role in ensuring a focus on recovery and prevention. The Kings Fund has found that where new models of care have been used to remove the barriers between mental health and other parts of the health system, local professionals saw this as being highly valuable in improving care for patients and service users. But there remains much to be done to fully embed mental health into integrated care teams, primary care, and urgent and emergency care pathways.

36 The White Paper refers to the NHS Long Term Plan agenda to transform mental health care in the community. This will see an expansion in mental health services for people with severe mental illnesses, to support them to maintain their independence for as long as possible. The aim is to shift the focus from reactive care to prevention and early intervention in the community.

37 Out of area placements (OAP’s) continue to be a challenge to ensuring choice and person-centred care and choice. The LGA support the Government’s ambition to eliminate inappropriate OAPs in mental health services for adults in acute inpatient care by 2020-21.

38 However, there will always be some people with severe mental health needs who will need an inpatient placement bed. Ideally this will be in their local area. However, the process of identifying beds for detained people is a challenge in many areas of the country. A lack of beds, together with a lack of alternatives to hospital and an increase in mental health issues, has meant that beds in a local mental health unit are often not available and so placements are sought many miles away in private or NHS provision.

39 Being placed away from their home can be confusing and frightening for a person. An out of area placement also presents major challenges for support services. AMHPS often cannot complete an assessment until a bed is found. Councils have an ongoing responsibility to oversee the person’s care and if the client is out of their area, that presents a challenge. Instead local council services, who have had no previous involvement with the decision or the patient, are asked to divert their services to assess and detain a person whom they have little knowledge.

40 Delayed discharge is also a challenge. Reasons for delay include problems with housing, homelessness, or lack of accommodation to return to. Limited availability of specialised community support services including step down options, supported housing and services to support recovery in the community. Many in acute care have other needs in addition to their mental health issues, such as drug or alcohol use or being on the autism spectrum. These can make accessing community support and housing more complicated. There needs to be an expansion of proven community-based services for people of all ages with severe mental health problems who need support to live safely as close to home as possible.

41 To improve discharge planning requires strong partnership work. A good example of a multi-agency partnership is Bradford. The council and partners have worked to ensure that social care is integrated across a range of acute and community mental health services. The aim is to prevent admission, support recovery or to discharge when appropriate (We need to talk about social care - Social care and the mental health forward view: ending out of area placements).

42 We strongly agree that detention should be for the therapeutic benefit of the individual. There needs to be a concerted, cross-organisation, drive to tackle the culture of risk aversion and that this will need to include a range of partners, including the LGA. We agree that services and support should facilitate a move away from a focus on risk, detention and medication, to build on a person’s strengths, the provision of personalised support and the services that enable a person experiencing mental health issues to live a healthy and fulfilling life.

43 A good example of a cultural shift in risk is demonstrated by the LGA and Association of Directors of Adult Social Services Making Safeguarding Personal. This is a sector-led initiative which aims to develop an outcome focus to safeguarding work, and a range of responses to support people to improve or resolve their circumstances approach. Core principles and values include:

43.1 A shared culture that supports risk enablement.

43.2 A human rights approach – promoting human rights, rather than solely a protective approach.

43.3 Making Safeguarding Personal – putting the person at the centre, empowering, and working in partnership with them.

43.4 a focus on wellbeing alongside safety, making sure the different dimensions of risk are embraced. (‘I feel safe and in control of my life’);

43.5 Application of all the principles of the Mental Capacity Act (MCA 2005); and Application of the six statutory principles for Safeguarding Adults (Care and Support Statutory Guidance, Department of Health, 2018).

44 We strongly support the principle of treating people as individuals. Councils have significant experience of supporting personalisation in social care and ensuring service users are fully involved in their care. It is important to note that ‘one size does not fit all’ and responses and services need to reflect the social and cultural circumstances of individuals and communities.

45 A particular area of need, recognised by the White Paper, is the disproportionate level of detentions of Black, African, and Caribbean people and other minority ethnic communities. We welcome the introduction of the Patient and Carer Race Equality Framework, as an approach to improve these communities’ mental health outcomes. But the framework will only apply to the NHS. In order to be successful, it will need to engage closely with local councils and voluntary and community services who often have close links with and great understanding of the needs of diverse local communities.

46 The Act needs to recognise the full spectrum of mental health services from prevention and mental wellbeing, to crisis intervention, treatment, and recovery, designed around the needs of the person, their families and carers. There needs to be a re-focus in mental health services away from medicalisation and treating mental ill health to early intervention and support for recovery through integrated community-based services. This would build upon the direction of travel set out in The Five Year Forward View for Mental Health.

47 We need to recognise and build upon the benefits of the connectivity between the NHS, local government, and other partners in preventing health prevention deterioration and promoting recovery, such as integrated NHS/local government community mental health teams.

48 A focus on community integration will strengthen links between NHS services and other council services and help to embed a ‘whole person’ approach that seeks to address the often-multiple factors that affect mental wellbeing. Councils deliver or commission services that help people in vulnerable circumstances and/or crisis points, such as supported housing, domestic abuse, homelessness support, substance and alcohol abuse and money advice, as well as services such as libraries, parks and leisure centres that help to improve people’s general mental wellbeing.

49 It is important that the Act recognises the link between substance misuse and mental health. For adults undergoing treatment, 59 per cent said they had a mental health treatment need. Over half of new starters in all substance groups needed mental health treatment (Adult substance misuse treatment statistics 2019 to 2020).

50 Additionally, domestic violence effect on survivors' mental health is profound and obvious. Women experiencing domestic abuse are more likely to experience a mental health problem, while women with mental health problems are more likely to be domestically abused, with 30 to 60 per cent of women with a mental health problem having experienced domestic violence (Mental health statistics: domestic violence). Domestic violence is associated with depression, anxiety, PTSD and substance abuse in the general population. Exposure to domestic violence has a significant impact on children's mental health. Studies have found strong links with poorer educational outcomes and higher levels of mental health problems (Mental health statistics: domestic violence).

51 We agree with the proposal to change the Act to be clearer that autism or a learning disability are not considered to be mental disorders for the purposes of most powers under the act. However, it is important that alternative support is provided in the community and that better understanding of both learning disabilities and autism is promoted amongst all agencies. Specialist advocacy services for people with learning disabilities or autism may also need to be developed, alongside all advocacy services being in a position to make reasonable adjustments for this group.

52 We support the commitment to reducing the reliance on specialist inpatient services for people with a learning disability and autistic people and to developing community alternatives. CQC in its 2019/20 edition of State of Care report found poor care in inpatient wards for people with a learning disability and/or autistic people. The overall proportion of services rated as inadequate rose from 4 per cent in 2018-19 to 13 per cent in 2019-20.

53 It is essential that alternative specialist community-based care, provided or commissioned by councils, is developed, and funded. A recent review of restraint, seclusion and segregation for people with a learning disability and autistic people who may also have a mental health condition by CQC (Out of sight – who cares? A review of restraint, seclusion and segregation for autistic people, and people with a learning disability and/or mental health condition) found that people in adult social care services were experiencing better person-centred care than people in hospital. This meant that they were experiencing a better quality of life than the people CQC saw with comparable complex needs in hospitals. CQC found that in the community:

53.1 Services were more likely to be able to personalise people’s living environments to their individual styles and personalities

53.2 There were more services with a positive social environment, with activities that were relevant to each person’s needs and interests.

53.3 Some examples of people receiving good physical health care within community settings, where staff were aware of any medical conditions and continuously monitored people for any changes. This was particularly important for those who had communication needs and may have struggled to communicate when they were in pain or needed help.

54 Furthermore, research has shown that hospital admission is particularly challenging for people who have a learning disability. Compared with the general population, this patient group is more likely to need and use health services and is also more likely to have a poorer experience of care and poorer health outcomes (including avoidable death) (Learning disabilities: making reasonable adjustments in hospital).

55 Darlington Council is a good example of council providing effective learning disabilities services in the community. Darlington Council learning disabilities service has strong focus on outcomes, a determination to fully understand the needs of children and adults, a commitment to personalised services and co-production. By focussing on outcomes and supporting people to achieve their best independence using the “Progression” model, and also investing wisely in service modernisation and market development, the authority is achieving outstanding efficiency and a highly cost-effective service model (Darlington Council Learning Disability Services).

56 In terms of continuity of care, we agree with the recommendation that a new designated role to manage the process of transferring people from prison or an immigration removal centre to hospital when they require inpatient treatment for their mental health. One option is for AMHPs to undertake this role. There may be resource implications if AMHPs are to undertake this role. We recommend further consultation with the sector to explore who may be best suited to take this role.

57 Good continuity of care is essential to support a person’s mental health needs on release from prison. Planning for support for a prisoner with mental health issues as they move into the community typically involves a minimum of five different organisations (Reconnect). The National Audit Office in 2017 found that prisoners do not routinely receive continuity of care on release (Mental health in prisons), making successful rehabilitation more challenging. We would welcome development, in consultation with local government, of clear national pathways to help plan ongoing care when offenders leave prison. 

58 We are supportive of the approaches set out in the Mental Health Act White Paper for children and young people. However, some concerns remain about the practical implementation of such plans:

59 There is no statutory test for under 16s to ascertain capacity and no presumption of competence. However, Advanced Choice Documents can only be created by people with capacity and do not require medical verification. Therefore, a clear process for under 16s needs to be developed and advocates need to be clear on this so they can support under 16s in creating them.

60 For informal patients under the age of 18, it needs to be clear how statutory care and treatment plans will work. The White Paper states that the legislative basis for these plans for informal patients aged under 18 will be in Tier 4 contract requirements and not the amended Mental Health Act.

61 Nominated Person - whilst parents, guardians and family members will be the right choice for many children and young people it may not be the right choice for all. For example, those separated from their families or where there are safeguarding concerns. There may also be issues where families have different perspectives to the young person’s needs. In addition, parents often do not receive appropriate support to manage their children’s needs and access support services.

62 It is positive that the White Paper does seek to strike a balance to ensure that parents and carers continue to have rights to information and consultation about care, even if they are not the Nominated Person. However, it is not clear how this will work in practice, and how the rights interact. This is of greater concern for those under 16, how they are afforded the choice and where parents will be informed of decisions.

63 For children in care (on a care order, not under section 20), the local authority is their corporate parent. Greater clarity is required on how the role of the Nominated Person will interact with the role of the Local Authority as a corporate parent.

64 An outstanding concern is where a child or young person chooses a Nominated Person who presents as a safeguarding risk to them. While these children should be afforded choice in who their Nominated Person is, councils and AMHPs should work together so that if a child chooses a Nominated Person who poses some risk to themselves, there are mechanisms in place for that person to be discharged from the role. 65 It is not currently clear how the IMHA proposals will complement the position of an advocate who already works alongside a young person. It is important to give young people a voice and not take any power away them, instead the proposals set out in the Act need to empower them where possible to make informed choices. New guidance must accompany any changes to legislation to support advocates to use new powers appropriately.

66 A current and future pressure on community mental health services is recruitment and retention of AMHPs. AMHPs are largely employed by councils and it is recommended that local areas have a minimum number of AMHPs. The AMHP role is under a great deal of pressure for several reasons . In some areas, it is increasingly hard to provide the statutory service prescribed by the MHA. This may lead to delays for assessments, an inability to find an appropriate bed for someone detained under the MHA or a lack of community alternatives.

67 In a recent CQC briefing on the rise in the use of the MHA, they found that between 2005/06 and 2015/16, uses of the Act have increased by 40 per cent to 63,622 sections per year . Most of these sections, plus the 58,920 short-term holding powers, will have needed the involvement of an AMHP at some stage in the process. AMHPs also act as Best Interest Assessors locally for the Deprivation of Liberty Safeguards (DoLS) a duty that has increased significantly since 2014.

68 Councils’ statutory children’s and adults’ mental health services and wider public health responsibilities need parity of funding with NHS mental health services, so that councils – harnessing all of their relevant services and assets, and working closely with partners – can help the whole population to be mentally healthy, prevent the escalation to clinical services and work with health colleagues to support people of all ages who are mentally unwell.

69 Any reforms to the Act need to be fully funded on a long-term basis. The impact Assessment addresses the extension of duties for Approved Mental Health Professionals and Independent Mental Health Advocacy (IMHA). But significantly there will be additional needs to support councils to develop the capacity and capability of community service providers. Many of these are commissioned by councils and all are operating in an increasingly fragile market. Council commissioning services may also have additional burdens and require resourcing. It is important that the additional costs are identified and resourced prior to implementation.

70 The Spending Review announced £500 million of funding for mental health to address waiting times, expand support, and invest in the workforce. And the government’s recent Mental Health Recovery Plan announced some additional spending for councils. However, research has predicted a rise in demand following the pandemic (Mental Health Act: The rise in the use of the MHA to detain people in

England), which will impact upon councils.

71 Statutory mental health care and support responsibilities of councils come under social care spending. Our analysis before 2020 Spending Review showed that adult social care faced a funding gap of £2.2 billion in 2021/22, rising to £2.7 billion in 2023/24.

72 From 2014/15 to 2019/20 council spending on mental health support for adults aged 18-64 has increased by 23 per cent and for older people (65+) has increased 31 per cent, compared to an increase across the adult social care service of 21 per cent .

73 In 2019/20 net expenditure on mental health support for adults aged 16-64 was £776 million, and for older people was £483 million, and together represent 7 per cent of total net expenditure on adult social care (ADASS Budget Survey 2018).

74 A significant proportion of this funding is spent on section 117 aftercare for people who have been subject to the Mental Health Act . The independent review of the Mental Health Act identified concerns about the funding and provision of health and social care support for people who have been subject to the Act. In respect of Section 117 aftercare, it found that there were variations between areas in the level of support and disputes between agencies about responsibility for funding ongoing care. It also noted that social care outside section 117 required payment by the individual.

75 The White Paper impact assessment identifies two main areas of additional expenditure for local authorities; Approved Mental Health Professionals and Independent Mental Health Advocacy. To successfully implement the Act, additional funds will also be needed for wider workforce development, communication, and system wide improvement. The Government Recovery Plan announced £3 million to begin preparations for implementing the Mental Health Act Reform, increasing capacity in the workforce, and laying the groundwork for broader reforms including testing ways to improve the quality of care and provide culturally appropriate advocacy. The LGA would welcome further detail about this funding and what proportion of the funding will support local implementation.

76 We welcome the White Paper statement that the government will work in close collaboration with Local Authorities, ADASS, ADCS, NHSEI and service users to update national guidance so that there is greater clarity on how budgets and responsibilities should be shared to pay for section 117 aftercare. The guidance needs also to clearly highlight any areas of increased responsibilities for local councils that may lead to additional burdens. It is also important that changes to Section 117 are aligned with Ordinary Residence guidance.

77 To clarify aftercare coordination and funding, the White Paper recommends that there should be a Statutory Care Plan (SCP) for people in contact with Community Mental Health Teams, inpatient care and/or social care services. We would welcome more detail on this proposal, as the White Paper also says that ‘we think this is already covered within existing duties and responsibilities. It is important to note that any additional statutory requirement will have a new burdens impact on councils.

78 To ensure successful implementation it will need to recognise and build upon the benefits of the connectivity between the NHS, local government and other partners in mental health prevention and recovery, such as integrated NHS/local government community mental health teams. Councils will need a clear timetable in advance of implementation, for all duties arising from the Act. 79 Local NHS plans for taking forward the mental health work stream should be developed in close partnership with Health and Wellbeing Boards and seek to build upon the place-based priorities already set out in joint health and wellbeing strategies, including for mental health. The early engagement of local political leadership in discussions to develop local plans will be crucial in securing the systemwide support and commitment necessary to deliver real and lasting change.

Kevin Halden, LGA Adviser 

Email: [email protected]