• Government spending review should commit to “multi-year” capital investment in the mental health estate
  • Mental Health Act review also calls for patients to be detained in healthcare settings rather than police cells

Mental health services are operating in some of the “worst estate the NHS has” and require major capital investment, a government review has said.

The long awaited independent review of the Mental Health Act has called for the government to make a “multi-year” capital funding commitment for mental health in its upcoming spending review.

The Mental Health Act review, published today, also called for investment in community based alternatives for detention and funding to build places of safety within healthcare settings by 2023-24, to avoid detaining people in police cells. 

No recommendations were made for how much capital will be required. But review chair Simon Wessely said the figure was more likely to be in the millions rather than the billions.

He added: “The biggest changes will come from sustained investment in alternatives to detention [such as] earlier intervention, better crisis care, better community care and in better learning disability placements and that is all going to cost, but it’s not for us to decide how much.”

The review, which was commissioned last year by prime minister Theresa May, made 150 recommendations for change, including:

  • NHS England taking over the commissioning of health services in police custody;
  • Creating a statutory requirement for care and treatment plans to be in place within seven days of detention and reviewed after 14 days;
  • Statutory “advance choice documents” being created for people at risk of future detention;
  • Ambulance services establishing formal standards for responses to section 136 conveyances, and trusts improving ambulance fleets, including the commissioning of bespoke mental health vehicles;
  • Placing a statutory time limit of 28 days from a patient’s first psychiatric assessment to their transfer to unit;
  • Greater representation of people of black African and Caribbean heritage in all professions and, in particular, psychology and occupational therapy; and
  • “Raising the bar” for individuals to be detained under the Mental Health Act, as well as any subsequent use of community treatment orders.

A number of recommendations were made for the Care Quality Commission, which included extending the regulator’s monitoring of the MHA beyond the NHS, and for it to develop new criteria to monitor the environments of mental health wards.

In a statement today, the Department for Health and Social Care said it will bring forward legislation to accept two of the recommendations made in the review and respond to the remaining 148 in the new year, including the review’s call for capital investment.

The two recommendations which will initially be accepted are:

  • Allowing people to nominate a person of their choice to be involved in their care decisions; and
  • Introducing statutory advanced choice documents for patients to express their preferences for future care.

Andy Bell, deputy chief executive of the Centre for Mental Health, said: “We welcome the report’s call for investment in updating the NHS estate. Every hospital ward should offer a safe, therapeutic and psychologically informed environment.

”We must ensure that no one is detained in an environment that compromises dignity and safety. And we need investment in improved crisis responses including alternatives to admission and ambulance services.”

This story was updated at 9:58 to include comment from the Centre for Mental Health.