A response to two amendments for the Third Reading of the Mental Health Bill October 14th from the Mental Health Action Group (https://mentalhealthaction.uk)
1. Proposal / key changes for patients with autism
Proposed at Third Reading : Detention under Section 3 restricted
People with autism or learning disabilities (LD) can no longer be detained for treatment under Section 3 of the Mental Health Act (MHA) unless they also have a co‑occurring psychiatric disorder that meets the standard detention criteria.
- Applies to Community Treatment Orders (CTOs).
- Does not apply to Part III of the MHA. Part III concerns forensic sections (offenders). The proposed changes would not limit detention for people with autism or LD in the same way.
And PROPOSED AMENDMENT to Clause 4, in October 2025
Clause 4, page 10, line 5, at end insert:
125FA Report: Sufficient commissioning services for people with autism or learning disability
(1) Within four months of the day on which the Mental Health Act 2025 is passed, the Secretary of State must lay before Parliament a plan to allocate sufficient resources for commissioning services regarding the treatment and detention of autistic people and people with learning disabilities to ensure operability of provisions in this Act.
(2) The plan must include: (a) revised assumptions of the number of autistic people and people with learning disabilities who may require detention under this Act; (b) the actions that the Secretary of State will take to ensure community services are available to meet demand after the 28-day detention period; (c) plans for data collection to support commissioning sufficient services; (d) plans to allocate appropriate resource to ensure the operability of services, including, but not limited to, financial resource; (e) plans to ensure that responsible bodies and individuals receive the necessary training to carry out support, diagnostic, and treatment plans.
Members’ explanatory statement
This amendment requires the Secretary of State to present a plan within four months to ensure sufficient services, resources, data, and training are in place to support autistic people and those with learning disabilities under the Act.
A clause is suggested to require the Secretary of State to produce a report and plan within 4 months of the Act being passed.
This plan must ensure sufficient commissioning of services (resources, training, data, etc.) for autistic people or those with LD so that the new provisions can actually work (i.e. for detention/treatment changes to be operable).
MENTAL HEALTH ACTION GROUP RESPONSE:
Potential consequences / risks
Risk of ‘diagnostic padding’
Because Section 3 detention requires a ‘psychiatric disorder’, there is concern that some clinicians will diagnose a psychiatric disorder in addition to autism/LD, perhaps even when borderline or ambiguous, in order to maintain the ability to detain. Autism and LD are broad and heterogeneous. Some people’s presentation may straddle autism/LD and psychiatric disorders. It may be unclear which categories apply, possibly creating gaps while navigating treatment options.
Use of alternative legal frameworks and risk of criminalisation
There’s a risk that people who would previously have been detained under Section 3 are instead detained under the Mental Capacity Act (MCA), or under Deprivation of Liberty Safeguards. These have fewer procedural safeguards, such as a lack of tribunals. If people with autism/LD cannot be detained under Section 3 in civil cases, but their behaviour becomes risky, misunderstood, or interpreted as offending, there is concern more will end up in the criminal justice system instead of receiving care. There is a risk of criminalisation or entry into criminal justice system.
The professional & carer consensus statement on the Mental Health Bill 2025 highlights many of these concerns: that autistic people and those with LD may be excluded from Section 3, forced into less safeguarded frameworks, or criminalised.
Insufficient community services; privatisation and inequalities
For the restriction on Section 3 to work well, strong community supports must be in place (care, treatment, housing, social care, etc.) to manage treatment options and prevent deterioration. But it is known that such supports are currently underfunded and inadequate to meet need.
From consultations so far, respondents have supported community support, but repeatedly raised concerns about lack of funding and capacity, risk of people ‘falling through the net’, misdiagnosis, or behaviour being misinterpreted.
What is currently happening in the community
Let’s take a look at what’s happening in the community when it comes to patients with neurodivergent conditions. Currently NHS Autism and ADHD assessment services have a waiting time of three to five years. Over 200,000 people in England were waiting for an autism assessment as of late 2024. (See: https://www.autism.org.uk/what-we-do/news/autism-assessment-waiting-times-8)
This also leaves the scope widely open for private services who already play a major role in autism management in community. In practice, many turn to private diagnoses (autism/ADHD etc.).
Private services may fill some gaps, as they offer access to assessment, diagnosis, and support services for both children and adults. However, they raise questions around affordability, access, quality, and consistency.
Private clinics, such as the Priory Group, PrivateAutism.com, and NeuroAffinity, provide assessments for adults and children that are typically priced between £1,200 and £2,500. (See: https://www.audhdpsychiatry.co.uk/private-autism-assessment-cost/).
Larger providers like Cygnet Health Care, Orbis Education & Care, and Mentaur Ltd offer private supported living, residential care, and specialist schooling.
A doctor in the Mental Health Action Group recalled a patient with co-morbid physical and mental health issues, who was intending to save his PIP money (instead of using it for heating or food bills ), so that he could access private services to get an assessment. In another case, when a patient suffered side effects caused by their ADHD medication, their private ADHD clinician was unable to manage the problem unless they paid further consultation fees they could not afford.
In general, there is more scope for privatisation because of the gaps created by the Bill being unfilled. The state may later, of necessity, have to buy in services at greater cost. Alternatively, individuals and their families may choose to buy in services to help in a very difficult situation. Yet, private care is often of dubious standard, unregulated and sometimes dangerous. There are studies that show that more NHS services being outsourced to private providers is associated with increases in treatable mortality.
We note that private mental health hospitals offer poor handover of information. So, often, a family member has to hold all the strands of information together in the absence of proper recording and handover. The family member ends up being the care coordinator. Those who cannot afford private support, or who lack friends and family support, will go without, involving more risk to vulnerable people.
Summary
Even before reforms, waiting lists for autism assessment are long. If civil detention is restricted, but diagnosis is slow, people might not access the necessary diagnosis or support and might be driven more towards the criminal justice system during crisis. Otherwise, they may be pushed to use private services and, if they are unable to afford this, they will have long waits.
The Clause 4 amendment (report and plan) is a positive step, but critics worry ‘sufficiency of services’ is vague. What counts as ‘sufficient’? Who monitors this? Are funds earmarked or just promised?
The proposal in the new Bill rightly aims to reduce inappropriate detention of autistic people / those with LD and promotes more rights and less coercive practice.
But without strong investment and realistic planning for community supports, diagnosis, alternatives to detention, the risk is that the law change becomes symbolic or even leads to worse outcomes. We question why the Bill is timetabled now, when there is so much change in play, with the dismantling of NHSE and 50% cuts to ICB staff. The Bill will also be affected by a lack of feedback systems: for example, the 10 Year Plan proposes to disband HealthWatch.
There is a danger of shifting detention into less well‑protected legal frameworks, or of criminal justice involvement rising, rather than solving the underlying lack of care.
The success of the change depends heavily on what ‘sufficient services’ really means in practice, how it’s funded, and how quickly it can be rolled out.
2. Proposed Amendment: NC14, in October 2025
Referring to amendment NC14, to remove the following Clause:
General duty to secure sufficient resources for services in the community
(1) It is the general duty of integrated care boards to ensure, insofar as is reasonably practical, that services in the community responsible for delivering care, treatment, or detention provisions under the Mental Health Act 1983 and this Act have the necessary resources, including financial support, to meet service demands.
(2) Additional forms of resource may be determined by integrated care boards in consultation with relevant local authorities or health care service providers
and may include—
(a) sufficient numbers of trained medical professionals;
(b) purpose-built facilities for patient care;
(c) community services responsible for out-patient care.
(3) Each Integrated Care Board must conduct an assessment of its resources every two years to evaluate its ability to deliver services in the community effectively.
(4) Each Integrated Care Board must publish a report outlining its findings upon completing the assessment in subsection (3). The first reports must be published within one year of the passage of this Act.
Members’ explanatory statement
The Members’ explanatory statement states that this new clause places a general duty on integrated care boards to ensure that services in the community have the necessary level of resource to meet demand on services to ensure that the provisions of the Bill function as intended and to assess and report on these every two years.
(See: (https://publications.parliament.uk/pa/bills/cbill/59-01/0272/amend/mental_health_rm_rep_0901.pdf)
MENTAL HEALTH ACTION GROUP RESPONSE:
The amendment has not been considered before, so we should say we support this amendment because so far it’s not in the Bill. The Members’ amendment is precisely so that the ICBs are properly accountable for adult community MH service provision, as necessitated by the Bill/Act, because without this amendment there is no accountability. If accepted, then it will very positive, as the passage of the Act will ensure that Integrated Care Boards (ICB) are responsible for making sure that services providing care, detention and treatment under the Mental Health Act 1983 will have enough resources; financially and practically. One would hope that this will include sufficient numbers of trained medical professionals, appropriate facilities and community services that provide out-patient care.
However, we have concerns that the ‘local authorities’ mentioned in Clause NC14 (2) stretch to the (Voluntary, Charity and Social Enterprise) VCSE sector. This sector has seen a steep rise in demand since the implementation of the NHS’s 5 year Mental Health Community Transformation plan, where demands within core services have increased and spilled over into these local authorities. (Kings Fund, 2023, p 17. See: https://assets.kingsfund.org.uk/f/256914/x/880b052718/actions_to_support_partnership_2023.pdf)
We welcome the statutory requirement for providing resources. However, currently, the VCSE sector is not being commissioned in line with demand and there is still the anticipatory anxiety of these organisations not winning funding bids from year to year. This can have an effect on continuity of care, and the level and effectiveness of service these organisations can provide. If more of the service provision will be intended to move to the VCSE sector, we implore that these services have the correct safeguarding, training and regulation needed for people who require the treatment or service, as well as adequate funding that meets service demand.
Not only that, but the VCSE sector should be able to have a larger voice within the health sector. Through offering services, they should have the same rights to advocate and raise concerns, at the same level as their health sector counterparts within scrutiny committees, for example, and directly with the ICBs. (Taylor, 2025. See: https://www.vonne.org.uk/changes-nhs-and-what-it-means-vcse-sector)
Additionally, concerns are still being raised in inquests, prevention of future death reports and safeguarding adult reviews around the lack of cross-organisational communication. This must be smoothed out and refined before the passage of the Act, with detailed procedures of how to navigate this issue. There is also a present concern that nationally there are incidences where certain service users with particular needs, when dealing with the linked services, may disengage with both statutory and non-statutory services and lose support altogether. This is an issue that may be resolved by reinstating the previous assertive outreach teams, so that no-one falls through the gap. (Hulin, 2024. See: https://link.springer.com/article/10.1186/s12889-024-18455-4)
Finally, we certainly welcome the idea that ICBs need to produce a report every two years outlining service demand and where their resources are being allocated. This should help to keep a record of local needs, but also increase transparency, openness and accountability between ICBs and their communities. ICBs should be answerable to the public, for example through public consultations, if it is felt that undetected local need is not being represented in spending.
MENTAL HEALTH ACTION GROUP:
Further comments
- We assert that Community Mental Health Teams (CMHTs) must be adequately staffed and resourced to provide comprehensive care for all adult mental health service users, not solely those entitled to support under Section 17 leave, or following discharge from Sections 3 or 37; specifically under Section 117 aftercare provisions. It is imperative that every service user receives a care plan that is appropriately funded and supported to meet their individual needs.
- A critical concern lies in ensuring that the professional composition, or ‘skills mix,’ within community teams is not so diluted as to result in patients having minimal or no contact with qualified clinical practitioners—such as nurses, psychiatrists, or clinical psychologists—being seen predominantly by unqualified personnel. While roles such as peer support workers, hostel staff, and home help providers are valuable, these must function as supplementary, not substitutive, resources. Furthermore, the inclusion of professionally trained social workers within CMHTs is essential, given their expertise in navigating housing, benefits, employment, and other social determinants of health that are vital to holistic patient care.
- Addressing the social needs of patients is as crucial as managing their clinical requirements, including medication management. The social determinants profoundly impact recovery trajectories and quality of life, demanding equal attention within care planning.
- Regarding legislative frameworks, those entitled to Section 117 aftercare must receive these comprehensive supports on a non-means-tested basis. Individuals with severe and enduring mental illness frequently present with complex clinical, social, and accommodation needs that necessitate intervention by highly skilled multidisciplinary teams. Unfortunately, Section 117 aftercare is often inconsistently delivered, frequently compromised by overburdened or inadequately resourced CMHTs. With anticipated reductions in hospital admissions under Section 3 of the new Mental Health Act, there exists an opportunity to enhance aftercare delivery. The proposed amendment, mandating oversight by Integrated Care Boards (ICBs), promises improved accountability and standards in the provision of Section 117 aftercare.
- The Community Treatment Order (CTO), effectively a form of conditional Section 17 leave where the patient remains under detention but resides in the community—often as a response to inpatient bed shortages—has been subject to considerable scrutiny regarding its efficacy. Historically, clinicians have justified CTOs primarily on the basis that they prevent patients from being ‘lost to follow-up’, ensuring contact and oversight by CMHTs, often through assertive home visits for those failing to attend appointments. While this may reflect a pragmatic approach to patient monitoring, it raises concerns that CTOs function more as mechanisms of control than therapeutic engagement.
- We contend that a uniformly rigorous and professional standard of follow-up care must be guaranteed for all service users discharged from hospital, irrespective of whether they are subject to Section 17 or Section 17A (CTO) leave. The amendment under consideration would introduce an important layer of accountability, by requiring those responsible for the care and treatment of individuals on Section 17 leave and CTOs to be answerable to the ICB, thereby enhancing transparency and public oversight.
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