Background on the Mental Health Act reforms 

In 2021, the Government published a White Paper, Reforming the Mental Health Act, which accepted many of the recommendations from the 2018 Independent Review of the Mental Health Act and set out a series of ambitious reforms to care under the Act. The White Paper included proposals for significant legislative reform but acknowledged that legislation alone would not be sufficient to deliver the broader improvements in culture and practice required to meet the overarching aims of the reforms. To support these improvements, one of the recommendations taken forward in the White Paper was a commitment for NHSE to deliver a national Quality Improvement (QI) programme.

The Independent Review identified inequalities faced by people from ethnically diverse backgrounds and by people with a learning disability & autistic people as one of the most pressing issues which the sector faces:

• The review noted the disproportionate number of people from black and  ethnically diverse backgrounds detained under the MHA, and the excessively poorer experiences and outcomes for individuals from black African and Caribbean communities.
• The review also noted that people with a learning disability and autistic people are at a particular disadvantage - for example, professionals do not always take the time or have the skills to understand how best to communicate and understand what is causing their distress.

Addressing inequity of experiences of care delivered under the MHA is core to this QI programme's aim and drivers of change.

Working with over 50 NHS Trust-run inpatient services to put into practice the principles set out in the reform of the Mental Health Act

Between August 2023 and March 2025, this QI programme will support inpatient services to develop and implement co-produced change ideas that put into practice the principles set out in reform of the Act - tackling inequity of experience faced by groups experiencing significant inequalities under the Mental Health Act. The programme aim is to:

"Improve the equity of experience for people from ethnically diverse backgrounds and people with a learning disability & autistic people when detained under the Mental Health Act in hospitals across England, including improving the cultural appropriateness of care they receive."

The programme will:

• Work with NHS Trust-run services that provide care of patients detained under the Mental Health Act
• Provide executive coaching, and service leadership and frontline delivery project mentoring and coaching to

1. Support cultural change
2. Build leadership capacity
3. Empower staff teams to co-produce and deliver change ideas aligned to the programme aim above

• Incorporate Lived Experience input at all levels - from co-production of change on the ground, to embedded involvement in the core programme delivery group, to representation on the programme's steering group
• Share and disseminate good practice and learning coming out of the programme

The programme takes a phased approach:

• Phase 1 (Jan '23 - Jul '23): Design work and pilot recruitment 

• Phase 2 (Aug '23 - Mar '24): Pilot implementation within recruited services 

• Phase 3 (Apr '24 - Jun '24): Refinement of programme design and recruitment for wider implementation 

• Phase 4 (Jul '24 - Mar '25): Wider implementation of programme within recruited services 

• Phase 5 (Feb '25 - Mar '25): Reporting and communicating key findings to the sector