by Gemma S.

I have been a qualified social worker since July 2021, and ten months ago, I was diagnosed with bipolar disorder.

An estimated 40 million people live with bipolar disorder worldwide, yet this is often viewed negatively in society. Stigma and discrimination are widespread, both within communities and health services.

‘I found myself hiding my diagnosis’

When I received my diagnosis, I really struggled emotionally. In truth, I mourned for my former self.

I strove to be open, raise awareness and show there was no shame in being bipolar. But I soon discovered it was not as easy as I initially thought. I found myself hiding my diagnosis and feeling ashamed of it.

At the beginning I was even unsure about disclosing my diagnosis at my workplace, out of fear I would be regarded negatively.

As a social worker, I pride myself on showing kindness, challenging injustice and working with people who feel on the margins of society.

But I was not giving myself that same kindness and understanding or standing up for what I thought I needed.

Ultimately, talking to my team felt right – I had built a good relationship with them and had a desire to support others in understanding mental health conditions.

A third of people with bipolar disorder face workplace discrimination

According to a 2020 survey carried out by mental health charity Bipolar UK, while 90% people disclosed their condition to their employer, 24% ended up regretting it.

The reasons for this were evidenced in a follow-up 2024 survey, where nearly a third (32%) of over 1000 individuals with bipolar disorder revealed they had faced workplace discrimination.

This time a quarter chose to keep their condition private.

A 2024 Community Care poll, meanwhile, found that over half of 625 respondents had either experienced or witnessed mental health-related prejudice.

However, one commentator on the related article spoke about how disclosing a diagnosis could help model authenticity about anti-discriminatory practice. That resonated with me.

I do feel that sharing my story with my manager and team has allowed me to be my authentic self.

‘They huddled around me like one big hug’

Having the right people in your corner is paramount.

I feel very fortunate to have an amazing team at the council I work at. They have shown understanding and care about my wellbeing.

On one occasion, when I was experiencing a depressive episode, I messaged my team and manager that I was struggling and feeling low, but that I still felt able to work.

They huddled around me like one big hug; checking in with me, offering a listening ear and recommending support services like occupational health and counselling/support groups within the local authority.

My team supported me with my workload and even brought in snacks and pop. It meant the world to me, and I truly appreciate them all.

Most importantly, this allowed me to continue working full-time and progress in a job that I love.

It makes me sad to know this is not everyone’s experience.

Receiving services as a social worker 

Adapting to my new identity as ‘someone who receives services’ has been a challenging experience.

As a person with lived experience and a professional, I was able to fight for the care I wanted. But there have been times when I felt vulnerable and powerless.

I have had to really fight for person-centred care for myself, to have a say and be part of the co-production around my own care.

When picking up my prescription from the pharmacist, medication changes were made without my input or any notification. I challenged this and asked the community mental health team to work with me, not for me.

I requested regular reviews and asked to be included in all discussions and decisions, as this is what I advocate for the people I support.

‘It’s important to be kind to yourself’

Currently, l feel positive about my future in social work and am returning to university to enhance my learning.

I am managing my bipolar disorder through medication, with support from my mental health team, practising good self-care and managing my wellbeing.

I have realised that being kind to myself is so important, especially when navigating life as a social worker. It requires much self-love, empathy, kindness and understanding.

‘Reach out for support’

I am sharing my experience to raise awareness that, even as a professional working within health and social care, I have faced difficulties with receiving person-centred support.

Working in a pressurised and demanding environment can be a challenge for anyone, but particularly for people with a mental health condition.

It is so important to reach out for support and have the backing of a marvellous team.

Think Ahead has raised concerns about cuts to mental health social work job numbers as it launched a campaign for the government to invest in thousands more roles.

The fast-track social work training provider said it had seen “trends of mental health social work roles disappearing in some NHS teams”, while some employers were pulling out of its programme on budgetary grounds because they could not commit to providing salaried jobs for trainees on qualification.

Under Think Ahead’s two-year programme to train people as adult mental health social workers, participants spend a qualifying year placed with an NHS or local authority employer, who then takes them on as a salaried employee in year two.

Cutbacks in mental health social work roles

The charity said that, of employers who partnered with it in 2024, 35% were unable to do this year for financial reasons, up from 20% of partners who pulled out last year for similar reasons. It said this was affecting NHS trusts more than councils.

“What we are experiencing in terms of the development of our programme is that where budgets are squeezed, non-clinical roles, like mental health social workers, seem to be first to take the hit – perhaps because they are seen as non-essential to mental health,” said Think Ahead chief executive Philippa Mariani.

Cutbacks to mental health social work numbers would mark a turnaround from the 20% growth in NHS mental health trusts seen from 2019-22, which left 3,576 whole-time equivalent (WTE) practitioners in post.

Despite the growth, this accounts for just 2% of England’s NHS mental health workforce, which numbered about 143,700 in 2023, according to think-tank the Nuffield Trust, with about twelve times as many mental health nurses (about 45,000) as social workers.

Also, the profession was not mentioned at all in the 2023 NHS workforce plan, prompting criticisms from Think Ahead and the British Association of Social Workers.

Call for 24,000 more practitioners

The plan is due to be refreshed this year and Think Ahead said it wanted to see a sevenfold rise in the number of NHS mental health social workers, to almost 28,000, over the next 10 years.

This is based on everyone with severe mental illness in England – of whom there were about 624,000 in 2024, according to an NHS estimate – having a social worker, and practitioners having a caseload of 20-25. The latter is based on a proposed limit for adults’ social workers set out in a 2022 report for Social Work Scotland.

Think Ahead said recruiting many more social workers would help tackle the social issues that were associated with mental ill-health, including those related to housing, poverty, employment, relationships and social connections.

Mariani said that, besides working in community mental health teams, social workers could be used more in inpatient settings, to support people’s recovery and discharge.

Think Ahead’s ambition would involve the recruitment of a net additional 2,400 social workers annually over the next decade, which the charity said would cost £130m in year one, including salary, oncosts and recruitment.

Social workers ‘a vital lifeline’ for tackling inequalities

Its Social Work Matters campaign was backed by charity the Centre for Mental Health, whose chief executive, Andy Bell, said social workers were “a vital lifeline” for tackling the inequalities faced by people with severe mental illness, including in relation to income, employment and life expectancy.

The NHS Confederation, which represents healthcare bodies, was also supportive, with its mental health director, Rebecca Gray, saying: “We welcome Think Ahead’s call to invest significantly more in mental health social workers in the NHS.

“They play a crucial role as part of multidisciplinary mental health teams – for example, in supporting patients who are leaving hospital, to finding suitable accommodation and working with parents who have mental health issues. This is so important as parental mental health is a significant risk factor for child mental health.”

Call for Casey Commission to address mental health social work

She said the Confederation hoped that Baroness Casey’s government-appointed commission on adult social care, due to start work shortly, “will present an opportunity to properly address the role and contribution of mental health social workers”.

In response to Think Ahead’s campaign, a Department of Health and Social Care spokesperson said: “Mental health social workers provide an invaluable service, and the workforce is critical to our reforms.

“We will publish a refreshed long-term workforce plan that ensures we have the right people, including mental health staff, in the right places, with the right skills to deliver the care patients need when they need it.”

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Many disabled people are facing benefit cuts in a government plan to save over £5bn a year by 2029-30 and get more people with health conditions into work, announced yesterday.

Access to personal independence payment (PIP) – the main disability benefit for people of working-age – would be restricted, while incapacity benefit rates for those out of work would be frozen for existing claimants and halved for new recipients.

At the same time, the Department for Work and Pensions (DWP) would invest an extra £1bn a year in employment support by 2029-30 in order to help get more disabled people into work.

Disabled people would also get a new right to try work without immediately losing access to benefits, while those whose lifelong conditions mean they will never be able to work would be given a benefits premium and spared reassessments.

‘Helping people who can work to do so’

Work and pensions secretary Liz Kendall, who launched the Pathways to Work green paper in a statement to Parliament, said the proposals were about “helping people who can work to do so, protecting those most in need, and delivering respect and dignity for all”.

The DWP will not publish an impact assessment of the reforms until next week, so it is not known as yet how many people will have their benefits cuts. However, charities warned the proposals would drive many disabled people into deeper poverty.

Scope said the changes would be “catastrophic for disabled people’s living standards”, while the Centre for Mental Health warned that they would worsen mental health, a concern also raised by NHS leaders.

Rising benefits caseload and cost

The green paper is the government’s response to the significant increase in the number of working-age people claiming disability benefits (mainly PIP) or incapacity benefits (employment and support allowance or the health element of universal credit) in the wake of the pandemic, and the ensuing rise in costs.

According to think-tank the Institute for Fiscal Studies (IFS), spending in Great Britain on these benefits grew from £36bn to £48bn in real-terms from 2019-20 to 2023-24 and are projected to hit £63bn in 2028-29 (in 2024-25 prices).

Annual spending on disability benefits grew by 45% in real-terms, and the number of recipients by 39%, while the inflation-adjusted cost of incapacity benefit grew by 26% and the caseload by 28%, from 2019-20 to 2023-24.

Greater levels of disability in population

The government has admitted that this has been, in part, caused by rising levels of disability, with 36% of people of working-age now having a long-term health condition, up from 29% a decade ago.

However, it said that this was being outstripped by the rise in the number of successful claims for disability or incapacity benefits. According to DWP figures, the number of disabled working-age people in England and Wales increased by 17%, but the numbers receiving an incapacity or disability benefit increased by double that amount (34%), from 2019-20 to 2023-24.

The DWP said this meant that the “structure of the benefits system” was partly responsible for the rise in cases.

In particular, the green paper said there was a “perverse” incentive within the incapacity benefits system for people to be found to have “limited capability for work and work-related activity” through the work capability assessment (WCA).

As a result, they are put on the health element of universal credit (UC) and receive £97 per week, in addition to the standard universal credit allowance, which is worth £91 per week for single people aged over 25. The difference in what they receive and what is given to those just on the standard allowance has grown over time due to a freeze in the standard allowance from 2015-19.

Changes to out-of-work benefits for disabled people

To address this issue, the DWP said it would:

• Scrap the WCA, meaning people would no longer be assessed on how far their disabilities or health conditions limited their ability to work. In future, the health element of UC would only be available to people assessed as eligible for the daily living component of PIP (see below). This is expected to come into force in 2028-29.
• Freeze the health element of UC at £97 per week until 2029-30 for existing claimants and halve the rate to £50 per week for new claimants, from 2026-27. In the spring statement on 26 March 2025, the government said that the £50 per week rate for new claimants would also be frozen until 2029-30.
• Increase the standard allowance of UC – for new and existing claimants – from £91 to £98 per week, from 2026-27. Combined with the cuts to the health element, this would significantly narrow the gap between payments to people without health conditions who only receive the standard allowance and those with a condition who receive both the standard allowance and health element.
• Consult on raising the minimum age for the UC health element from 18 to 22, with the savings reinvested in work support for young people. This would be to “remove any potential
  disincentive to work” and support the government’s “youth guarantee”, to give those aged 18-21 access to education, training or help to find a job.
• Enhance investment in employment support for people who are out of work who have a work-limiting health condition or disability, with an extra £1bn a year provided by 2029-30.

To protect those with the highest needs, the DWP said it would pay an additional premium on the health element of UC for those with severe, life-long health conditions, who have no prospect of improvement and will never be able to work, and ensure that they would not have to have to be reassessed.

Restricting access to PIP

Despite the government’s emphasis on getting more disabled people into work, one of the biggest measures in the green paper is restricting access to PIP, which is designed to compensate people for the costs of disability and is paid regardless of work status.

The DWP said spending on PIP was “becoming unaffordable” and needed to be focused on those with higher needs.

To restrict eligibility, it plans to bar people from receiving the daily living component if they do not score at least four points on any one of the 10 assessed activities, a policy that would apply to new applicants from 2026-27 and existing claimants, at the point of review. To be eligible for the daily living component of PIP, you must score at least eight points across all 10 activities.

Under the plans, you would not be eligible if you needed assistance to wash your hair or wash below your waist (two points) or needed assistance getting in or out of the shower (three points), under the washing and bathing activity, unless you scored four points or more in one of the other activities.

The DWP said it was “mindful of the impact this change could have on people” and so would consult on offering a review of disabled people’s health and eligible social care needs should they lose access to PIP.

Loss of benefit

The IFS said the impact of the reforms to PIP was uncertain because the consequences of changes to eligibility criteria were hard to predict. However, it added that:

• People who received the health element of UC but were not eligible for PIP would lose access to the health element through entitlement being based on the PIP assessment. This would make them worse off by £2,400 a year (in today’s prices), from 2028-29. Currently, 600,000 people qualify for the health element of UC but do not receive PIP.
• About 2.4m families would be worse off by £280 a year by 2029-30 due to the freeze in the health element of UC.
• New claimants for the health element of UC would be worse off by £2,500 a year than were the green paper changes not introduced.

The proposals sparked widespread anger from disability and anti-poverty charities.

Government ‘choosing to penalise some of society’s poorest’

With almost half of families in poverty having at least one disabled person, Scope said the government was “choosing to penalise some of the poorest people in our society”.

While welcoming the increased investment in employment support, the charity’s executive director of strategy, James Taylor, said this would be undermined by the benefits cuts.

“These cuts will be a catastrophe for disabled peoples’ living standards and independence,” he added. “The government will be picking up the pieces in other parts of the system with pressure on an already overwhelmed NHS and social care, as more disabled people are pushed into poverty.”

Impact on carers and child poverty

The End Child Poverty Coalition and Child Poverty Action Group warned that the measures risked deepening child poverty – which the government is developing a strategy to tackle – while the Carers Trust and Carers UK flagged up the impact of the proposals on carers.

Access to carer’s allowance is dependent on the person caring for someone who receives one of a set of disability benefits, and Carers UK said half of awards are tied to the person being cared for receiving PIP. It also pointed to the fact that disability rates are higher among carers than in the general population, with about 150,000 people receiving both PIP and carer’s allowance.

“1.2 million unpaid carers in the UK are living in poverty, (with 400,000 in deep poverty),” said its chief executive, Helen Walker. “Raising the qualifying threshold for support could mean even more carers will struggle to afford essentials like food and heating.”

Risk of deterioration in mental health

The Centre for Mental Health, meanwhile, warned of an adverse impact of the policy changes on people’s mental health.

While welcoming the planned increase in employment support funding, chief executive Andy Bell said: “Evidence shows that when governments tighten benefit rules, people’s mental health gets worse. If more people fall into poverty, both the prevalence and severity of mental ill health is likely to rise.”

This issue was also picked up by health trust representative body NHS Providers, which warned that the proposals risked increasing pressures on mental health services.

“Mental health trust leaders previously told us that changes to universal credit and benefits were increasing demand for services, as were loneliness, homelessness and wider deprivation,” said its interim chief executive, Saffron Cordery.”

“With poor mental health the leading driver of ill-health related economic inactivity, they will also be worried that today’s announcement could lead to worse mental and physical health for patients and shift further costs and pressures onto the health and care system, including overstretched emergency departments and mental health services.”

By Tim Spencer-Lane

The Mental Health Bill, which would amend the Mental Health Act 1983 (MHA), has now passed through committee stage in the House of Lords after five days of debate.

This stage allows peers to scrutinise the detail of a bill, although by convention no votes are taken on tabled amendments.

Committee stage normally provides an important indicator of which issues peers are interested in and may revisit at third reading, where amendments are likely to be put to a vote. It is important to remember that the government does not have a majority in the Lords and could be defeated on particular votes.

Principles

The bill does not insert principles onto the face of the MHA. Instead, it sets out four principles (choice and autonomy, least restriction, therapeutic benefit, and the person as an individual) to be included in the MHA code of practice.

Baroness Tyler (Liberal Democrat) was concerned that “placing the guiding principles in the code leaves a loophole in which they can be deviated from”. She also proposed that “equity” should be added to the principles to “provide additional momentum towards the goal of addressing the racial disparities in the Mental Health Act”.

Lord Bradley (Labour) supported a principle based on identifying and supporting “the communication needs of the individual”.

In response, Baroness Merron (parliamentary under-secretary of state, Department of Health and Social Care), argued that, in respect of statutory principles “the real concern is about making very complex legislation even more complex”.

Unlike the Mental Capacity Act 2005 (MCA), the MHA “has not been designed or structured around statutory principles”. She also argued that “it feels unnecessary to include equity as a specific principle because it is already a requirement of the Equality Act 2010” and that the code of practice will give guidance for practitioners “on how to support individuals with communication needs to make sure that their voices are heard”.

Learning disability and autism exclusion

A topic that dominated debates in the Lords was the position of people with learning disability and autistic people. The bill would prohibit people being detained for treatment under the MHA solely on the basis of learning disability or autism.

Baroness Browning (Conservative) welcomed “the removal from the Mental Health Act of the presumption of mental illness in people with autism and learning difficulties”.

However, she was concerned that “once it is removed the Mental Capacity Act will be used more frequently” to deprive autistic people and people with learning disabilities of liberty. In relaition to this, she pointed to the widespread difficulties associated with the Deprivation of Liberty Safeguards.

Baroness Berridge (Conservative) argued “there is the other danger that – when there is no co-occurring mental health condition – you end up with people coming through the criminal justice system”.

In response, Baroness Merron stated that “the number of people with a learning disability and autistic people in mental health hospitals is indeed unacceptable”. She argued that the government did not want the MCA to “be a loophole, back door or anything of that nature”.

She also pointed to the bill’s duty on integrated care boards (ICBs) to establish and maintain a register of people with a learning disability and autistic people who are at risk of detention. ICBs and local authorities must have regard to the register and the needs of the local ‘at risk’ population, when carrying out their commissioning duties.

Baroness Merron said the intention of these provisions was that “people with a learning disability and autistic people are not detained but supported in the right way”.

Professional roles and responsibilities

Amendments were tabled by the former prime minister, Baroness May (Conservative), intended to “widen the definition of those who can attend a mental health incident and act to detain an individual in a variety of circumstances”.

These aimed at extending the powers given to police officers to remove a person suffering from a mental health crisis to a place of safety, to health and social care professionals (including social workers and paramedics). The proposals were supported by several peers, who argued it would lead to the reduction of police attendance at mental health incidents, in line with the Right Care, Right Person concordat.

However, Baroness Merron argued that “extending the ability to health and social care professionals to enter someone’s home without their permission would be a major shift in their roles” and “it would impact on relationships between patients and health and care staff”.

She committed to look at reducing police time in health settings and to update the code of practice to clarify the handover process between police and health, including in A&E.

Community treatment orders (CTOs)

The bill proposes to tighten the criteria for the use of CTOs and limit how often they are used. A range of views on CTOs were expressed in the debates. Baroness Fox (non-affiliated) referred to their “spiralling and increasing use”. She noted that “CTOs are necessary when community care is under huge strain, because the idea of voluntarily accessing a wide variety of support in the community is a myth in today’s circumstances”.

Baroness Berridge (Conservative) felt that CTOs should be “in the last chance saloon”. On the other hand, Baroness Parminter (Liberal Democrat) felt that CTOs “can be valuable for people with eating disorders – and for forensic patients”. Lord Kamall (Conservative) called for more data on why a disproportionate number of black people were subject to CTOs.

Baroness Merron restated the government’s position that “CTOs can be valuable for certain patients” but “reform is needed so that they are used only when appropriate and for the shortest possible time”.

She also confirmed that “officials are working with NHS England and others to understand what additional data should be collected to understand the impact of the reform”, adding that the government was “committed to ongoing monitoring of CTOs as we implement the changes”.

Children and young people

Many of the safeguards in the bill are linked to a determination of capacity (for those aged 16 and over) and competence (for those aged under 16); for example, the rights for a child to appoint a nominated person or make an advance choice document depend on their competence to make this decision.

However, Baroness Tyler (Liberal Democrat) raised concerns that “there is also no clear and consistent approach for determining whether a child is competent. Although the concept of competence is generally understood, how to assess a child’s competence is not.”

Consequently, she argued, children may not benefit from the reforms in the bill that depend on competency.

Several peers called for a statutory test of competency to be inserted onto the face of the MHA. Lord Meston (crossbench) tabled an amendment which adopted the MCA’s functional test but without the need to consider if the inability to make the decision is caused by an impairment of or disturbance in the mind/brain.

Peers were concerned about how the nominated person role, which replaces the nearest relative, would work for children and young people. Baroness Berridge (Conservative) called for a prescribed list of people that an approved mental health professional could appoint as the nominated person for children and Baroness Butler-Sloss (crossbench) called for greater rights for parents to be consulted and challenge appointments in the court.

The bill does not provide any reforms aimed at addressing the position of children placed on adult mental health wards and those placed in hospitals out of area. Earl Howe (Conservative), therefore, called for procedural safeguards for children placed on adult wards and Baroness Berridge (Conservative) wanted a new notification process for out-of-area placements.

For the government, Baroness Merron rejected the amendment for a statutory test of competency, pointing out that the courts had rejected the proposed definition.

She added: “To introduce a statutory test for under-16s only under the Mental Health Act is likely to risk undermining Gillick, which remains the accepted competence test for under-16s across all settings, including reproductive health and children’s social care, and the wider legislative framework on matters related to children.”

The minister also said detailed guidance would be provided in the code on how the nominated person role would work for children and young people, and confirmed that people who were a risk to a child could not be the nominated person.

Baroness Merron said that additional guidance would be provided “on the process to determine, and review throughout a child’s detention and treatment, that the environment in which they are accommodated continues to be in their interests”.

Racial disparities

The bill does not include any reforms expressly aimed at reducing racial and ethnic inequalities in the use of the MHA. However, there was depth of feeling amongst peers when debating this area.

Baroness Whitaker (Labour) highlighted the discrimination faced by the Gypsy, Roma and Traveller communities and their lack of access to services. Baroness Tyler (Liberal Democrat) felt that the bill “still does not go far enough to address that deeply entrenched inequity”. Lord Kamall (Conservative) probed the government “to understand what they know and what research they are aware of, so we can understand the reasons for these racial disparities and put in place measures to tackle them”.

Some peers called for the creation of a “responsible person” in each hospital who would be responsible for driving change

Baroness Merron acknowledged the need for better data and argued that the patient and carer race equality framework (PCREF) “will improve data collection on racial disparities over the coming year, and the [Care Quality Commission (CQC)] has existing duties to monitor and report on inequalities under the Mental Health Act”.

She also said the department “will continue to monitor racial disparities in the use of CTOs”. But the minister rejected the creation of a responsible person role as “it would duplicate existing roles and duties”, including the public sector equality duty under the Equality Act 2010 and the monitoring role of the CQC.

Implementation of the reforms

Many peers called for greater clarity and specific guarantees over when the bill would be implemented.

Lord Scriven (Liberal Democrat) tabled an amendment to “create an obligation for the government to lay a costed plan for sufficient services before Parliament within four months of the passage of the bill”. Baroness Tyler (Liberal Democrat) called for a costed plan for community care to support the reforms in the bill and Lord Stevens (crossbench) advocated for a statutory backstop for implementing the bill.

Baroness Merron set out an indicative plan for implementing the bill. The first priority would be the code of practice (which would take a year) and the secondary legislation. There would be training of the existing workforce in 2026-27 and commencement of the “first major phase of reforms in 2027”. It would take up to 10 years to fully implement the bill.

Mental health commissioner

The joint committee on the draft bill had recommended the post of a statutory mental health commissioner should be created to provide an independent voice advocating for mental health service users and act as a watchdog to oversee the implementation of the reforms. This was not included in the bill.

Baroness Tyler (Liberal Democrat) called for the creation of a statutory commissioner to provide “sustained leadership for mental health”, transform mental health services and drive forward the reforms.

Lord Bradley (Labour) disagreed with claims that the commissioner would duplicate the functions of the CQC, pointing to the example of the Children’s Commissioner for England, which functions alongside Ofsted. Lord Kamall (Conservative), however, expressed some concern about the creation of a new bureaucracy.

Baroness Merron repeated that a commissioner would duplicate existing functions of the CQC and Healthcare Inspectorate Wales, as well as NHS England. She also claimed that the Children’s Commissioner was operating in a much broader landscape than that proposed for the mental health commissioner and was therefore less duplicative.

The ‘human rights protection gap’

In the months leading up to the publication of the bill, the High Court handed down its judgment in Sammut v Next Steps Mental Healthcare Ltd [2024] EWHC 2265 (KB). This decision confirmed that private care providers commissioned by local authorities and NHS to deliver services under section 117 of the MHA were not public authorities for the purposes of the Human Rights Act 1998, so were not bound by its provisions.

Consequently, Baroness Keeley (Labour) raised concerns about the ongoing gap in protection for those receiving care from the private sector and tabled an amendment to extend the protection of the Human Rights Act to include all section 117 service users, informal patients and those being deprived of their liberty in any setting. The amendment was strongly supported by ‘legal’ members of the Lords – Lord Pannick (crossbench), Baroness Chakrabarti (Labour) and Baroness Butler-Sloss (crossbench).

In response, Baroness Merron confirmed the government was “actively considering” this matter.

What was not debated at committee stage

It is noteworthy that several important areas of the bill received little mention in the debates.

These include the new powers to enable restricted patients, who have capacity to consent to their arrangements, to be discharged from hospital with conditions amounting to a deprivation of liberty. Stakeholders have raised concerns that the reform crosses the Rubicon by allowing the detention of people with capacity in the community and argued that greater safeguards are needed.

The part 4 reforms concerning consent to treatment also provoked little debate, no doubt in part because of their complexity. But there was little discussion of matters such as the  increased right for mental health patients to refuse medication and urgent electroconvulsive therapy, as well as the new clinical checklist to guide decision makers.

There was also no mention of the reforms to the meaning of ordinary residence for the purposes of section 117 aftercare services, including the introduction of new ‘deeming rules’. These will have a significant impact on local authority funding of section 117 services.

What happens next?

The next stage for the bill will be the report stage, which is an opportunity for the whole House of Lords to consider what has been done during the committee stage. This will be followed by the third reading which is the final opportunity for peers to consider the whole bill. Amendments will be tabled, debated and voted on during these stages.

The bill will then be considered by the House of Commons.

Tim Spencer-Lane is a lawyer specialising in adult social care, mental capacity and mental health and legal editor of Community Care Inform. 

A lack of staff and hospital beds, at a time of “overwhelming demand”, is leading to “harmful” gaps in mental healthcare, the Care Quality Commission (CQC) has said.

As a result, people were being discharged prematurely, often without adequate community support, leading to cycles of readmission to hospital, with increasing use of inappropriate out-of-area placements.

The warnings came in the regulator’s annual report on its monitoring of the Mental Health Act 1983, which covered 2023-24.

This was based on conversations with 4,634 patients and 1,435 carers from 823 monitoring visits to mental health services, interviews with other people with lived experience of detention and analyses of national data on mental health.

Spike in demand for care

Demand for mental healthcare has grown significantly in recent years, said the CQC, which reported that:

• There had been a 43% rise in the number of people in contact with secondary mental health services in the five years to March 2024, according to NHS England’s mental health services data set (MHSDS).
• There was an 18% increase in the number of adults with a serious mental illness who accessed community mental health services between March 2023 and March 2024 (source: MHSDS).
• The number of very urgent adult referrals to crisis teams more than doubled in 2023-24.

The latter figure suggested that people were becoming more unwell while waiting for help than was previously the case.

People ‘more unwell on admission than in the past’

This was reflected in services reporting that people admitted to hospital under the MHA now were more unwell than in the past, which the CQC said could increase recovery time and made it more difficult to admit new patients.

However, inpatient services lacked sufficient beds, which meant that occupancy levels in mental health wards continued to be much higher than the 85% maximum recommended by the Royal College of Psychiatrists. Since the start of 2023-24, the occupancy rate has ranged from 89.6%-90.6%, according to the college.

The pressure on beds meant people were placed on wards that were not suitable for them. For example, the CQC observed that people with dementia or cognitive impairments had been placed on wards for those with functional mental health conditions, meaning they were not cared for in dementia-friendly environments.

In another case, seclusion rooms – which are designed to segregate patients from others in times of crisis – were being used as bedrooms due to bed shortages, meaning people were being cared for in overly restrictive settings.

Rising numbers of out-of-area placements

The situation was also leading to people being placed in hospitals far from home, with official figures showing there were 5,500 new inappropriate out-of-area placements in 2023-24, up 25% on the previous year, the CQC said.

The regulator cited a report last year from the Health Services Safety Investigations Body (HSSIB), which found that people were being harmed by OAPs, due to the increased anxiety of not knowing new staff and being separated from support networks.

The CQC said it saw “multiple examples” of people being placed out of area, without clinical benefit, because of a lack of local beds.

‘Pressure to discharge least unwell patients’

The pressures on wards meant managers felt they had to discharge the “least unwell” patients, with carers also telling the CQC that loved-ones had left hospital too soon.

The regulator found examples of good practice in the provision of post-discharge support, however, this was affected by the pressures on community services, which increased the risks of readmission.

Though the MHA code of practice states that aftercare, provided under section 117 of the act, should encompass health, social care, employment support and supported accommodation, as required, the CQC said its provision was “often far less holistic” than this.

Lack of staffing

Service pressures were exacerbated by a lack of staffing, despite a 35% rise in the number of full-time equivalent mental health workers in the NHS from 2019-24.

Issues included wards not having a permanent responsible clinician, multiple wards not having occupational therapists available and others not having physiotherapists.

Staff shortages led to activities, such as group excursions, day trips and access to gyms, being delayed or cancelled, and patients being prevented from taking authorised leave, potentially delaying recovering and leading to distress.

The situation was leading services to use agency or bank staff, resulting in a lack of continuity of care for patients and, sometimes, poor interactions between staff and patients.

Also, shortages and a high turnover of care co-ordinators in the community led to challenges with the discharge process.

In addition, the CQC found that gaps in staff knowledge were affecting the quality of care for autistic people and those with a learning disability, with some staff having not completed mandatory learning disability and autism training.

People’s rights not explained to them

Other issues cited by the regulator included cases of people not understanding their rights under the MHA. This included:

• patients not being informed of their rights at admission or significant delays them being informed after admission;
• staff not providing updates to patients on their legal rights when the section of the act under which they were detained changed;
• patients not being referred to an independent mental health advocate (IMHA) when they did not understand their rights;
• legal rights information not given in a person’s preferred language.

‘Legislation alone won’t fix issues’

The report comes with the government legislating to reform the MHA in order to reduce the use of detention, improve patients’ rights over their care and prevent autistic people and those with learning disabilities from being detained without a co-occurring mental health condition.

While acknowledging the aims of the Mental Health Bill, the CQC said the sector’s problems could not be fixed by legislation alone, in the absence of additional resource.

“It is essential that the government addresses these significant gaps now to protect people for the future,” said the regulator’s interim director of mental health, Jenny Wilkes. “With the right funding, a sustainable and well-trained workforce and enough beds to meet demand, we can break this damaging cycle.”

‘The very opposite of dignified, humane care’

In response to the report, the chief executive of the charity Mind, Sarah Hughes, echoed the CQC’s calls for greater investment in community care, the workforce and mental health facilities.

“Fundamental problems with the very basics of safe care, like adequate staffing levels, bed capacity and run-down hospitals, are severely impacting people’s ability to properly recover,” she added.

“Being sent hundreds of miles away from your family and loved ones, and not even being able to contact them due to facility issues, would be difficult enough at the best of times, let alone when you’re experiencing a mental health crisis. Isolating people in this way, and holding them in crumbling, outdated facilities, is the very opposite of dignified, humane care.”

Social work opinion is divided on the police withdrawing from attending mental health incidents, a poll has found.

This follows approved mental health professionals (AMHP) raising safety concerns over the lack of police involvement since the introduction of the right care, right person (RCRP) policy in 2023.

Under RCRP, police should only attend mental health callouts to investigate a crime or when there is a real and immediate risk to life or of serious harm.

The policy was based on an analysis that found 45% of police attendances involved no crime or immediate threat of serious injury.

Yet, a Community Care poll with 1760 votes revealed a divide in social work opinion on whether the police should be attending most mental health incidents.

While just 13% agreed with the RCRP policy outright, a further 46% said they supported it in principle, but stressed that health and social care would need to be resourced to deal with the added workload. 

However, 41% believed police absence would put practitioners at increased risk.

Overreliance on the police force

Some social workers took to the comments section of the related article to speak out about social care’s overreliance on the police to “plug the gaps”.

“Taking police for granted that they will plug the gaps in our services and be an alternative safe space was always going to bite us eventually,” said one practitioner.

“I had this discussion practically every opportunity I got in the past four years with our AMHP lead but, as ever, it went nowhere.”

Gill S agreed that police involvement had helped mask social care’s lack of resources.

However, she warned that while officers should step back “from a responsibility which is beyond their remit”, the pace at which this was happening was worrying. 

“The impact on services and individuals could be catastrophic.”

“We as AMHPs, as mental health workers and social workers, need to own our responsibility in our overreliance on the use of police as a default,” added Tahin.

“There we are telling the public that people with mental illness are no more violent than them but seek police assistance as routine. Why? We too are culpable for why the police have decided to narrow their reasons for responding.”

Safety concerns

However, others voiced safety concerns over practitioners attending mental health assessments alone.

“Police should be involved where necessary as they have more safety equipment where doctors and AMHPs have a pen and a piece of paper,” said one practitioner.

“They are crucial in some cases in the [presence] of harm to the individual concerned and the other people involved, including family members. I speak from a 40-year career in social care.”

Sheena, who quit social work after being attacked while completing an assessment alone, stressed the danger of practitioners working at early hours on their own.

“The attack ended my social work career. They stated that the local authority could not foresee that I would have been attacked. My concern [is] aimed at the lone working policy out of hours and how this places AMHPs at unacceptable risk.”

Another practitioner, Neil, spoke out about the danger police absence posed to both citizens and AMHPs.

“After 14 years of disastrous austerity cuts, including over £40 billion from local authorities, and over 3,000 inpatient beds cut, there is no money in the NHS or councils to fund practical support for AMHPs or other mental health staff to do their riskiest work, such as mental health assessments. 

“The police knew this but withdrew anyway.”

What are your thoughts on reduced police presence during mental health incidents?

Celebrate those who’ve inspired you

Photo by Daniel Laflor/peopleimages.com/ AdobeStock

We’re expanding our My Brilliant Colleague series to include anyone who has inspired you in your career – whether current or former colleagues, managers, students, lecturers, mentors or prominent past or present sector figures whom you have admired from afar.

Nominate your colleague or social work inspiration by filling in our nominations form with a letter or a few paragraphs (100-250 words) explaining how and why the person has inspired you.

If you have any questions, email our community journalist, Anastasia Koutsounia, at anastasia.koutsounia@markallengroup.com

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The government has budgeted for a 2.8% rise in NHS salaries in England next year.

The money would cover both the headline pay rise for staff on Agenda for Change (AfC) contracts – including social workers and social care staff employed by NHS trusts – and planned changes to the AfC pay structure.

The Department of Health and Social Care (DHSC) announced the plan in its submission to the independent NHS Pay Review Body (NHSPRB).

Based on the DHSC’s evidence and that of the Welsh Government, Northern Ireland Executive, NHS employers, trade unions and others, the NHSPRB will make recommendations for AfC staff in England, Wales and Northern Ireland for 2025-26.

It will then be up to the three governments to accept or amend these in relation to their countries’ staff.

5.5% rise this year for NHS staff

Shortly after taking power in July 2024, the Labour government accepted the NHSPRB’s recommendations of a 5.5% rise for AfC staff in relation to workers England in 2024-25.

The Welsh Government subsequently followed suit in relation to staff in Wales.

This meant that NHS social workers in England and Wales were given a larger pay rise this year than counterparts in most local authorities, who received increases of 3-4%.

Council concerns over social work pay differences

This prompted concerns from the Local Government Association (LGA) that councils were losing ground to the NHS in terms of social worker pay competitiveness.

However, in Northern Ireland, where statutory social workers generally are employed by the NHS, no deal has been done because the region’s Department of Health says it cannot afford to deliver the NHSPRB’s recommendations.

The DHSC’s submission to the review body would, if implemented, entail a headline salary rise for NHS staff of less than 2.8% in 2025-26.

The remaining budget would be spent on amending the AfC pay structure, including to tackle the relatively small differences between some pay bands, which the NHSPRB has said creates disincentives for staff to seek promotion.

Prospect of real-terms pay cut

With the independent Office for Budget Responsibility (OBR) predicting an average rate of inflation of 2.6%, this would mean that many staff would likely see a real-terms pay cut or freeze.

In justifying its submission, the DHSC said it faced an “extremely challenging fiscal position”, in which the AfC pay rise would need to be considered alongside other priorities.

While NHS England’s budget is due to rise from £182.8bn this year to £193bn in 2025-26, a cash increase of 5.6%, the DHSC said the health service needed to boost productivity and efficiency to achieve the government’s targets around cutting waiting times.

Should the NHSPRB recommend a higher increase than that budgeted for by the department, the DHSC said it would need to consider “difficult trade-offs” in relation to NHS budgets.

‘Not what NHS workers wanted to hear’

The proposals were criticised by UNISON, whose head of health, Helga Pile, said they were “not what NHS workers wanted to hear”.

“Staff are crucial in turning around the fortunes of the NHS,” she added. “Improving performance is a key government pledge, but the pay rise proposed is barely above the cost of living.”

The government should invest in mental health social work to meet its key objectives for the NHS, Think Ahead has said.

Recruiting more social workers will help mental health services move from “hospital to the community” and “from sickness to prevention”, two of three overarching goals set by Labour for the NHS, the training provider claimed.

However, the profession is not being prioritised by the health service, with practitioners facing “unacceptably high caseloads”, it warned.

Profession not mentioned in workforce plan

And despite about 3,600 full-time equivalent mental health social workers working in the NHS as of 2022, the profession was not mentioned once in last year’s NHS long-term workforce plan, published under the Conservatives.

Think Ahead, which runs a fast-track course to train people as mental health social workers, made the claims in a submission to a government consultation designed to shape the forthcoming 10-year plan for the NHS.

It said supporting mental health recovery involved addressing the social challenges people faced – such as housing, poverty or relationship issues – alongside clinical care, with social workers being ideally placed to carry out this role.

Lack of investment in mental health social work

However, this was being stymied by a lack of investment in the workforce that left practitioners “overstretched” and carrying “unacceptably high caseloads”.

As a result, they were only able to respond to people in crisis and were unable to carry out the relationship-based practice needed to help them navigate complex challenges in their lives, build independence and overcome barriers to treatment.

Though the number of mental health social workers in the NHS grew by 20% from 2019-22, Think Ahead said some trusts saw the profession as a “nice to have”, rather than critical to service delivery.

Councils withdrawing social workers from joint teams

And over the past several years, several councils have withdrawn social workers from integrated NHS-based teams by dissolving partnership agreements under section 75 of the NHS Act 2006.

Think Ahead pointed to a recent report on out of area placements by the Health Services Safety Investigations Body, which cited this issue and said that placing social workers in integrated mental health teams could speed up hospital discharge.

“When leaving hospital, service users may have lost their homes, their jobs, relationships may have suffered, they may even be in a new area of the country,” said Think Ahead. “Embedding social work within post-hospital care means that these social issues can be improved, tackling isolation, and reducing chance of re-admission.”

The government is planning to refresh the NHS workforce plan next year, and Think Ahead said this should set targets to grow the number of mental health social workers, which should be adopted by integrated care boards.

The Change NHS consultation runs until spring 2025.

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Approved mental health professionals (AMHPs) have voiced concerns about the impact on their safety of a national police policy of not attending most mental health incidents.

In some areas, AMHPs are attending mental health callouts in pairs because of a lack of police involvement, in the light of the introduction of the right care, right person (RCRP) policy, but this is not always possible due to staffing constraints.

More broadly, health and social care services are struggling to manage the increased demands placed on them from RCRP, introduced last year under an agreement signed by the government and health and policing leaders.

Those were among the findings of an evaluation of RCRP published by the Home Office and Department of Health and Social Care (DHSC) this week.

The study was based on an analysis of the policy’s impact in a sample of police areas, alongside surveys of NHS integrated care boards (ICB) and local authorities and research with health and social care staff, carried out by the University of  York and the King’s Fund.

Health and social care struggling to meet additional demand

A Home Office analysis of the impact of RCRP on five police forces from 2022-24 found monthly savings in officer time of between 1,030 hours in the Northamptonshire force to 18,910 hours in the Metropolitan Police, due to reduced attendance at mental health incidents.

However, health and social care services were struggling to deal with the resulting increase in demand, found a DHSC survey of 34 of the 42 NHS integrated care boards (ICBs) and 35 of the 153 councils in England.

Sixty two per cent of ICBs and 40% of councils said they had faced barriers to implementation. For NHS respondents, the most significant barrier by far was cost and funding pressures, which was cited by 21 of the 34 ICBs. Meanwhile, for councils, the most significant obstacle was a lack of infrastructure to implement RCRP, which was cited by 10 of the 35 authorities.

The Home Office and DHSC found that health and social care services were struggling to take on tasks previously carried out by the police, in the context of rising demand for mental healthcare. Referrals for adults increased by 3.3% a year, and those for children by 11.7% a year, from 2016-24, according to the recent Darzi review of the NHS in England.

Demand set to rise

No additional funding was provided to the NHS or councils to implement RCRP, which the DHSC/Home Office report said “will make it difficult for health and social care services to meet the demand that was being dealt with by the police, prior to RCRP”.

Looking to the future, most ICBs and councils expected to see greater demand on their services as a result of RCRP.

Eighty seven per cent of councils expected to see moderately or significantly increased demand for AMHP services, with 74% saying the same of other adult social care services and 80% of community mental health teams (CMHTs).

Most ICBs (85%) also expected to see increased demand for CMHTs, with all of them anticipating growth in the requirements on mental health crisis teams.

Lack of workforce capacity and capability

Similar themes were reported in the King’s Fund and University of York report, which was based on interviews with 29 staff from across mental health, social care, ambulance, acute trust and voluntary sector services.

Participants said a lack of staff was a particular constraint on being able to respond to mental health incidents, including because of high vacancy levels.

Having staff with the right capabilities was also an issue for some services. This was particularly true of ambulance services, who were being increasingly called upon to deal with welfare issues, despite lacking the police’s legal powers to gain entry to premises or detain people should this prove necessary.

Ambulance staff raised concerns about police not staying with patients when they transported them to a place of safety, since they did not have training in restraint or appropriate safety protection.

Reduced use of police powers to detain

Use of the police’s power to remove a person to, or keep them at, a place of safety under section 136 of the MHA fell by 10% in 2023-24, which police chiefs linked to the implementation of RCRP.

AMHPs interviewed by the King’s Fund and University of York said the implementation of RCRP was reducing police attendance for the purpose of using section 136 powers in their areas.

In some cases, AMHPs had resorted to making increased use of section 135 of the MHA in order to guarantee police attendance. This empowers a magistrate to issue a warrant, on the application of an AMHP, enabling a police officer to remove a person with a mental disorder from a private place to a place of safety for assessment.

Some interviewees said it was easier to organise a section 135 than risking a need for a section 136, because the requirement to attend at a defined time gave services an opportunity to plan and ensured the attendance of all required professionals.

AMHP safety concerns

However, AMHPs also voiced concerns for their safety when undertaking Mental Health Act assessments in the community without police involvement.

In some areas, AMHPs were attending callouts in pairs, but this was not always possible due to capacity constraints.

Areas were also struggling to reduce handover times from the police to healthcare staff when a person had been removed to a place of safety under section 136.

According to the DHSC and Home Office report, ICBs said this was down to factors including a lack of health-based places of safety to remove people to and insufficient trained staff to manage people in a crisis.

A ‘police-led initiative’

The King’s Fund and University of York researchers said they heard “several examples of good practice, with strong multi-sector partnership working and communication, enhanced by open and, if necessary, robust feedback”.

Practitioners also welcomed the intent of RCRP to enable a more health and social care-focused response to mental health issues, said their report.

However, it added: “Our interviewees generally felt that there has been insufficient focus on the impact of RCRP on health and social care service users, staff and systems, with a perception that it is a police-led initiative, and reports of its impact focusing on efficiency gains for the police.”

Integrating local authority social workers within NHS mental health trusts can help reduce the number of “harmful” out-of-area hospital placements (OAPs), a report has found.

The Health Services Safety Investigations Body (HSSIB) said that placing social workers in mental health hospitals could help speed up safe discharge, thereby freeing up beds and enabling discharge.

However, the report said that, in recent years, councils had withdrawn social workers from integrated services hosted by NHS mental health trusts, despite such arrangements being seen as beneficial by practitioners.

The HSSIB investigates patient safety concerns across the NHS in England. Its study of OAPs was part of a wider government-commissioned investigation into the safety of mental health inpatient setting, with previous reports covering the assessment of suicide risk and safety planning and the impact of workforce challenges on the delivery of safe and therapeutic care.

Missed target to eliminate inappropriate out-of-area placements

Under government guidance, an OAP occurs when a person is placed in an inpatient unit that does not usually admit people from their area and where they cannot be visited regularly by their care co-ordinator.

In 2016, the then government set a target of eliminating inappropriate OAPs – meaning those where the person was placed out of area because no acute mental health beds was available locally – by 2020-21.

However, this target was missed and, as of 31 March 2024, there were 900 out-of-area placements in England, of which 805 were inappropriate, based on data from 72% of relevant organisations.

NHS England told the HSSIB that increased complexity of need in the wake of the pandemic had had an impact on treatment times and lengths of stay in hospital that had not been planned for, leading to increased use of out-of-area placements.

Harm from being placed out of area

The HSSIB found that people and their families and carers were being harmed by OAPs, due to the increased anxiety of not knowing new staff and being separated from support networks.

The placements were also resulting in “significant anger, frustration and loss of trust in the mental health system”.

However, many NHS trusts told investigators they were “overwhelmed” by the number of people needing acute care and felt they did not have any option but to use OAPs, as this was better than the person remaining unwell in the community.

NHS England has put forward using community mental health, crisis and home treatment teams as key to tackling OAPs, by reducing people’s need for inpatient care.

But trusts said that there was “not always have the time, capacity or ability to make the changes needed” because of the pressure they were under.

Mental health system ‘cannot be looked at in isolation’

Practitioners told the HSSIB that the mental health system could not be looked at in isolation in consider OAPs.

“Many patients needed acute services because the lack of appropriate provision of community mental health care, social care support, drug and alcohol services, or delayed diagnosis of neurodevelopmental conditions, meant their needs had not been met to keep them safe in the community,” the report said.

The investigation found that “limited patient flow through mental health and other services”, meant it was difficult for trusts to discharge people from hospital, with the resulting lack of beds driving OAPs.

Local authority social workers told the HSSIB that high caseloads and “too many competing priorities” meant that they struggled to support the timely discharge of people from mental health wards, while the process was also slowed down by struggles getting support packages signed off by funding panels.

Loss of social workers from integrated teams

Practitioners told investigators that patients had benefited from council social workers being integrated into mental health trusts through partnership agreements drawn up under section 75 of the NHS Act 2006.

Social workers said this had given them greater visibility of patients in hospital and in the community and promoted collaborative working and improved understanding of cross-system pressures.

However, councils have pulled out of section 75 agreements in many areas over the past several years, reportedly due to operational pressures in other parts of the social work system, said the HSSIB.

This had had the unintended consequence of social workers who lacked mental health experience being assigned to support a patient.

Call to embed social workers in mental health hospitals

Based on its findings, the HSSIB said: “Health and social care organisations can improve patient safety by working together and embedding mental health social workers from the local authority in mental health acute hospitals.

“This can ensure that patients’ holistic health and social care needs are considered throughout their acute mental health admission and on into the community, and improve efficiency of working, patient flow and discharge and reduce the use of out-of-area placements.”

It recommended that the Department of Health and Social Care (DHSC) reviews current policies concerning mental health, social care and housing impacting on OAPs and “creates a proposal for the future accountability and integration of health and social care”, to help reduce and prevent out-of-area placements.

‘Close working relationships should be the norm’ – BASW

In response to the findings, British Association of Social Workers chief executive Ruth Allen, a former mental health social work director, said: “Section 75 arrangements have had challenges for the governance and quality of social care and social work when staff are seconded to Trusts.

“They have also foundered because of financial pressures.  But the principle of joint working on the ground and seamless, holistic support must not be lost in high level debates and disagreements about money and accountability.”

She added: “Joint teams and close working relationships should be the norm, and social workers must be available to support social needs and issues – in whatever way they are employed and managed.

“A focus on high quality delivery arrangements in well-functioning multidisciplinary teams – rather than on particular structures of multiagency governance and contracting – may break down barriers between professionals more effectively and ensure more truly integrated practice.”

In its response to the report, the DHSC said: “Patient safety is paramount, and anyone receiving treatment in an inpatient mental health facility deserves safe, high-quality care, and to be treated with dignity and respect…This government will reform the Mental Health Act, to ensure that people with the most severe mental health conditions receive better, more personalised treatment that is appropriate, proportionate, and compassionate to their needs.”