The Mental Health Bill: Autism and Sectioning
I survived OCD, anxiety and depression, and growing up autistic without my needs being understood. But I also survived the mental health system - which is something that can be hard to explain.
In September, 2,020 autistic people/people with learning disabilities were in mental health hospitals across England, with 200 being under the age of 18 (Assuring Transformation NHS Digital data). Except, this is only the number diagnosed. A significant proportion of us on the CAMHS unit I was on were autistic. We just weren’t recognised as autistic at the time. Whilst there, we endured more trauma - restraint, seclusion, lack of freedom and privacy, and traumatic incidents. Though in many ways, I was fortunate (e.g. autistic people are 4-9 times more likely to die by suicide and the average length of admission is 5 years), I still struggle with some of the things I experienced.
“Our society is failing autistic people in so many ways, but nothing shows it quite as starkly as these figures.
We are putting autistic people through hell - and when they break, if they survive, we put them in hell to try to manage their brokenness.
The system is unfit for purpose.”
We need autistic people’s needs to be understood and supported. We need to avoid autistic people reaching such crisis and distress that hospital, especially sectioning under the Mental Health Act is considered to be required. We need professionals assessing us in crisis to understand neurodivergence so that our distress isn’t misunderstood.
Eight years ago, former Prime Minister Theresa May committed to ‘modernise’ the Mental Health Act. In 2018, an independent review panel made recommendations. It took until 2022 for the government to publish a draft Mental Health Bill. In November 2023, the Government decided not to proceed with its planned and promised Mental Health Bill. However, a Mental Health Bill has now been announced and gone to the House of Lords this week. Amongst the proposed reforms are:
statutory care and treatment plans
ending the use of prison cells to place people experiencing a mental health crisis
updates to Community Treatment Orders (CTOs)
access to Independent Mental Health Advocates (IMHAs) for patients not on a section
shortening detention periods and increasing frequency of renewals
increasing safeguards for people subjected to compulsory treatment following hospital admission
a 28 day limit on sections for autistic/learning disabled people without a co-occurring mental health condition requiring treatment
We need change, yes. And some of the proposed reforms are important. But we need meaningful change, and I’m sure there are lots of us who aren’t super optimistic about what this Bill will actually do. For instance, will limiting the ability to section autistic/learning disabled people without a co-occurring mental health condition to 28 days actually make any difference, when so many of us are diagnosed with co-occurring conditions such as personality disorders or depression or anxiety? Regardless, 28 days is more than enough time for us to experience trauma in hospital settings. Furthermore, will a 28 day limit mean we end up in a cycle of being detained on and off without our needs properly being met or supported in the community, and each admission traumatising us further? Will there be any thought given to the traumatising inpatient environments that exacerbate our distress and make it harder for us to be discharged? Where is the mention of alternatives to hospital admissions and community support to prevent our distress reaching such a critical level and stop the need for admission?
“I know now that I was sectioned because I was autistic - and not only because of the impact of growing up undiagnosed and in a world that traumatised me. The act of sectioning was literally because I was autistic. Because I couldn’t give up my diary, an object I had become so hyper-fixated on that I couldn’t function without it. It gave me a routine I otherwise lacked and helped me to block out the overwhelming chaos around me. Taking it away from me removed the only remaining coping mechanism I had. I was left to process the comments from the people keeping me there that I was being over-dramatic and hysterical. I crumpled.”
“You see, psychiatric wards are not built for autistic people. You could hardly design a better environment to enhance our distress - and yet we are placed there at our most vulnerable. ”
Claire Murdoch, the NHS National Mental Health Director, says that this Mental Health Bill is a “once in a generation opportunity”. That means that it is imperative the Bill does what it should, reduces restrictive practice, upholds patients’ rights and dignity, fights for the rights for autistic people, and paves the way for a better mental health system for everyone.
Thank you to charities like Mind, Rethink Mental Illness and National Autistic Society for pushing for reform.
References
Department of Health and Social Care, NHS England, Lord Timpson & The Rt Hon Wes Streeting MP. (2024). Better care for mental health patients under major reforms. https://www.gov.uk/government/news/better-care-for-mental-health-patients-under-major-reforms
National Autistic Society. (2024). Number of autistic people in mental health hospitals: latest data. https://www.autism.org.uk/what-we-do/news/number-of-autistic-people-in-mental-health-ho-24
Newell et al. (2023). A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability. Molecular Autism, 14, 12. https://doi.org/10.1186/s13229-023-00544-7
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