Three perspectives, one reformed Act: a conversation on the future of mental health care

When the Mental Health Act is discussed in policy circles, the focus often centres on structures, duties and statutory requirements. But sitting three people together who encounter the Mental Health Act from very different vantage points creates a different kind of conversation. The discussion becomes less about clauses and more about what the next decade of crises, care and reform will actually feel like.

A decade of change ahead

Arden Tomison, founder of Thalamos and a long-standing advocate for digitising statutory mental health pathways, began the conversation by setting the scale of what lies ahead. To him, the reformed Act should be understood not as a single moment of upheaval but as ten years of marginal changes unfolding across health, social care and policing. The major themes are well known, he said, but the lived reality for organisations will be continual rounds of education, process redesign and practice change as new regulations take effect.

That long horizon matters because the people at the centre of these pathways experience something far more immediate. Steve Gilbert OBE, a prominent lived experience leader who helped shape the 2018 Mental Health Act Review, returned to the perspective he heard repeatedly during that engagement. For many, detention was experienced as degrading. People spoke of losing dignity, agency and humanity in ways that were not the result of ill intent, but of systems drifting away from those they were designed to support. Implementation choices, he argued, will either reinforce that degradation or actively rebuild dignity.

Sitting beside him is Dr Iain Grant, a consultant psychiatrist and medical director with years of experience delivering inpatient care. Grant, who is Regional Medical Director at Elysium Healthcare alongside his role as Medical Director and Clinical Safety Officer at Thalamos, as sees the intentions behind the reform clearly. Higher thresholds for detention, more checks and balances and more frequent statutory reviews are designed to strengthen safeguards. But he worries about what these changes mean in practice. In serious mental illness, he explained, the longer a condition such as psychosis remains untreated, the worse the prognosis becomes. A higher threshold might mean that care is only accessed once someone reaches a significant level of deterioration, making early and intensive intervention harder to deliver.

“Mental Health Act reform is not a single moment of change but a decade-long process, and without digital coordination the system will struggle to deliver the joined-up care the reforms demand.” Arden Tomison

Where dignity, access and risk intersect

That tension between reducing unnecessary detention and ensuring timely access to care becomes a shared thread. The aspiration behind the reforms is widely supported, yet systems must also prepare for the consequences. Tomison noted that leaders are already asking what it means when someone who previously would have been admitted no longer meets the criteria. Will they deteriorate in the community or come into contact with police through Section 136. These questions, he added, will begin playing out as soon as the new provisions take effect.

For Gilbert, the implications become concrete when viewed through the moments that matter in crisis care. Across more than 50 focus groups as part of the 2018 review, people consistently described the early encounter with professionals as pivotal. How someone is approached, who speaks directly to them and whether they are treated as a person rather than a set of risks all shape the entire episode. Explanations of rights delivered too quickly to absorb, sensory environments that heighten distress and transitions where progress is lost were also defining features of many accounts. To the person in crisis, he explained, these moments are everything.

Grant then turned to the operational reality of delivering care under the reformed Act. More frequent reports, mandated intervals for tribunals and detailed expectations around documenting wishes, beliefs and values create significant statutory work. On a ward with high turnover, he noted, these requirements could increase workload by 25 to 30%. Without careful planning, especially in acute services and psychiatric intensive care units, teams could be overwhelmed. In his view, safe implementation will require either increased staffing or redesigned caseloads, because current structures will not be adequate.

“The success of these reforms will ultimately be judged by whether people in crisis feel their dignity and humanity are actively restored, not quietly eroded by the systems meant to support them.” Steve Gilbert OBE

A system struggling to keep pace

Workforce pressure is only part of the challenge. Tomison reflected on conversations with leaders across health and policing and noted that many have not yet prepared for the scale of change ahead. For years, the long horizon for implementation meant the changes could be pushed aside. Now, he added, preparations remain limited beyond a few early adopters. Yet the reform creates an opportunity for something the system has struggled to achieve. A joined-up pathway across health, policing, local authorities and other partners. In his view, digitising that pathway is the only realistic route to coordinated care.

Joining up information is also central to Gilbert’s perspective. Fragmentation, he commented, does not only create operational inefficiencies. It actively harms people in crisis. Many described the exhaustion of telling their story repeatedly, navigating conflicting advice and falling between organisational gaps. True coordination, he argued, would allow a person to tell their story once and have information follow appropriately across services. His aspiration is a system where the burden of integration does not fall on the person who is in distress.

Gilbert also emphasised that equity must be integral to implementation. People from Black and racialised communities spoke of feeling criminalised, misunderstood or pathologised through racial stereotypes during assessments and detention. Addressing this requires meaningful use of the Patient and Carer Race Equality Framework, interrogation of disparities in pathways and outcomes and embedding lived and living experience roles from diverse communities in decision making. Without this, he warned, reforms risk embedding existing inequalities.

Grant hears echoes of this in clinical decision making. The Mental Health Act now expects clinicians to apply discretion while also demonstrating detailed reasoning for capacity, best interests and treatment choices. Confidence in these decisions, he added, comes from consensus and clear organisational interpretation. Doctors will always prioritise patient care, but legitimacy is strengthened when decisions are made within shared frameworks, tested with colleagues and supported by clear policy.

“Stronger safeguards are welcome, but if implementation overwhelms already stretched teams or delays treatment, we risk undermining the very care the reforms are designed to protect.” Dr Iain Grant

Building the foundations for meaningful reform

For Tomison, none of this can be evaluated without robust data. Without consistent reporting, he said, it will be impossible to know whether the reform’s four principles are being realised. Yet organisations use different electronic systems, and full integration across them is unrealistic. The solution, he believes, is a national interoperability standard for Mental Health Act data. This would allow digital tools to create a connected pathway and generate the evidence needed to understand whether reforms are working.

As the discussion draws together, a shared conclusion emerges. The updated Act creates both pressure and possibility. For Gilbert, its success will be judged by whether people in crisis feel their humanity has been respected. For Grant, it will depend on whether reforms strengthen care rather than overwhelm the workforce or unintentionally restrict access. For Tomison, the opportunity lies in using the legislative pathway to finally unify fragmented services and embed digital coordination that has historically been absent.

Although they begin from different professional and personal experiences, their conclusion aligns. The changes to the Mental Health Act will succeed only if implementation balances dignity, clinical realities and system design. In a decade shaped by incremental change, the decisions taken now will determine whether the reforms become a safeguard, a burden or a catalyst for a more connected crisis care system.