6 December 2018

The Independent Review of the Mental Health Act 1983, chaired by Sir Simon Wessely, has been published by the Department for Health and Social Care. The report puts forward a series of recommendations aimed at modernising the Mental Health Act and improving the experiences of those detained.

The report recommends that the ‘families of those who have died should receive non-means-tested legal aid’ and is therefore a welcome addition to widespread calls for change on this urgent issue. This follows written and oral evidence by INQUEST to the review team.

The report also recognises the profound structural factors and inequalities that exist for people from ethnic minority communities in accessing treatment, experiences of care, and quality of outcomes following mental health care. The review team report that they “heard repeatedly that black African and Caribbean communities have a real fear of death when interacting with the mental healthcare system”.

Some of the significant recommendations include:

  • Clear guidance that a death under Deprivation of Liberty Safeguards/Liberty Protection Safeguards in a mental health setting should be considered to be a death in state detention for purposes of triggering an inquest with a jury, known as Article 2 inquests.
  • Wards should not use coercive behavioural systems and restrictions to achieve behavioural compliance from patients, but should develop, implement and monitor alternatives.
  • The review team also endorses the recommendation made by the Angiolini report for an Independent Office for Article 2 Compliance.

INQUEST is however disappointed that the review has not recommended independent investigations following a death of someone detained under the Mental Health Act at this stage. 

Deborah Coles, Director of INQUEST said: “The recognition of the need to shift away from practices of coercion and control, towards creating therapeutic environments is welcome. The review found, unsurprisingly, that black African and Caribbean communities hold a real fear of death when interacting with mental health services. Our casework reiterates the real dangers of the over use of restraint in mental health settings. This is one example of the extent of cultural change required. The strength of this review depends ultimately on its implementation.

We are glad to see this review adding to the widespread calls for non-means tested legal aid for bereaved families. Access to justice is essential to enable accountability and learning from deaths. INQUEST will continue to push for robust, truly independent investigations following deaths in mental health settings, which are necessary to ensure appropriate scrutiny and prevent future deaths.”


For further information, interview requests and to note your interest, please contact Lucy McKay or Sarah Uncles on 020 7263 1111 or [email protected]  [email protected]

  • The full report Modernising the Mental Health Act – final report from the independent review is available here.

  • INQUEST has worked on numerous disturbing cases of deaths following restraint in mental health settings, and involving the police, including David “Rocky” Bennett, Sean Rigg and Olaseni Lewis.

  • The recommendation for non-means-tested legal aid has been recently supported in a range of reports including the Joint Committee on Human Rights report on their inquiry Enforcing human rights, the annual reports of two Chief Coroners, the Angiolini review on deaths in police custody, the Bishop’s review on the experiences of Hillsborough families.
  • The disparity between bereaved families, who often struggle to access legal aid, compared with state agencies involved in deaths, who are automatically represented at public expense, is a longstanding concern of INQUEST.

  • The Mental Health (Use of Force) Bill, known as Seni’s Law received Royal Assent last month. The law will increase protections and oversight on the use of force in mental health settings.

  • High levels of restraint are routinely used behind the closed walls of secure settings inflicting physical and psychological harms and the ever-present risk of death. Restraint is used disproportionately against people from black and minority ethnic groups, women and children, young people, and people with learning disabilities and autism.

  • Since 2015, INQUEST has called for independent investigations following deaths in mental health setting (rather than internal investigations by health trusts) as is already the case in prisons and police custody.

  • INQUEST has campaigned an Independent Office for Article 2 Compliance for decades. As recommended by the Angiolini review, this Office would be accountable to parliament, and tasked with the collation and dissemination of learning, the implementation and monitoring of that learning, and the consistency of its application at a national level.