A Deep Dive into the Mental Health Bill 2024 – Autism and Learning Disability

On 4 March 2025, Dr Oliver Lewis held the third seminar in Doughty Street Chambers’ series about the Mental Health Bill 2024 (‘the Bill’), as amended. His seminar was about how the Mental Health Act 1983 (‘MHA 1983’) affects people with autism and learning disabilities, and whether the Bill changes that. 

There were eight speakers:

1. Oliver Lewis, a barrister at Doughty Street Chambers.
    
2. Lisa Perry, who settled a human rights claim on behalf of her son who has learning disabilities and autism.
    
3. Jack Moore, a young autistic man who likes animals and is building a model of the Titanic. 
    
4. Julie Newcome, co-founder of Rightful Lives who settled a human rights claim on behalf of her son, Jamie, who has learning disabilities and autism.
    
5. Alexis Quinn, an autistic human rights campaigner who works at the Restraint Reduction Network. 
    
6. James and Katie from the Oxfordshire campaigning group, My Life My Choice.
    

1. Dawn Cavanagh, founder of the Welsh organisation Stolen Lives. 
    
2. Wendy Ewins, Head of Commissioning and Case Management at Black Country Healthcare NHS Trust who commission ‘crash pad’ facilities. 

To assist readers, speakers are grouped under three subheadings: (1) setting the scene: the problem with the Bill, (2) lived experiences of MHA 1983, and; (3) recommendations for the future. Speakers’ slides are available here.

1. Setting the scene: The problem with the Bill

Oliver Lewis: Accepting disability as part of human diversity

Oliver said that people with learning disabilities and autism are, in principle, protected by the United Nations Convention on the Rights of Persons with Disabilities (‘CRPD’). For example, Article 3(d) of CRPD recognises ‘Respect for difference and acceptance of persons with disabilities as part of human diversity and humanity’. However, that respect can easily be withheld or denied and, for those with autism and/or learning disabilities, recovering it can be difficult. 

The central problem for people with autism and/or learning disabilities is that there are insufficient community options for their residence and care. Superficially, there have been positive attitudinal changes - Oliver recalled that, in his youth, his nearby neurodevelopmental hospital changed its name from the ‘Brentry Certified Inebriate Reformatory’ to the ‘Brentry Colony’ to, at last, the more respectfully named ‘Brentry House’. However, semantic changes are insufficient to secure rich, fulfilling lives for those with autism and/or learning disabilities. 

Such lives are not made more likely by the Bill. As Oliver explained in his written evidence to the Joint Committee on Human Rights, three amendments would make the Bill more helpful. 

1. The Secretary of State could be obliged to ensure that, in each locality, there are services that prevent the compulsory admission of people with autism and learning disabilities into hospitals. 
    
2. While the Bill proposes obliging Responsible Clinicians to ‘have regard to’ the recommendations of Care and Treatment Reviews, that duty could be enhanced to require that they ‘implement’ those recommendations. 
    
3. Section 117 of MHA 1983 could be amended to encourage patients’ prompt discharge from hospital. For example, from the moment a patient’s hospital stay becomes unnecessary, their Local Authority and Integrated Care Board could be obliged to fund it. As hospital stays are often more expensive than community placements, requiring public bodies to fund unnecessary hospital stays might incentivise them to promptly facilitate discharge into the community. 

Unless community resources are developed, the primary state response to a person with autism and/or learning disabilities in crisis will be to detain them, often in hospitals that are overstimulating, antitherapeutic and traumatising. The Bill does little to shift that paradigm.   

2. Lived experiences of MHA 1983 

Lisa Perry: AP’s mother

AP, Lisa’s son, was diagnosed with autism whilst young. He went to a residential school three hours away because no school nearer home could meet his needs. AP was eventually excluded from that school. Thus began a cycle of harsh treatment in the community.

AP was admitted to an Assessment and Treatment Unit in Birmingham and held there for six-months. After discharge, he was apprehended by police and detained for a further seven-months. Then, AP was transferred to St Andrew’s Hospital (Northampton) where he suffered tremendously for twenty-two months. After discharge, he was detained again, this time on a forensic adult ward, despite having committed no crime.

This pattern continued for years. In 2015, a Care and Treatment Review recommended that a property be acquired for AP. For years, there was no progress. Then, in 2020, a property was acquired and adaptations began. Whilst they were underway, AP was detained again, this time at a so-called ‘place of safety’ under section 136 MHA 1983. 

After discharge, AP moved into his property. Before long, roof repairs were needed. Whilst they were done, AP was detained in hospital yet again, now on the pretence that his epilepsy needed addressing. 

In short, the state detained AP ad nauseam because there was nowhere appropriate in the community for him to live. Whilst resource constraints are often cited for the lack of community provision, there was no shortage of funds to lock AP away. AP has been traumatised by these experiences. Lisa hopes that, in time, he can heal. 

Jack Moore: A life (now) well lived 

Jack was detained in hospital for several years. He has difficult memories from hospital, but is now thriving in his home, which he has transformed into a museum and zoo. 

Jack’s home contains the skull of an African elephant, carefully catalogued skeletons, live tarantulas, snakes, geckos, piranha, tegu, and a wonderful collection of Lego structures. Currently, Jack is building a Lego model of the RMS Titanic, without instructions and largely from memory. You can see Jack and his model here. Outside his home, Jack likes visiting friends, going to the park and singing karaoke. 

Jack says that hospitals aren’t the right place for people with autism and learning disabilities. He says that they should be ‘in the right places, with the right care’.

Julie Newcombe: Rightful Lives and Jamie Newcombe

Julie founded Rightful Lives, a community and creative campaign that promotes the human rights of people with autism and learning disabilities. Julie founded Rightful Lives after her son, Jamie, suffered human rights abuses while detained in hospitals.

Julie said that it is common for people with autism and/or learning disabilities to be mistreated. Sadly, when parents are involved in the life of such a person, the parents are often blamed and excluded from important decisions. A more integrated, constructive approach is necessary if people with autism and/or learning disabilities are to flourish in the community. 

Alexis Quinn: Societal risks for autistic people  

Before 2012, Alexis was an accomplished swimmer and a teacher. Then, her daughter was born, and she describes becoming increasingly overstimulated by everyday life. Alexis voluntarily sought mental health assistance in an Assessment and Treatment Unit, but was later detained there under MHA 1983.

Alexis was detained for three years and diagnosed with autism part-way through. Alexis has written books about these experiences. Since discharge, Alexis has campaigned for autistic people to be treated better in society, partly in her role as manager of the Restraint Reduction Network.

Alexis explained that people with autism and/or learning disabilities are disproportionately at risk in the population:

• Autistic people are more likely to die by suicide than the non-autistic population, according to a 2020 study by Tatja Hirvikoski and her and colleagues.
   
• Autistic people are more likely to be homeless than their non-autistic counterparts, according to a 2021 study by Elisabeth Garratt and Jan Flaherty.
   
• In prison, 50% of detainees are expected to be neurodivergent, despite that autistic people offend at lower or similar rates to non-autistic people, according to the 2021 ‘Neurodiversity in the Criminal Justice System: A review of evidence’ by the Criminal Justice Joint Inspection. 
   
• Another study found that prisoners self-reported autism 13.7x more than the civilian population, according to a 2025 study by Katy-Louise Payne and Emma Gooding. 

Against the background of vulnerability, the state currently has two main ways of responding to an autistic person in crisis: (i) to detain them in hospital under MHA 1983 or; (ii) to sweep them into the criminal justice system. Alexis criticised the MHA 1983 option but feared that, if it is removed, autistic people will instead be increasingly imprisoned or deprived of their liberty in the community. 

Ultimately, society must stop treating autistic people like second-class citizens. They are societally vulnerable, victimised and discriminated against and given few resources to cope. These structural problems need dismantling. The Bill does little to help.

3. Recommendations for the future

James and Katie: My Life My Choice

My Life My Choice is an Oxfordshire-based charity run by, and for, people with learning disabilities. Attending the seminar remotely were James (Inspections and Campaigns Coordinator) and Katie (who has learning disabilities, lived experience of MHA 1983, one cat, one rabbit and four guinea pigs, several of whom joined her onscreen).

The motto of My Life My Choice is ‘nothing about us without us’. This reflects that, as the Bill will affect people with autism and learning disabilities, they should be involved in shaping it. My Life My Choice want the Bill to ensure that, in the community, there are:

• ‘Good homes’ (i.e. safe places to live in the location of your choosing). 
   
• ‘Local services’ (i.e. services at flexible times and with continuity of professionals). 
   
• ‘Safe spaces’ (i.e. safe, homely-looking places in the community that feel relaxing, healing and can support people through crisis).

Dawn Cavanagh: A Welsh perspective

Dawn leads ‘Stolen Lives’, an organisation campaigning against the detention of people with autism and learning disabilities in Welsh hospitals. 

Wales has fewer protections than England for people with autism and/or learning disabilities. For example, Wales lacks the Care and Treatment Reviews that are available in England, instead offering ‘Care and Treatment Plans’ that are less flexible. Additionally, unlike in England, Wales does not keep up-to-date data sets about those with learning disabilities, making it difficult to ensure their welfare. 

Dawn doubted whether reforming MHA 1983 would help Welsh people with autism and/or learning disabilities. While ministers are right to stop people with autism and learning disabilities being detained in hospitals purely on the basis of those diagnoses, detention may yet proceed on other grounds. For example, people with autism and learning disabilities might be given new diagnoses (e.g. personality disorder) and detained with reference to those conditions, or detained under the forensic provisions of MHA 1983, or detained in the community in conditions amounting to deprivations of liberty.

Until this changes, Stolen Lives will advocate for Welsh people with autism and/or learning disabilities and petition for greater funding of community placements. For an Easy Read version of their manifesto, please see here.

Wendy Ewins: Crash pads

The Black Country Healthcare NHS Foundation Trust has commissioned two ‘crash pad’ facilities for use by people with autism and/or learning disabilities. The crash pads are houses that people with autism and/or learning disabilities can stay in during times of crisis, rather than being detained in hospital. For photographs of the crash pads, see here.

The crash pads were created because, historically, the Trust struggled to support the families of people with autism and/or learning disabilities and wanted to avoid such people being detained in hospital during crises. The Trust’s first approach was to commission a team of emergency staff who, on principles including ‘citizenship’, ‘rights’ and ‘inclusion’, tried to support people with autism and/or learning disabilities in the community. Around fifty-five people were thus supported each year. 

However, the Trust soon realised that, to be most effective, vacant properties were needed to support people through their crises. The Trust bought two properties: one for adults and one for children. These became the crash pads. The Trust is now sourcing a third, which will be adapted to be especially structurally robust. For those who need them, the crash pads are homes away from home and available at short notice. 

The crash pads are more therapeutic and cheaper than hospital admissions. Hopefully, the idea will spread across the United Kingdom so that, nationwide, people with autism and/or learning disabilities can benefit. For more information about the crash pads in the Black Country Healthcare NHS Foundation Trust, see here.

Related Events

Doughty Street Chambers thanks all attendees. Links to notes from related seminars are below. 

• 21 January 2025: Sophy Miles, Liz Cleaver and Oliver Lewis introduced the Mental Health Bill and the topics that would be discussed throughout the seminar series. The write-up is here.
   
• 27 February 2025: Sophy Miles, Elizabeth Cleaver and Laura Shapcott held a seminar about changes to the Bill, Advance Choice Documents and the aims of the Wesselley Review. The write-up is here. 
   
• 16 May 2025: Doughty Street Chambers will host a seminar about MHTs and aftercare. Further information will be released in due course.