Nikki Bond, Senior Research Officer, Money and Mental Health Policy Institute

How Advance Choice Documents would help put autonomy and choice at the heart of the government’s Mental Health Bill

23 January 2023

Last year, the government published the long-awaited draft Mental Health Bill. The Bill sets out wide-ranging changes to transform the care patients receive and increase people’s rights, choices and autonomy. Last week, the Joint Committee, responsible for scrutinising the Bill, published its final report. We welcome the Committee’s recommendations to strengthen those rights and address the rising numbers of people detained under the current Mental Health Act and failures on racial inequalities. 

Over the last six years, through our Research Community of 5,000 people with lived experience of mental health problems, we’ve regularly heard about people’s experience of detention under the Mental Health Act – and the devastating impact on their finances. So, we were particularly delighted to see the Joint Committee make one particular recommendation we’ve been calling for. To give people a statutory right to make an Advance Choice Document (ACD). A document that details, in advance, a person’s treatment wishes and preferences, with a small but important explicit reference for how ACDs can be used to to include plans for our financial affairs.

Small changes, big impact

Our previous research found that people can experience extreme financial harm when admitted to hospital for mental health treatment. Incomes from employment may suddenly cease, and difficulties engaging with the benefit system mean benefit payments can be suspended or sanctions incurred. All of which may have the knock-on effect of direct debits bouncing, rent going unpaid, and gas and electricity debts increasing. 

One such story, which illustrates the financial devastation that an admission to hospital can cause, is that of Suzanne. Suzanne shared her experience of financial difficulties while detained under the Mental Health Act, and how she returned home upon discharge to mounting debts and a council tax court summons. Since Suzanne’s experience, Mental Health Breathing Space has been introduced. This new legislation can protect people in mental health crises from debts escalating fees and charges. Which is incredibly important in helping people to resolve financial difficulties. 

But the recommendation around ACDs, and the potential inclusion of a financial prompt within these documents, would strengthen this. This recommendation paves the way to empower people to plan for and protect themselves from financial harm when they’re too unwell to deal with their own financial affairs. This is a small, but important change, that has the potential to help tens of thousands of people who are admitted to hospital each year.  

Never more needed

As the cost of living crisis continues to take its toll, and people struggle to keep up with bills and meet credit repayments, it’s more important than ever that systems are in place to equip us to protect ourselves from financial harm – especially when we’re too unwell to do so. As the Bill passes through parliament, we’ll be watching closely to ensure that the government takes this recommendation on board. 

Making ACDs a statutory requirement embodies the principles of choice and autonomy – which are central to this Bill. Harnessing the potential of ACDs to support people to protect themselves from the financial hardship caused by mental health crisis, is a tangible way of turning talk into action.