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The views of psychiatrists on proposed changes to the England and Wales Mental Health Act 1983 legislation for people with intellectual disability: A national study

Tromans, Samuel, Robinson, Gemma, Gabrielsson, Alexandra, Basset, Paul, Sawhney, Indermeet, Triantafyllopoulou, Paraskevi, Hassiotis, Angela, Shankar, Rohit (2023) The views of psychiatrists on proposed changes to the England and Wales Mental Health Act 1983 legislation for people with intellectual disability: A national study. International Journal of Social Psychiatry, 70 (2). pp. 388-401. ISSN 0020-7640. E-ISSN 1741-2854. (doi:10.1177/00207640231212112) (KAR id:104103)


Background: The Draft Mental Health Bill proposes removal of both intellectual disability and autism from Section 3 of the Mental Health Act for England and Wales (MHA). This would lead to people with intellectual disability (PwID) and/ or autism could not be detained beyond 28days, in the absence of diagnosed co-occurring mental illness.

Aim: To obtain views of psychiatrists working with PwID in England and Wales regarding the proposed MHA changes. This study focusses specifically on the impact on PwID.

Methods: A cross-sectional online mixed methodology survey of Likert and free-text response questions was developed, to ascertain perceptions of proposed legislative changes to the MHA. A non-discriminatory exponential snowballing technique leading to non-probability sampling was used to disseminate the survey. Quantitative data was analysed using descriptive statistics, Mann-Whitney and Fisher’s exact tests. Thematic analysis was conducted on free text responses.

Results: A total of 82 psychiatrists (33%) from approximately 250 eligible completed the survey. Nearly two-thirds (64%) reported good awareness of the proposed changes, with over half (55%) reporting disagreement with the changes. Psychiatrists working in inpatient settings for PwID reported increased awareness of the changes, less agreement with the reforms, and increased expectations of the reforms having negative unintended consequences, compared to their peers working exclusively in the community. Consultants reported greater disagreement with the changes compared to their non-consultant peers. Qualitative analysis identified five main themes: impact on diagnosis and treatment, seeking alternative options, introducing inequities, resources, and meeting holistic care goals through the Care, Education and Treatment Reviews (CETR) process.

Conclusion: Psychiatrists working with PwID report widespread disagreement with the proposed changes to the MHA for PwID, with greater levels of disagreement among those working in inpatient services. Caution with respect to the proposed changes, and monitoring of the impact of the changes if implemented, is advised.

Item Type: Article
DOI/Identification number: 10.1177/00207640231212112
Uncontrolled keywords: Mental Health Act; developmental disability; behaviours that challenge; mental disorders; detention; sectioning
Subjects: H Social Sciences
Divisions: Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research > Tizard
Funders: University of Kent (
Depositing User: Milly Massoura
Date Deposited: 11 Dec 2023 13:41 UTC
Last Modified: 07 Mar 2024 14:19 UTC
Resource URI: (The current URI for this page, for reference purposes)

University of Kent Author Information

Triantafyllopoulou, Paraskevi.

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