From Crisis Management to Recovery: The Next Phase of Mental Health Reform Must Start Now

Rt Hon Andrew Stephenson CBE

Chair, Curia, Health, Care, and Life Sciences Research Group

As the Mental Health Act receives Royal Assent this week and following the publication of Curia’s recent report on mental health following a Parliamentary roundtable, Health, Care, and Life Sciences Research Group Chair at Curia, and former Minister of State for Health at the Department of Health and Social Care, Andrew Stephenson writes exclusively for Politics UK. Mental health reform is not stuck for lack of plans – it is stuck because delivery is failing, discharge is blocked, and a culture of blame is driving defensive decisions; this piece sets out what must change now to shift from crisis management to recovery.

For too long, mental health reform in England has been framed by ambition at the centre and frustration on the frontline. That tension was laid bare at a recent Parliamentary Mental Health Roundtable hosted by Cat Eccles MP and organised by policy institute Curia, where clinicians, system leaders, patient advocates, charities, local government and independent providers spoke with unusual candour about what is – and is not – working.

The diagnosis was consistent and sobering. We do not lack plans, strategies or legislation. We have long term commitments, a Ten Year Health Plan, and now a reformed Mental Health Bill. What we lack is delivery that matches those intentions. Patients experience the system not as a pathway to recovery, but as a set of bottlenecks – struggling to get help when they are unwell and then struggling to leave hospital once clinically ready. That implementation gap is where trust is lost, staff burn out, and lives are put on hold.

Nowhere was this clearer than in the discussion on delayed discharge. Too many mental health beds are occupied not because people need hospital care, but because there is nowhere safe and supported for them to go. Housing, social care and step down provision are not peripheral concerns; they are core determinants of whether the system flows or clogs. When discharge decisions are made in isolation, without housing providers or local authorities at the table, we create a revolving door that is costly, unsafe and deeply demoralising for patients and staff alike.

The roundtable was equally clear on what the debate should not be about. This is not an argument of NHS versus independent or voluntary providers. Those sectors are already integral to mental health care across acute, secure, rehabilitation and community settings. The real question is whether we are aligning every part of the system around shared recovery outcomes, consistent standards and transparent data – or allowing fragmentation and institutional defensiveness to undermine progress.

One of the most striking contributions came from a comparison with physical health. In many areas of physical care, the NHS has made real strides towards a learning culture – one that recognises complexity, encourages reflection, and treats mistakes as opportunities to improve systems rather than to apportion fault. By contrast, there was broad agreement around the table that mental health remains trapped in a culture of blame.

That culture has consequences. Fear of scrutiny, fear of getting decisions wrong, and fear of personal accountability in a system where risk is individualised rather than shared all shape behaviour. They drive risk aversion, longer lengths of stay, and overly cautious discharge decisions. They also discourage honest conversations about failure and improvement. Several participants noted that in mental health, the question is still too often “who is responsible if this goes wrong?” rather than “what can we learn to make this safer next time?”

If reform is to succeed, that must change. A learning culture in mental health would recognise that risk cannot be eliminated, only managed collectively. It would support professionals to make proportionate decisions, backed by shared frameworks and data, rather than defensive ones. And it would treat recovery as a system outcome, not an individual liability.

This shift is inseparable from dignity and autonomy. Lived experience contributions reminded us how easily Mental Health Act assessments can strip people of voice in ways that echo long after the crisis has passed. Advanced choice documents are not an abstract policy idea; they are a practical tool to ensure people are seen as individuals, not simply as risks to be managed. If reforms are to mean anything, they must be visible at the point of crisis, not buried in guidance.

Technology also featured prominently, though not in the way it often does. The message was simple: digitisation that reinforces organisational silos will fail. Patients do not live in one system, yet their information is scattered across many. A patient centred approach – starting with the Mental Health Act pathway as a shared backbone – offers a realistic route to better continuity, clearer accountability and smarter commissioning. Importantly, shared data also supports a learning culture, enabling services to see patterns, identify pressure points and improve practice together.

None of this will succeed without a workforce that is supported and retained. The pressures on staff, particularly at senior levels, are real and growing. Workforce wellbeing is not a “nice to have”; it is a leading indicator of whether reform will stick. A blame culture corrodes morale and accelerates attrition. A learning culture retains experience and builds confidence.

Finally, the roundtable reminded us that reform cannot be blind to inequality. Experiences of mental health care vary sharply by background, culture and community. Culturally sensitive provision, better access and honest measurement of disparities are essential to rebuilding trust.

What struck me most was not the scale of the challenge, but the level of consensus. There is broad agreement on the problems, and remarkable alignment on the practical steps that could be taken now – many of which do not require new legislation or vast new budgets, but clearer direction, shared metrics and the courage to move from blame to learning.

Mental health reform is often described as a challenge. What I heard around the table was something different: an opportunity to move beyond crisis management and build a system that supports recovery, respects dignity and shares responsibility.

The question is no longer whether we know what to do – but whether we are prepared to create the culture that allows it to happen.

To find out more about Curia’s Health, Care, and Life Sciences Research Group, contact Partnerships Director, Ben McDermott at ben.mcdermott@chamberuk.com