Mental Health Bill (2025): Reform or Rhetoric?

The Centre for Mental Health estimates that in 2022, mental ill health cost the UK economy approximately £300 billion: around £110 billion in lost economic output, £130 billion in human costs, and £60 billion in health and care expenditure. Strikingly, £175 billion of this total is borne directly by people living with mental health difficulties and their families. Businesses absorb a further £101 billion, while central government carries just £25 billion per year (Centre for Mental Health, 2025).

The majority of the burden generated by mental ill health falls not on the state but on individuals, households and employers — through reduced wellbeing, lost earnings and diminished productivity.

Despite this, recent parliamentary and media commentary has placed responsibility for reducing state expenditure squarely on the shoulders of those already paying the highest price. Some parliamentarians have argued that individuals and businesses must “do more” to alleviate public-sector costs (The Guardian, 16 March 2025), and the government has intensified rhetoric that implicitly shames people with mental ill health who are unable to work full-time (Wandsworth Times, 2025). This sits uneasily alongside the fact that parliamentary research itself cites the very same cost breakdowns from the Centre for Mental Health (UK Parliament POST, 2025). It is therefore difficult to assume that legislators are unaware of who currently carries the fiscal load.

Why, then, is blame and its accompanying stigma directed toward the very people absorbing the greatest losses?

This is a crucial question for social theorists and policy researchers, particularly when the Mental Health Bill (2025), currently being reviewed in the House of Lords (November 2025), proposes sweeping changes to the Mental Health Act 1983. The Bill’s stated aims are to strengthen patient rights, modernise detention criteria, reduce inequalities, and improve safeguarding and community treatment. Yet it can reasonably be argued that many of the proposed reforms will require additional time, energy and financial input from the individuals and families who rely on these services. As the UK Parliament has noted, mental health funding has not kept apace with wider healthcare funding, it decreased from 9% of NHS budget in 2018/19 to 8% in 2022/23 (UK Parliament POST, 2025). Furthermore, the government’s own independent investigation into the NHS in England led by Lord Darzi found that mental health prevention has been hindered by declining funding and this has had a greater impact on people and communities in the most deprived areas – which in turn would put further strain on the system (GOV. UK 2024).

This does not negate the potential benefits of reform, including improved protections for people with learning disabilities and autism. But it does raise concerns about the broader political framing: namely, that the patient and not the state is expected to “give more,” be more “resilient”, even as NHS services face ongoing cuts and workforce strain, and are expected to do so for the length of the new NHS 10 year plan (GOV.UK 2025).

Stakeholders must question this narrative rigorously, because those living with mental health difficulties, their families and their communities are already stretched to the limits of their fiscal and emotional capacity.

Any reform that intensifies these pressures without addressing the structural causes of mental distress risks deepening inequality under the guise of progress.

The political-philosophical lens

Michel Foucault’s (1926-1984) work on mental health and the modern state remains relevant to the current moment. He argued that mental-health systems are never merely clinical institutions: they sit at the intersection of power, knowledge, and social control. Across history, each shift in mental-health provision has reflected not only advances in treatment but also the state’s evolving strategies for managing populations: containing deviance, maintaining social order, and defining the boundaries of “normality.”

Against this backdrop, the present legislative reform forces a deeper question: is the aim to transform mental-health care, or to recalibrate the mechanisms through which the state governs distress?

The previous section outlined how political rhetoric has already placed disproportionate responsibility on individuals and families. Foucault would suggest this is not incidental but symptomatic of a broader logic in which the state seeks to minimise its own fiscal burden while maximising behavioural expectations placed on the population.

A reformed Mental Health Act may indeed expand rights, tighten safeguards and reduce certain coercive practices. But it cannot, on its own, shift the wider political rationality in which mental health is governed, especially when public discourse continues to deploy narratives of shame and blame. If social conditions remain precarious, housing insecure, work increasingly unstable, and inequality entrenched, then “diagnosis” risks becoming a back-door method for managing distress produced elsewhere. Moreover, the system is already fractured: the economic, healthcare, business and community infrastructures do not currently operate in tandem.

In Foucauldian terms, the question becomes: do we treat pathology, or do we quietly medicalise the suffering generated by the socio-economic order?

This tension cuts through contemporary policy. The NHS’ stated aim is to expand access to medication, therapies, crisis support and, increasingly, AI-driven interventions. However, the rising prevalence of mental-health difficulties correlates with austerity, inadequate housing, insecure employment, racialised disadvantage and social fragmentation. The state stands between two strategic orientations:
– A clinical-administrative approach: refining treatment pathways, improving throughput, sharpening risk-management and updating legal frameworks.
– A socio-political approach: recognising that a proportion of what we call “mental illness” is shaped and/or amplified by unsafe living conditions, unreasonable workplace demands, educational inequities, chronic deprivation, discrimination and accumulated social strain.

Both approaches matter. The danger arises when the first is used as a substitute for the second — when medication, diagnosis and narrow reform act as shock absorbers for deeper social failures. Without substantial investment in people’s lived conditions, legislative reform risks becoming, in Foucauldian terms, a technocratic pacifier: administratively efficient, rhetorically progressive, but ultimately complicit in leaving the structural drivers of distress intact.

Stigma and mental health

Stigma must be understood not as a personal failing or an outdated attitude but as a technology of power. It shapes who is seen as credible, risky, employable, or deserving.

Stigma influences who enters care voluntarily, who reaches crisis, how coercion is justified, and whose suffering is minimised or pathologised.

It falls heaviest on those already shaped by inequality: people in poverty, racialised communities, young women, LGBTQ+ people, and those whose distress reflects the accumulated weight of structural harm.

To reduce stigma, then, is not only to challenge misconceptions but to challenge the conditions that make stigma plausible: social hierarchy, exclusion, and narratives of “undeservingness” – all of which it could be argued have been amplified by the current government under the banner of getting people to be productive without infrastructure support. Without tackling these, reforms risk offering compassion with one hand while the broader system reinforces marginality with the other.

Patients and population: statistics and analytics

• Mental health conditions are one of the biggest contributors to illness and disability in England. Around 1 in 4 adults experience a mental health problem each year, and 1 in 5 children and young people now have a probable mental health condition according to Mind UK.
• According NHS England, 3.79 million people were in contact with NHS-funded secondary mental health, learning disability or autism services in 2023/24 – 6.6% of the population (it was 5.8% in 2021/22).
• Only 2.4% of those in contact spent time in hospital. Community settings bear the brunt of treatment.
• Over a third of these service users were under 18 years of age.
• 1 in 5 16-year-old girls are now in contact with NHS mental health services.
• Working-age adults (18–64) form the largest group in contact with secondary services and dominate referrals to NHS Talking Therapies (common mental health problems).
• According to Age UK, older adults, those over 75 represent only 2% of referrals to NHS Talking Therapies nationally, despite high levels of depression, anxiety and loneliness in this group which suggests a significant under-identification and under-treatment in older people.
• In England, 19% of women compared to 12% of men report symptoms of depression or anxiety.
• Women aged 16 to 24 years are almost three times as likely as men the same age to experience a common mental health issue (26% vs 9%) according to the Mental Health Foundation. This is reflected in service use with 66% of referrals to NHS Talking Therapies being women (House of Commons Library).
• In terms of race, detentions under the Mental Health Act show inequalities with people from Black or Black British backgrounds having detention rates of around 262 detentions per 100,000 people, which is almost four times the rate for White people (66 per 100,000). Rates are declining for White people but increasing for Black people.
• In terms of deprivation, people from more deprived areas attend Accident and Emergency for mental health issues almost four times more often than those from the least deprived areas.
• Despite record numbers being treated, capacity has not kept pace with need. Crisis referrals are rising, waits for beds and community care are long, and there are serious concerns about violence, restraint and safety for both patients and staff – particularly in inpatient and emergency settings according to the Care Quality Commission (CQC).
• According to NHS England, people with severe mental illness (SMI) e.g. schizophrenia, bipolar disorder, clinical depression, continue to have poor physical health outcomes; only around 60% receive an annual physical health check, down from 66.5% the previous year.
• The CQC reports that urgent adult mental health crisis referrals more than doubled from 1,400 in April 2023 to 3,063 in March 2024, with services struggling to find beds and staff.
• NHS data on out-of-area placements (OAPs) show that people are still regularly sent far from home for inpatient care which is contrary to national policy aims.

Healthcare workforce: statistics and analytics

• NHS England’s violence-prevention work, drawing on the NHS Staff Survey, reports that 25.1%of staff experienced at least one incident of harassment, bullying or abuse from patients, service users or the public in the last 12 months and mental health settings bear a disproportionate burden: around 70% of all physical assaults on NHS staff occur in mental health services. 46% of psychiatric ward nurses report being physically assaulted in the previous year. 1.7% of mental health trust staff experienced violence more than 10 times in a single year (Assist Security Group).
• Recent analysis of workforce data shows that in June 2025, NHS staff took over 620,000 sickness days for mental health reasons (anxiety, depression, stress) in a single month, accounting for nearly a third of all sick days; about 5% of staff were absent on any given day (The Times).
• The CQC’s State of Care 2023/24 and Monitoring the Mental Health Act 2023/24 reports highlight: Persistent concerns about safety on mental health wards, including sexual safety, ligature risks and restraint; severe workforce shortages, dependence on agency staff, and high staff turnover; over-use and poor recording of restrictive interventions in some services.

Future forward in mental health discourse and policy

Any reform of mental-health legislation must be anchored in a clear moral universe grounded in ethics, dignity, and human rights, rather than political point-scoring or fiscal expediency.

The data show that individuals, families and communities already bear the overwhelming share of the economic and social costs associated with mental ill health. Yet public narratives continue to frame mental illness as a matter of personal shortcoming, productivity failure or insufficient individual effort. This is not merely inaccurate; it is ethically untenable.

A rights-centred approach demands a narrative correction. It requires political leaders to acknowledge the structural drivers of distress including poverty, discrimination, housing insecurity, educational inequities, exploitative workplace conditions, and to situate mental health not as a private misfortune but as a shared social responsibility. Without this reframing, legal reform risks becoming a technical exercise that adjusts the machinery of the system while leaving the moral foundations untouched.

Embedding human rights into the discourse means more than including them in the text of a Bill; it means operationalising them in funding decisions, service design, data reporting, workforce planning, and public communication. It means resisting the temptation to use mental health as a stage for political opportunism. And it means recognising that coercion, compulsion and diagnostic expansion are not neutral tools but practices that must be constantly scrutinised for their disproportionate impacts on those already marginalised.

A truly ethical mental-health system is one that sees the patient not as an economic unit to be “returned to productivity” but as a person entitled to safety, care, agency and the material conditions necessary for wellbeing. If Parliament chooses to embed these principles into both the narrative and implementation of the Mental Health Bill, reform can move beyond administrative adjustment and become a genuine social advance. If not, it risks deepening the very inequalities it claims to address.

References

Age UK / NHS England (2024) NHS Talking Therapies Positive Practice Guide: Older People.
CQC (2024) The State of Health Care and Adult Social Care in England 2023/24.
CQC (2025) Monitoring the Mental Health Act 2023/24.
Centre for Mental Health (2024) The economic and social costs of mental ill health.
Department of Health and Social Care / The King’s Fund (2025) The NHS Budget and How It Has Changed.
GOV.UK (2024) Independent investigation of the NHS in England.
GOV. UK (2025) Fit for the future: 10 Year Health Plan for England.
House of Commons Library (2024) Mental Health Statistics: Prevalence, Services and Funding in England (SN06988).
Mental Health Foundation (2023–24) Men and Women: Mental Health Statistics.
Mind (2024) The Big Mental Health Report 2024.
National Housing Federation (2025) Analysis on delayed discharges for mental health patients, reported in The Guardian, February 2025.
NHS England (2019) NHS Long Term Plan and Mental Health Implementation Plan 2019/20–2023/24.
NHS England (2024a) Mental Health Bulletin, 2023–24 Annual Report.
NHS England (2024b) NHS Talking Therapies, for Anxiety and Depression, Annual Reports 2023–24.
NHS England (2024c) Mental Health Services: Monthly Statistics – Performance February 2024.
NHS England (2025) Violence Prevention and Safety – Supporting Our NHS People.
NHS Staff Survey Coordination Centre (2024) NHS Staff Survey 2024 National Results Briefing.
Office for Health Improvement and Disparities / Race Disparity Unit (2024, 2025) Detentions Under the Mental Health Act – Ethnicity Facts and Figures and Mental Health Act Statistics: Detentions – Differences Between Groups of People.
NHS Providers (2025) Trusts Tackling Inequalities as Black People Almost Four Times More Likely to be Arrested Under Mental Health Laws.
The Guardian (2025) Wes Streeting: There is Overdiagnosis of Mental Health Conditions, 16 March 2025.
Wandsworth Times (2025) Starmer Suggests Rethink on Benefits for People With Mental health Illness, 1st October 2025.
UK Parliament Post (2025) Mental health: prevention and resilience, 14 April 2025.