In the mental health white paper, the government regrettably
showed a conflicting approach to the one set out in the National
Service Framework for Mental Health – namely, a wilful refusal to
listen to practitioners from a multi-disciplinary base, opting
instead for the view of “experts” – the medical profession.
Take the premise of “dangerousness”. This seems to be based on
the wholly specious argument that people with mental health
problems are more likely to harm or kill you than those without.
Even government statistics don’t bear this out.
The problem originates not with those who are known to mental
health services but among those who are not known or have not been
identified in time. The solution must therefore lie with the
primary services and is an issue about more accurate early
assessment and identifying risk factors.
Fear appears to be the impetus behind both the drive for
compulsory treatment law and the revision of what is one of the
most important key elements in the Mental Health Act 1983, the
“treatability clause”. Again the government’s figures show that
using a standard definition of personality disorder, about 70 per
cent of the prison population would be classified with such a
disorder. Only a few would be amenable to medical treatment and
there is already provision under the act to treat them. The vast
majority would not respond, although they may benefit from some
form of behavioural therapy. Care and control is best approached by
teams prepared to work in ways underpinned by a holistic view of
the patient, their community and their life.
There are serious implications for us all in the combination of
proposed changes to the act. First, “personality disorder” is such
an undefined and misunderstood definition that it could easily be
used to control any person perceived to be a “public nuisance”.
Without the requirement of treatability, anyone the psychiatric
profession considers might “benefit” from admission to hospital
would be at risk of being admitted against their will – especially
when the role of independent arbiter of a person’s human rights,
currently the approved social worker’s, is passed over to other
The proposals for compulsory treatment are aimed at those who do
not comply with prescribed medication and therefore relapse and
become ill again. The arbiter here will be the same person
controlling the process as before.
In a worst case scenario the combination of all the above could
be that a person who is seen by the local community as being
“strange” and/or threatening in some way could be diagnosed as
personality disordered, and because they resist incarceration, put
on medication and end up in hospital for years.
Before dismissing these statements as being far-fetched,
remember that it was only a few years ago that people were released
from long-stay institutions for being single parent mothers or
Paul Jewitt is an approved social worker for
Bedfordshire and Luton Community NHS Trust.