Compulsion in the Mental Health Bill:-
The bill proposes a new legal framework for the compulsory
treatment of people with mental disorders.
– Compulsory treatment can be used where it is necessary for the
health or safety of the patient.
– People with dangerous and severe personality disorders can be
detained even if they argue their condition is untreatable.
– Patients may be subject to community-based compulsory treatment
orders, but will be returned to secure accommodation if they fail
to comply with their terms.
– The role of approved social workers in deciding whether
compulsory powers can be used will be replaced by approved mental
Opposition to the draft Mental Health Bill has been growing
steadily since it was first unveiled in June. Last week, that
opposition became visible when about 50 demonstrators with giant
syringes, straitjackets and “hugs not drugs” placards protested
outside the Department of Health’s offices in London.
“We felt there was a need for public opposition and concern, given
that the consultation is halfway through,” says Dave Harper, one of
the organisers of the demonstration by the Critical Mental Health
Forum (CMHF), a predominantly London-based group of service users,
professionals and academics.
The forum argues that the proposals represent severe challenges to
human rights. It claims there is an over-emphasis on risk and that
there is no evidence that mental health professionals can
accurately predict who will be violent before an offence is
About 5,000 people with mental illnesses would need to be detained
just to prevent one homicide by one person with mental illness, the
group claims. It wants the government to introduce separate
criminal justice legislation on risk and to keep safeguards such as
the “treatability” criterion, which prevents indefinite detention
in hospital if treatment is unsuccessful.
Harper, senior lecturer in clinical psychology at the University of
East London, says he would also like to see a capacity test to
establish whether a person is able to make a decision about their
treatment. “Something that acts as a hurdle before you can take
someone’s liberty away,” he adds.
Disapproval of the proposals in the bill has served to unite a
number of organisations. The Royal College of Psychiatrists and the
Law Society have recently joined the Mental Health Alliance (MHA),
a coalition of more than 50 organisations concerned about the
proposed changes to the law.
Consequently, it was a range of groups, including lawyers, nurses,
psychiatrists and social workers, as well as charities, carers, and
users, that met earlier this month to decide how to challenge the
government. They concluded that individuals and organisations
should flood the consultation with their views and support the
“Rights not Compulsion” march planned for 14 September.
The aim of the demonstration is to show publicly the strength of
feeling against the proposals. Statements are to be handed in at
the Department of Health and 10 Downing Street and the march will
culminate in a rally at the Geraldine Mary Harmsworth Park in south
London, the historic site of the original Bethlem psychiatric
The MHA believes that the proposals contained in the draft bill
will increase compulsion, and wants to see tighter criteria on its
use so it is used only as a last resort.
Rather than focusing on compulsory treatment, it would like to see
the bill give people the right to receive the services and support
they need. It claims that too many people who ask for help from
mental health services are turned away.
It believes that people with mental health problems should have the
right to draw up statements setting out what they would like to
happen if they become too ill to make decisions for themselves, and
wants advocates to be provided for people before they are subject
to compulsory powers.
Richard Brook, chief executive of mental health charity Mind, and
one of the leading members of the MHA, believes that people will be
scared of turning to mental health services for fear of being
detained or receiving compulsory treatment. He says certain types
of people are likely to be badly affected.
“Black and ethnic minorities will be more at risk,” he says.
“Because the criteria have been widened, the more disproportionate
groups are likely to get caught up even more.”
He says that Mind is particularly opposed to the proposal for
compulsion to be extended to the community, believing it will be
used more frequently and inappropriately.
The bill has also provoked anger among social workers, who oppose
the proposal to water down the role of approved social workers in
deciding when to detain a person. The bill replaces the ASW with an
“approved mental health professional”.
The British Association of Social Workers’ mental health special
interest group claims that, if the bill is passed, within a few
years most decisions to detain a patient would be made by a
consultant psychiatrist and a nurse, both employed by and
accountable to the detaining body. In addition, it claims that the
nurse would be professionally obliged to defer to the psychiatrist
on clinical matters.
BASW questions whether social workers will take on the approved
mental health professional role. Recruitment to ASW posts is
already falling, and BASW claims the fall is likely to accelerate
as the implementation date approaches because social workers see
little point in seeking approval or renewal of approval for a role
that is going to disappear.
Approved and forensic social worker Paul Jewitt is opposed to the
intention to substitute ASWs. He has been contacted by about 25
ASWs who oppose the move, and at least 70 ASWs from
Buckinghamshire, Northamptonshire, Hertfordshire and Bedfordshire
will meet early next month to formulate their response to the
Jewitt describes the draft bill as “very distasteful and
complicated”. “It’s not just a matter to do with ASWs and the
Mental Health Act, it’s about civil liberties,” he says.
There are also concerns about human resource implications. Fifteen
per cent of consultant psychiatrist posts across England and Wales
are vacant, too few students are entering the profession, and too
many consultants are leaving prematurely, says the Royal College of
The RCP is concerned as to where the extra psychiatrists needed to
sit on the new tribunals will come from, and feels that
dissatisfaction with the proposals will worsen the recruitment and
Overall, the RCP considers the bill “ethically unacceptable and
practically unworkable”. RCP president Mike Shooter says that a
change in mental health law has been wanted for some time, but that
the proposed changes are not the way forward.
“Our principal reason for opposing it is that it is basically
public order legislation in disguise. It’s not about treating
people with mental health problems – it is about maintaining public
order,” Shooter says.
Others believe that the bill fails to cover children and
“We’d like to see a separate section in the bill focusing on the
particular needs of children and adolescents and the importance of
having specialist child psychiatrists and social workers and not
adult trained workers,” says Dinah Morley, deputy director of
children’s mental health charity YoungMinds.
Morley does not anticipate that a separate piece of legislation
will be drafted to cover children, but hopes that there will be a
section within the bill that focuses on them.
The consultation ends on 16 September, but protests against the
bill are likely to continue long after that date. Despite
objections towards the government’s green and white papers, the
resulting draft bill contains some of the very proposals that
caused the initial outcry. Some say that the proposals in the bill
are even more draconian than the original plans, in spite of the
ongoing opposition to them.
The government failed to listen before and so it is understandable
that some people are questioning the validity of the current
Consultation and draft Mental Health Bill are available at: