Plans to replace approved social workers with approved mental
health professionals from a variety of backgrounds were due to be
confirmed this week.
News that the revised draft mental health bill retains proposals to
end the ASW role will disappoint those who had warned that such a
change would endanger the holistic approach to mental health care
and lead to medical dominance.
Currently, an ASW must agree with two doctors before a patient can
Under the new proposals, this responsibility could fall to others
including specially trained mental health nurses or
Mental health tsar Louis Appleby insisted that the proposal should
not be seen to be undermining the social care model of mental
health, but as part of a wider programme within the NHS to broaden
professionals’ roles. “This is about their training, not their
background,” Appleby said.
He insisted that the revised draft was “clearly improved” and that
concerns raised by those in the sector about the earlier draft
being too focused on danger to the public and not enough on mental
health had been taken seriously.
As part of this, he said changes had been made to the conditions
for compulsory treatment.
The revised draft states that, for compulsory powers to be used, an
individual must be considered at risk of one of three clinical
circumstances: suicide, harming someone else or serious
Before detaining an individual, a professional carrying out an
assessment must ensure the person fits into at least one of those
They will also have to be satisfied that the detention is
Appleby said this meant that people with untreatable personality
disorders could only be detained if they were both a risk and
detention was clinically appropriate.
Treatment orders will not be used in the community under the
revised draft unless an individual meets the conditions for
compulsory treatment and has a previous admission.
Additionally, compulsory powers will not be allowed to be used in
In the light of concerns that the proposed definition of mental
disorder in the first draft of the bill could cover people with
conditions such as epilepsy, the revised draft offers a new
definition which places a greater emphasis on psychological
Although advanced directives are not included in the new draft,
Appleby insisted that professionals would be encouraged to give
patients a say in their care.