News

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 health professionals.

news analysis:

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 committed.

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 hospital.

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 consultation.

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 Psychiatrists (RCP).

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 retention problem.

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 adolescents adequately.

"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 process.

Consultation and draft Mental Health Bill are available at:

http://www.doh.gov.uk/mentalhealth/draftbill2002/index.htm