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Louis Appleby was interviewed by Community Care reporter Katie Leason, who put questions to him regarding the draft mental health bill sent in from visitors to communitycare.co.uk and readers of Community Care magazine.

Question: Were you surprised with the opposition the bill has faced?

Answer:  It's a very contentious issue, setting out the circumstances under which somebody can be detained for treatment or assessment and so in that sense I'm not surprised that people have very strong views about it and these views are concerned about how these powers will be used. There is obviously a strength of feeling across the mental health field that we have to take account of and professional groups and patient groups have been very careful to emphasise how strong their views are held and how much backing there is in their constituencies and their organisations and we have to take that very seriously. It's not a question of being surprised, it's a matter of being prepared to understand where those very strongly held views are coming from and respond properly to them.

Q. Can they all be wrong?

A. No. This is a consultation period and a draft bill and the implication of that is that views have to be listened to and changes made if that's thought to be right and I don't think there is any shame in that. It's right for the two government departments to think that they will benefit from comments from people in the field so we don't start out with the assumption that people are wrong. That's not to say I agree with all the criticisms of course but I think it's right to listen to people and I think the overall point that there are places where the bill can be strengthened is bound to be correct and there wouldn't have been any point in having a consultation period if we weren't then prepared to make certain changes. That's what we now have to do.

Q. Given the strength of the opposition, how are you going to get the bodies and organisations on board now?

A. I think first of all by making clear that this is a genuine attempt to get the bill right. I hope people understand that now. There was a strength of feeling at the beginning of the consultation that this wasn't genuine consultation and without going into the history of that and whether it was fair or unfair, that is obviously how a number of people felt and a number of important organisations felt. I suppose a lot of the strength of feeling, and some of the quite bitter things that were said in the early period of consultation reflected the fact that people felt they weren't being listened to as much as concerns about the substance of the bill itself. I hope that's changed now and people have got the message that their views are being properly taken into account and that will continue. I don't think we should simply say we've had a consultation period so that's it we'll disappear into a room now and a bill will emerge in a few months time or whatever. I hope now people have also understood that there isn't some sort of dark government intent to increase compulsion for some sort of unidentified reason of social cleansing or something. There is nothing like that. There is no intention to increase compulsion.

Q. We've had a lot of interest from our readers about the ASW role and its replacement with the approved mental health professional. Why is the ASW role being changed?

A. It's really because of change across the health service to have people defined by skills rather than their professional background, and that is an NHS wide phenomenon. There is a much greater interest now in making sure people who come into the NHS that their role in the NHS is not determined by the door they come in at marked psychiatrist or social worker or nurse, but by the kind of skills they can develop within the system. There are several ways in which people are moving away from traditional professional boundaries and inevitably when considering what might change about the current mental health act that was one of the things, and I don't blame the social workers for feeling nervous about that because of course people always feel uneasy when their professional position might be changed. But it will still be the case that we will need people who bring the non-clinical perspective to mental health care, not only in relation to the act but in general to the nature of care. There is still a need for that and in some ways that is in a stronger position now than three or four years ago as a result of our national service framework which talks particularly about mental health promotion, social inclusion and some of the other issues which are not strictly clinical in the traditional sense.

Q. How is it going to be guaranteed that assessments will be balanced and not dominated by the medical model? In terms of if it's a nurse replacing a social worker there's a great fear among our ASW readers that it will become a very medical assessment.

A. Being honest about it, we have to make sure that doesn't happen because it's still part of the way the act is constructed that there will be people playing different roles. We're still talking about two doctors, we're still talking about somebody from a different profession making what is at the moment called the application. Those roles are kind of retained even though the exclusive professional position of social worker isn't retained. There are two doctors in the mental health act as well and the origin of that is to try to have independent medical opinion as part of the act and that will continue. But there are going to be difficulties about it that we have to work out partly because trusts are now much bigger, mental health services now cover a much larger area so the availability of somebody from an independent organisation is not so clear, and that will also be true in relation to the mental health professional who makes the application, whether or not actually it's a social worker because some organisations are now health and social care together. So people's concern is that if you're working for the same organisation and you're part of the same multi disciplinary team then how do we make sure there's an independent voice. I think that would apply whatever we were doing about the approved social worker role because of changes in the organisation of NHS and social care. We have to be sensible about working them through.

Q. Are you confident that a balanced assessment is going to be made which is not overshadowed by medical views?

A. I am confident about that because I think that's what happens at the moment, not because of the demarcation we've got in place, but because in general the act is operated by sensible people and people are aware of their position and aware of their responsibilities and I think that's why the process works, why we get differences of views between social workers and doctors properly thought through and worked out. I don't think it's just because one person is a social worker and the other is a doctor and therefore there's a clash between medical and social perspectives. I think it's because professionals working in this area are aware of the importance of what they do and the seriousness of the process of detaining somebody and so they do properly operate and reflect the position of importance they have been given and that will be true if we have a different sort of person playing that traditional social worker role. That will still be true because those professionals will still have that right expertise and training and the right kind of principles behind them.

Q. Regarding children, do you think they need a separate piece of legislation which is formulated particularly to meet their needs?

A. I hadn't thought of that. I haven't seen an argument that makes a strong case for that. There are some changes in relation to children being proposed which essentially makes them rather like adults from the age of 16 and there's an attempt to get the balance right between what the child wants in relation to treatment at any age and what parental rights there are. So no I hadn't really thought of that and I think in some ways the position of children is strengthened by being aligned with what's being set out for adults in the act.

Q. Scotland produced its bill, but it hasn't attracted the same amount of criticism as the English bill. Why do you think that is?

A. There's an important difference between the Scottish bill and the English bill which is not particularly to do with the bill, but to do with the history of how the services operate and in particular how they operate in relation to the criminal justice system. Scotland doesn't have the tradition that England has of its mental health services, forensic specialist mental health services, addressing the issues of dangerousness in personality disorder (DSPD). That's much more of an English phenomenon than it is in Scottish services. The link between this bill and the so called DSPD initiative has been at the root of a lot of the controversy. So I think it's not so much to do with the bill except that the bill reflects that kind of tradition. In England one of the reasons why people are worried about the increased use of compulsory powers is because of this link with DSPD, and what's being proposed for DSPD. There is no such proposal in Scotland because it hasn't really been an issue in Scottish services in the way that it has in England. I think the other thing is that there has been a debate about capacity and the issue of mental capacity and how it should be part of a mental health act or not.

Q. Under the proposals, the Mental Health Act Commission is to go. How are you going to ensure that its functions are continued?

A. What we're looking at is that Commission for Health Improvement (CHI), or the CHI successor, that it will have that role because it has that role for services in general, that issue of monitoring standards and carrying out inspections. That is what CHI does in general so the question is should we have a separate organisation that does that in relation to the use of the mental health act or should we have that as part of the brief for CHI who are doing this for mental health services as a whole, and I think the sensible thing is to bring the two together. It is a complaint of a lot of clinicians that there are far too many inspections. People sometimes feel they are over inspected so anything that helps to streamline the system should be good.

Q. Are patients still going to be visited and how will you ensure that the act is properly implemented?

A. We're not trying to make it more difficult to inspect the use of the act. On the contrary we are trying to bring it in line with the rest of how mental health services are examined and those things will still happen - it's just a question of who does it. At the same we are trying to increase the patient's access to support when they are detained under the act by bringing in advocacy for people who are under the act. What we're trying to do is make it easier for patients who are detained to express their views, have their rights respected and get proper treatment.

Q. In terms of the new tribunals, it has been estimated that 600 more psychiatrists are to be needed. Where are they going to come from?

A. There's no question that tribunals will need additional psychiatrists. I should say it's not actually to put people on the tribunal that we need more psychiatrists, it's to provide expert witness to the tribunals because we've quite deliberately not asked, not insisted on a doctor being a member of the tribunal because of the workforce difficulties that might cause. The tribunals have been brought in for a very important reason - to provide independent scrutiny for patients care plans. They are a very important safeguard in the new bill and if we think they are sufficiently important then we need to follow through the implications and if there are workforce consequences which of course there are then we need to address them.

Q. Are more people going to be subject to compulsion under the new act?

A. There is no intention to do that. The key to it is not the act in some ways it's what services we provide. The act isn't a substitute for good care. It never could be, it's not intended that way. The measures that will reduce compulsion are the measures that will improve services in general. So the way we will reduce compulsion is set out in the NHS plan, by brining in assertive outreach teams to support the most vulnerable people who at the moment come in and out of hospital often under compulsion. So if we support them better they will not need quite so many compulsory admissions. The early intervention teams in the NHS plan are there to make sure people's first experience of care is a much earlier one so they don't get so ill they have to be admitted to hospital under the act.

Q. Some say that people with mental health problems are going to be afraid of accessing help. Do you think they have reason to be afraid?

A. No because just as now most care will be voluntary. There is no intention to increase the use of compulsory powers. People look at the broad definition of mental disorder in the new bill and worry that will bring a lot of people under compulsion. It isn't the definition that brings people under compulsion it's the criteria. The criteria we do need to make sure is sufficiently tight so only those who absolutely need to be treated involuntarily are treated involuntarily. There's no intention to extend compulsory powers to people who might otherwise be treated informally. The aim is the opposite, it's to reduce compulsion and people need to be reassured about that.

Q. Regarding carers, does the legislation do anything to enhance their role as key partners?

A. It's not primarily for legislation to do that. I think that's an issue for services in general and I hope that's been at the forefront of what we have been trying to do in services over the last couple of years. I personally feel very strongly about the role of carers and the position they have, but I think we do that mainly through getting our services right and getting them to work in a way which is a proper partnership with carers. There have been some criticisms of the bill - people are worried that carers may be sidelined when it comes down to detaining somebody because it's up to the patient to nominate somebody. There are worries that someone who is ill might, because they're ill, be suspicious of their family members who they might normally live with and rely on and because they are ill might name somebody else as a nominated person which would effectively cut their normal carers out of the picture. That's certainly not intended at all and we need to make sure the wording of the bill doesn't allow that to be possible.

Q. What's your response to the accusation that the bill is complicated and hard to read?

A. I think it is complicated and hard to read. I think it's probably true, but I don't pretend to be an expert on parliamentary process. I think bills have to be written in a very precise and occasionally turgid language so they are legally defensible. On the issue of being clear with people and getting the message across and having proper discussion, that is obviously what we need to do and if the bill can't do that because of the parliamentary requirements then we need to have another way of doing it.

Q. Interviewing people in a suitable way, are there any safeguards to ensure that deaf people, for example, will have access to somebody to help them if sign language is their first language?

A. There is no intention to draw back from that. I think that's one of the issues we'll now be discussing because I think that has come through in consultation but I think people can be reassured that there is no intention to make it more difficult for people.

Q. Funding: are the proposals going to be any more costly?

A. Costs are being considered as part of the government's current spending review. The result of which hasn't been announced. Obviously these costs have been taken into account in what's been requested. There will be training costs for the bill. These costs are inevitable and we must be prepared to take them on.