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Ever since the publication of the first draft Mental Health Bill two years ago, the prospects for the Mental Health Act Commission have looked bleak. In his "cull" of regulatory bodies last week, health secretary John Reid finally confirmed what was mooted at the time of the draft bill: that the MHAC will be absorbed into the new Healthcare Commission.

Given the loud protests about the MHAC's abolition when the first draft bill was published, it hardly bodes well for the government's willingness to compromise on a host of other issues when the next version is published later in the year. The official line is that the Healthcare Commission's takeover will harmonise inspection regimes and make the lives of mental health trusts easier. So it may, but the main consideration ought to be how it will affect the lives of mental health service users.


There are at least two grounds for concern. First, will the Healthcare Commission give the interests of users under the Mental Health Act 1983 the same attention as the MHAC did? And, second, does this represent the final victory of the medical over the social model of mental health care? The MHAC, for all its imperfections, has been a stalwart champion of mental health service users, particularly those sectioned under the act. The mental health act commissioners have never been afraid to publicise weaknesses in services or bring injustices to light, visiting 12,000 detained patients every year in the process. True, the Healthcare Commission also has a brief to stand up for service users, but it has the entire health service to inspect and regulate. The question will surely arise whether it can devote the same time and energy to a single sector as the MHAC did at its best. As a minimum, the skills, knowledge and experience of MHAC staff should be transferred to the new set-up, yet, since Reid's avowed aim is to cut staff, this is unlikely to happen.


Critics of the bill rightly worry about the proposal to replace the role of approved social worker with that of approved mental health professional. The Healthcare Commission's new duties risk a further shift in the balance of power away from social work and a further medicalisation of mental health. This would be a great pity for service users.