Not in the best of health

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.