As Long As It Takes

The provision of free mental health aftercare for patients
compulsorily detained in hospital was always in keeping with the
principles of care in the community. If the community could support
patients outside hospital – and community mental health teams
and initiatives such as assertive outreach increasingly meant that
it could – then this was where they should be. But, by the
same token, there was always a strong moral argument that, like
hospital, aftercare services should be free at the point of
delivery. No one should have to pay for the necessary aftermath of
compulsory hospitalisation.

Money, as it often does, spoke louder than morals. The draft Mental
Health Bill’s proposal of an arbitrary six-week cap on free
aftercare follows a prolonged battle over how section 117 of the
Mental Health Act 1983 is to be interpreted. Two-thirds of local
authorities were thought to be charging for section 117 aftercare
services when, three years ago, the law lords ruled that they
should be free, forcing councils to reimburse patients who were
some £80m out of pocket. Now the government has pinned its
hopes on the draft Mental Health Bill to save some of this
money.

The Alzheimer’s Society correctly points out that people with
dementia leaving hospital after compulsory treatment are likely to
have a high level of need, requiring intensive support from health
and social services. And, it might have added, so are the vast
majority of their counterparts with other mental health conditions.
Many of them will require care and support for much longer than six
weeks, particularly if they are to avoid the trauma of forcible
readmission to hospital and the wasted hard work of practitioners
who contribute to the care plan. An arbitrary time limit on free
aftercare threatens to blur the whole focus of mental health
policy, not least elsewhere in the draft bill itself, on
maintaining patients with the most intractable problems in
community settings.

It is to be hoped that the parliamentary scrutiny committee on the
draft bill listens to sense. Otherwise the advice of the British
Medical Association may turn out to be right after all: tear it up
and start yet again.