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


    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. 

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