Last gasp concessions win approval of MPs and Lords

Nine years of controversy over mental health law reform ended last week, after both Houses of Parliament approved the Mental Health Bill.

MPs approved the bill for a final time, after the House of Lords, most of which had previously opposed the bill, agreed three compromise amendments with ministers, ending the possibility of the bill “ping-ponging” between the chambers.

This means the government has finally achieved its ambition of reforming for England and Wales the Mental Health Act 1983, initiated in 1998 (see Timeline).

Peers agreed to introduce a respect for diversity principle within the bill’s code of practice to allay fears about the impact of the legislation on black and ethnic minorities.

They backed a clause requiring renewals of detention to be agreed by a responsible clinician, such as a nurse or social worker, and a worker from a different profession, in response to concerns that detention should not be authorised by a single person.

And an amendment requiring clinicians to have regard to a patient’s history and risk of deterioration before imposing compulsory community treatment was also supported by peers.

The bill is expected to receive royal assent before the end of July but a Department of Health spokesperson said it had not yet decided on an implementation date. It will consult on the code of practice for the legislation in the autumn.

During the bill’s final debate, new mental health minister Ivan Lewis admitted that the bill had been “contentious from the time when work began on it in 1998, and throughout its passage”.

He said there was still much work to ensure regulations, codes of practice and implementation were right and wanted to work with stakeholders in a genuine partnership.

Andy Bell, chair of the Mental Health Alliance, said the government had made important concessions over the course of the bill’s passage, including a right to advocacy for detained patients and safeguards over the use of electro-convulsive therapy.

But he expressed disappointment that the government had missed the opportunity to introduce more “humane and progressive legislation”, failing to heed warnings about the possible over-use of compulsory community treatment.

Bill’s measures

Five key changes introduced by the bill:

● People will no longer have to be considered “treatable” before they can be detained. Clinicians will instead need to demonstrate that treatment must have the purpose of alleviating their condition.
● All detained patients will have the right to an independent advocate.
● Approved social workers will be replaced by approved mental health professionals, who can be drawn from other professions.
● Compulsory community treatment can be imposed on patients who have previously been detained in hospital and are felt to be in danger of deteriorating.
● Primary care trusts will have a responsibility to provide age-appropriate treatment for under-18s.

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 Simeon Brody