publishes revised draft mental health bill
government yesterday published its revised draft mental health bill
to almost universal condemnation from bodies representing mental
health professionals and service users.
insist the revised bill will provide improved safeguards for patients
and better procedures for treatment to people with mental health
problems who "need to be treated against their will".
the Mental Health Alliance, a coalition of more than 60 professional
bodies, service user and carer groups and charities warned the revised
bill "could bring mental health services to their knees".
alliance said the revised bill risked driving thousands away from
mental health services, for the sake of a tiny number of people
who pose a risk to others.
the new proposals, it would be left to psychiatrists and other staff
to decide whether it was "clinically appropriate" to order
compulsory treatment. This might mean sectioning people who, it
is judged, could not be treated for their diagnosis of personality
disorder, but might benefit from treatment of depression or anxiety.
Louis Appleby, the government's national director for mental health,
said that there might be dangerous people diagnosed with personality
disorder who would not benefit from care or treatment. If they posed
a threat to society, they would have to be handled by the criminal
justice system, not the NHS.
revised bill also
raises the threshold for compulsory treatment from that proposed
in the 2002 draft bill of for the health and safety of the
patient to for the protection of the patient from suicide,
or serious self-harm, or serious neglect by him or his health or
addition, psychiatrists must be satisfied that appropriate treatment
is available for the patient.
revised bill is to be subject to pre-legislative scrutiny by an
expert parliamentary committee which has been instructed to present
a report by March next year.
remains likely, therefore, that there will be not be sufficient
time to bring forward a complete bill before the expected general
election next year.
revised draft bill would :
non-offending people diagnosed with personality disorder to be detained
indefinitely "if clinically appropriate". This would replace
the "treatability" test of current law.
* Introduce a change to the definition of mental disorder to emphasise
that it is the psychological condition as much as the underlying
diagnosis which is important before implementing compulsory detention.
Introduce compulsory treatment in the community (CTO). This law
would focus on patients who leave hospital only to return when they
fail to take their medication. Patients would first need to be assessed
in hospital before a CTO could be issued
Raise the threshold for compulsory treatment to for the protection
of the patient from suicide, or serious self-harm, or serious neglect
by him or his health or safety
Allow people to refuse electroconvulsive therapy if they retain
Increase maximum sentences for those convicted of ill-treating patients
Establish a new independent tribunal to review every detention lasting
longer than 28 days
an independent advocacy service to help patients assert their rights
the Mental Health Alliance believes the whole tone of the revised
bill is flawed.
Paul Farmer said: "We are deeply disappointed that the government
has still not listened to professionals, carers or people using
services. Despite receiving 2,000 responses opposing its original
plans, the government has pressed ahead with many of its most disturbing
most worrying of all is that the government's way of defining who
qualifies for treatment against their will is far too broad. This
will force professionals to bring too many people in for compulsory
treatment, damage the trust that is so vital between doctors and
patients and lead to a bureaucratic overload on an already overstretched
have a bill that is rooted in an out-dated, false stereotype that
people with mental health problems are a danger to society and are
unable to make their own decisions about care and treatment. The
revised bill remains objectionable in principle and unworkable in
Zigmond, deputy president of The Royal College of Psychiatrists,
said: "People who are capable of making choices about their
healthcare should be entitled to do so. Those
who are not capable should have the right to treatment that is in
their best interests. These principles should not
depend on the patient's diagnosis. The equivalent laws in Scotland
respect these principles. The proposals in this bill do not and
are an affront to justice."
Pegler, publisher and mental health service user, said: "Service
users need to feel that they will be understood, respected and treated
with compassion. Making them feel that they are more likely to be
punished for being ill will mean fewer people coming forward to
receive the care they need, when they need it. This bill could seriously
violate innocent people's fundamental human rights."
alliance has said that it will use the pre-legislative scrutiny
process to present its own proposals.
Zigmond has already urged his psychiatrist colleagues to write letters
of objection to MPs.
Appleby, however, emphasised that, ultimately, the decision to compulsory
detain someone remains with mental health professionals.
said the intention of the clinically appropriateness
test, which will replace the treatability test, was
to remove the dilemma of psychiatrists who found themselves unable
to treat patients they thought they could help because they could
not say with complete confidence that their symptoms would improve
as a result.
the moment, clinicians have to be sufficiently confident there will
be a direct benefit to the patient to use the act, otherwise they
cant use it, Prof Appleby explained. In
the future, they will just have to be confident that they are doing
the right thing.
said: "It will be for clinical and social care staff to decide
whether, in their professional judgement, it is clinically appropriate
to treat someone under the act. If they decide that they are not
then compulsory powers cannot be used.
criteria for compulsory treatment under the [revised] bill are carefully
drafted - to make sure that only people who need compulsory treatment
receive it. Mental health services will have a duty to respond to
requests for assessment and patients who are treated under the bill
will have to have an individual care plan focussed on their individual
Minister Rosie Winterton said: "Safeguards
for patients will also be greatly strengthened with
choice of representative, access to advocacy and all use of
compulsory treatment beyond 28 days having to be authorised by a
new independent mental health tribunal."
government's revised draft mental health bill (pdf)
15, 2004: Revised draft mental health bill will not satisfy critics,
admits government - "I think we will be able to give a
lot of reassurance, but there will be some people who just want
a different bill," says Health Minister Rosie Winterton
12, 2004: Mental health tsar indicates government to specify in
more detail the conditions under which people can be detained
- "There is no dark government intent behind the bill, says
Louis Appleby. "It just did not feel in the end that we had
got the right message about the criteria underwhich compulsion powers
might be used."
26, 2003: Revised draft mental health bill to be scrutinised in
parliament - ministers promise a code of conduct on how proposed
new mental health law should be applied
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