advocate for detained psychiatric patients
by Chris George
detained psychiatric patients will have the legal right to an advocate,
after the government’s mental health bill was passed yesterday
But while welcoming a right to independent
advocacy and the assurance that children will not be placed on adult
psychiatric wards, campaigners say the new law was a “missed
opportunity to achieve a modern and humane new mental health act”.
new law, a series of amendments to the Mental Health Act 1983,
specifies the conditions and procedures under which people can be
Following pressure from campaigners,
ministers have made a number of changes to the original bill. This
includes adding the condition that "appropriate treatment"
must be available before a person can be detained in hospital or
subsequently placed on a community treatment order.
But the Mental Health Alliance,
consisting of more than 70 mental health and law groups, fear not
enough safeguards have been put in place to prevent an “over-use”
of community treatment orders. It also says “excessive”
powers have been given to clinicians. The new law will, for the
first time, allow psychologists, nurses, occupational therapists
and social workers to renew, or terminate, a patient’s detention.
The alliance also said because
the bill contains no condition that a patient should be lacking
capacity for detention, people able to make rational decisions
will be sectioned.
Dr Andrew McCulloch, chief executive of the Mental Health Foundation
charity, said: “Taken as a whole, the bill is disappointing
and represents a missed opportunity to provide truly progressive
mental health legislation.
"However, we welcome the concessions made by government, in
particular the decision to provide advocacy to service users. This
is a fundamental change that should protect the rights of many people.”
Dr Tony Zigmond, vice-president
of The Royal College of Psychiatrists, said: "Advocacy, treatability
and the additional protections for children are all important and
welcome gains...We hope sufficient resources will be provided for
mental health services to ensure the legislative changes can be
made to work properly."
new law, which the government insists is a balance between patient
rights and public safety, is expected to come into effect during
the winter of next year. It has been five years since the government's
first draft mental health bill was published.
of the mental health bill:
definition of mental disorder in the bill?
* any disorder or disability of the mind.
* drug or alcohol dependence, learning disability unless with "abnormally
aggressive or seriously irresponsible behaviour". Clinicians
must also "respect” diversity, including cultural and
the criteria and conditions for a patient to be detained or placed
on a community treatment order (CTO)?
of mental disorder
* in the interests of the patient’s health or safety or the
protection of others
* medical treatment is available (medical treatment includes nursing,
psychological intervention and specialist rehabilitation)
can apply for someone to be detained?
* Approved social worker is replaced in the bill by an approved
mental health professional (AMHP), who can be a psychologist, nurse,
occupational therapist or social worker. AMHPs can makes application
for a patient’s detention which is initiated by psychiatrists.
What is a
* A patient’s responsible clinician is s/he with overall responsibility
for a patient. All detained patients or those on a CTO must have
a responsible clinician who can be a nurse, occupational therapist,
psychiatrist, psychologist, or social worker
Who can renew
detention, including CTOs?
* A responsible clinician (after consulting with one or more other
persons professionally involved).
sets the conditions of a CTO:
* Responsible clinician may vary or suspend conditions and/or recall
a patient back to hospital
treatment safeguards are there?
* No ECT to be given if refused, other than in an “emergency
rights for patients?
* Advocates for all detained or CTO patients
June 28, 2007:
Psychologists, nurses and occupational therapists to have new psychiatric
detention powers - "it will be possible for clinicians
to use this power in the best interest of clients,” says Peter
May 24, 2007: Five professional organisations
leave Mental Health Alliance - psychologists, mental health
nurses and occupational therapists express frustration at how the
alliance has represented them
May 17, 2007: Leading psychiatrist
turns down OBE in protest at "deeply flawed" mental health
bill - Suman Fernando fears planned new law could exacerbate
discrimination of black people
March 15, 2007: Black patients
seeing psychiatrist for first time should have advocate, government
urges - ...meanwhile, the Commission for Racial Equality is
investigating whether the mental health bill might break race law
March 14, 2007: Treating psychiatric
patients under compulsion in community has no clinical benefit,
says report - there is no evidence for decreased hospital readmission,
improved medication compliance or patient quality of life, states
Institute of Psychiatry international review of CTOs.
Feb 28, 2007: Peers defeat government
over plans to extend compulsory plans of treatment over mentally
ill - controversial bill now due to go before MPs after Easter
Jan 25, 2007: Clinical
psychologists should refuse to detain patients, academic urges
- new government law means psychologists will be required to implement
“social control”, argues David Harper
Jan 12, 2007: Government set to
win bid to extend compulsion powers over mentally ill, says MP
- "I do not think there will be a major Labour rebellion,"
says Lynne Jones of group of MPs with previous "misgivings”
over mental health bill.
Dec 12, 2006: CTOs do not
work...and that's according to the evidence base - Community
treatment orders will help protect the public from mentally people
who kill, says the government. But what of the evidence for such
1, 2006: Government presses ahead to force some psychiatric patients
to take medication in community - plans in new mental health
23, 2006: Government drops key proposals of draft mental health
bill - new "streamlined” bill will be an amendment
to the present mental health act, says mental health minister Rosie
11, 2005: We can do a power of good - Many clinical psychologists
welcome the draft mental health bill because it would give them
extra powers, such as preventing the use of ECT or the over-medication
of patients. Moreover, argues Peter Kinderman, it's time clinical
psychologists stopped clinging to the myth that, at present, they
have no power
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