Psychologists, nurses and occupational therapists to have new detention powers

June 28, 2007
by Chris George

(NB: This article was slightly modified on July 4, 2007)

Psychologists, nurses and occupational therapists are set to have new powers to detain people diagnosed with a mental disorder.

A mental health bill presently going through parliament will enable non-psychiatrists to renew detentions, including community treatment orders, on patients sectioned in psychiatric units. But such “responsible clinicians” will not be able to implement a patient's initial hospital detention. This must be implemented by two psychiatrists.

Present law states a psychiatrist - as a “registered medical practitioner” - must be involved in renewing detention. But mental health minister Rosie Winterton, after recent lobbying by a new coalition of non-psychiatrist professionals, wants to enable non-psychiatrists to also have these powers.

However, the House of Lords, where the bill is due to go next week, wants law to specify that at least one psychiatrist is involved in renewing a patient's detention.

In the government's proposals, a responsible clinician will also have powers to place a patient on a community treatment order. These is when a hospital-detained patient can be ordered to live at a designated place in the community and to accept medication.

Two "approved" clinicians will also be able to end a patient’s detention. There would, unlike now, be no legal requirement for a psychiatrist to be involved.

Organisations representing psychologists, nurses and occupational therapists say these planned new powers reflect the true status of non-pharmacological approaches, such as psychological therapy, in mental health work

Clinical psychologist Peter Kinderman of the Mental Health Coalition, a splinter group from the campaigning group the Mental Health Alliance, said the new powers would enable detained patients to benefit from multi-disciplinary approaches to care.

"Yes, we have got more powers, but it will be possible for clinicians to use this power in the best interest of clients,” he said.

In a separate development, the government has rejected calls for a capacity test to be retained. The bill contains no condition that a patient’s decision-making ability be "significantly impaired” for them to be detained. This lack of a capacity test could enable more people with a diagnosis of personality disorder to be detained.

However, the government has shifted its position on a "treatability test”. Ministers had argued they did not want such a test as it may have prevented clinicians detaining dangerous people diagnosed with personality disorder who some judge to be untreatable. The bill now states that "appropriate medical treatment” must be available for someone to be detained.

Meanwhile, the Guardian newspaper reported that The Commission for Racial Equality has warned ministers that the bill unlawfully discriminates against ethnic minorities.

Nick Johnson, the commission's policy director, has said the bill could be challenged by judicial review.

Matilda MacAttram, director of Black Mental Health UK, said: "Community treatment orders are no more than psychiatric asbos, which have no place in mental health legislation", and make "countless numbers of black people becoming prisoners in their own homes".

Read for yourself:
The government's mental health bill, as it stands (pdf)

See also:
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.
Mental health comment
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 a claim?
Dec 1, 2006: Government presses ahead to force some psychiatric patients to take medication in community - plans in new mental health bill
March 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 Winterton (left)
Clinical psychology comment
April 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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