The mental health “tsar” Prof Louis Appleby has been accused of encouraging staff to unlawfully coerce patients to adhere to treatment.
In a war of words between two leading mental health figures, Chris Heginbotham, chief executive of the Mental Health Act commission, wrote to Appleby complaining that a recent report he produced may lead to more incidents of staff coercing psychiatric patients to stay on wards and accept treatment.
The row has erupted as the government endeavours, in a mental health bill, to extend powers of compulsory detention over people diagnosed with a mental illness.
Heginbotham objected to Appleby’s referral of informal patients as “leaving a ward without permission” and being guilty of “absconsion”. Appleby used the terms in his December national confidential inquiry into suicide and homicide by people with mental illness report.
Heginbotham told Appleby such a “blurring” of distinction between informal and detained patients may encourage “unlawful” coercion.
The commission has previously raised concerns about the use of coercion in mental health units.
“The report assumes informal inpatients require “permission” to leave a ward and have “absconded” if they leave without such permission,” Heginbotham wrote in a letter to Appleby.
“Mental Health Act Commissioners… see examples of unlawful ‘de facto’ detention on their visits…
“It is of great concern to the commission that the report’s blurring of the distinction between informal and detained patients, and the apparent assumptions regarding the powers over informal patients as a consequence, may encourage such unlawful practices.”
In response, Appleby wrote of his “surprise” that Heginbotham should criticise a “choice of words”.
Appleby, the government’s national director for mental health, told Heginbotham he did not use the term “permission” in a legal sense.
Appleby wrote: “A good care plan will include whether a [suicidal] patient should spend time off the ward and it is in this context that patients are often asked to check with staff before leaving the ward.
“This is the sense in which “permission” is used in this report, not in a legal sense.
“When staff say that a patient may leave the ward, they are saying whether it is safe or consistent with the care plan, not explaining the patient’s legal entitlement.
“I suspect most people in clinical practice, and most patients, understand this point.”