Psychologists, nurses and occupational therapists to have new detention powers

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”.

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