Right to advocate for detained psychiatric patients

All detained psychiatric patients will have the legal right to an advocate, after the government’s mental health bill was passed yesterday in parliament.

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”.

The new law, a series of amendments to the Mental Health Act 1983, specifies the conditions and procedures under which people can be detained

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.”

The 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.

Key points of the mental health bill:

What’s the definition of mental disorder in the bill?
* any disorder or disability of the mind.

What exclusions are there?
* drug or alcohol dependence, learning disability unless with “abnormally aggressive or seriously irresponsible behaviour”. Clinicians must also “respect” diversity, including cultural and sexual orientation.

What are the criteria and conditions for a patient to be detained or placed on a community treatment order (CTO)?
* presence 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)

What professionals 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 responsible clinician?
* 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).

Who sets the conditions of a CTO: 
* Responsible clinician may vary or suspend conditions and/or recall a patient back to hospital

What new treatment safeguards are there?
* No ECT to be given if refused, other than in an “emergency “

New rights for patients?
* Advocates for all detained or CTO patients

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