Reform of the Mental Health Act

• Mental health bill 'will instil fear'. Guardian Unlimited 29 Oct 2003.Britain's mental health system is "broken" and will deteriorate further if the government presses ahead with its plans to widen the powers to compulsorily detain people for treatment, healthcare experts warned today. Proposals in the much criticised draft mental health bill to detain people with untreatable mental disorders and to compulsorily treat patients in the community would breach human rights and deter those in distress from seeking help, according to experts at a mental health summit organised by the Conservative party. Alan Franey, the former chief executive of Broadmoor special hospital, said the draft bill, which is expected to be reintroduced in the Queen's speech, would drive mental illness underground because people in need of help would be too afraid to seek it for fear being treated against their will.
  "Under this proposed legislation, if you go to your GP and say you're suffering from depression and he offers you antidepressants and you ask for a therapeutic treatment instead, you could be slapped with a compulsory treatment order," said Mr Franey, now director of Buckinghamshire Association of Mental Health. The bill was so broadly drafted that it threatened the civil liberties of the whole population, he said. "We do need a new mental health act but one that balances public safety with treatment, not one that instils fear." Mr Franey said the plan to detain and treat people formerly known as psychopaths - now termed as having a dangerous and severe personality disorder - even when they have committed no offence was "morally wrong".
  Beverly Malone, general secretary of the Royal College of Nursing, branded the draft bill as "totally inadequate". "The [mental health] system is broken. You don't fix a broken system by adding broken legislation to it. It will not do anything to repair the system, it will only break it to a greater degree," she warned. Dr Malone, said nurses feared that the proposed legislation would turn them into jailers because their assessments of patients would be used to detain people considered potentially dangerous. She called for new legislation that gave people a right to treatment and access to a greater choice of therapies in order to improve the lives of service users and restore public confidence in the mental health system.
  Mr Franey also warned that the poor state of many mental hospitals was adversely affecting patient care. "Staff struggle to provide quality care in surroundings akin to a Victorian asylum," he said. "Old buildings help to create an atmosphere where levels of fear and anxiety are high." He called on the government to ensure that mental health funding was not spent on clearing the debts of hospital trusts. "There has been new money. But it has often been spent by primary care trusts on clearing acute trusts deficits. I know of £2.25m of this money in two counties was used to clear acute debts in this way."
• Mental health workload would double under draft bill. Community Care 19 Nov 2003. The proposals set out in the draft mental health bill could double the mental health workload for professionals and lead to a workforce crisis, a report by the NHS Confederation warns. The organisation for NHS employers warned that under the proposals, social workers, psychiatrists and administrative staff would have to spend double the amount of time they currently spend implementing the Mental Health Act 1983. An extra 1,000 staff would be needed just to manage existing caseloads. Clinicians could be forced into rationing resources and giving treatment to patients who are formally detained, to the disadvantage of those not subject to mental health legislation, the report added. It concluded: “Mental health services are already hard pressed and affected by staff shortages in key areas. We are not yet convinced that the benefits of new legislation, as currently drafted, are commensurate with the extra process time.” The increase is largely due to the proposal for all cases to go through a new mental health tribunal when requiring compulsory treatment beyond 28 days. Currently, a tribunal is only required if a service user applies. Estimates suggest there would be an immediate increase of between 60 and 100 per cent in the number of hearings. Paul Farmer, chairperson of the Mental Health Alliance, said that the draft bill threatens to “overwhelm” health and social care staff, and risks people who do not need compulsory treatment being neglected. 'Assessment of implications of new mental health legislation on mental health service organisations'
  
  
• Draft Mental Health Bill, letters from campaign headquarters. The Royal college of Psychiatrists. May 2003.
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• House of Commons Written Answers, 13th March 2003. Tim Loughton: To ask the Secretary of State for Health what estimate he has made of the number of people who would be subject to compulsory treatment, whether resident or non-resident, under the proposals contained in the draft Mental Health Bill, who are currently exempt under the Mental Health Act 1983.

  Jacqui Smith [holding answer 4 March 2003]: The 1983 Mental Act liberalised the law to incorporate more tolerant public attitudes in relation to sexual preference so that this could no longer be viewed as a condition of mental disorder. Also excluded were people who are substance or alcohol misusers. However, people with psychosis exacerbated or caused by substance misuse, including alcohol, can be treated under the 1983 Act. A misunderstanding of section 1(3) of the Act has resulted in many instances in substance abusers being denied the treatment they need. Proposals under the Bill will remove all exclusions to ensure that those who fulfil all the conditions for compulsion receive the help that they need. The draft Mental Health Bill proposes a single broad definition of mental disorder, coupled with tightly drawn conditions that must be satisfied for compulsory powers to be used. It is the intention that the strict conditions will ensure that the powers are only used where the patient is suffering from a mental disorder which is serious enough to require treatment under the care of a mental health consultant; the risk to self or others warrants it and appropriate treatment is available for the individual patient. This approach would remove exclusions and the "treatability" requirement so that there are no arbitrary obstacles to the treatment of anyone who satisfies the conditions for compulsion. While the new legislation will lead to some change in the group of people treated, overall it is not the intention that more people will be subject to compulsion under the Bill. Investment under the NHS Plan and service improvements under the national service framework for mental health, such as assertive outreach, crisis resolution and early intervention, will help to provide more effective care and ensure that fewer people become so ill that they need compulsory treatment.

• House of Commons Written Answers, 12th March 2003. Tim Loughton: To ask the Secretary of State for Health whether the Mental Health Bill will place a legal obligation on health and social services authorities to honour advance statements and advance directives.

  Jacqui Smith: It is not proposed that the Mental Health Bill should place a legal obligation on health and social services to honour advance statements and advance directives since the use of compulsory powers under the Bill is based on the concept of treatment being necessary rather than the capacity of the individual to take decisions, whether those decisions are expressed at the time or in an advance statement or directive. As part of our consideration of the Mental Health Bill consultation responses we are, however, looking further at how best to ensure that clinical teams take notice of patients' wishes and feelings.
  

• Holmes, G. (2002) Some thoughts on why clinical psychologists should not have formal powers under the new Mental health Act. Clinical Psychology, 12, 40-43
• Church of England demands changes to 'regressive' mental health reforms The Independent. By Sophie Goodchild, Home Affairs Correspondent 02 March 2003. The Church of England has condemned the Government's Mental Health Bill which will lead to mentally ill people who have not committed a crime being locked up against their will. Over 270 senior church leaders have given unanimous backing to a motion which brands the Bill's central provisions "unworkable and regressive" and "preoccupied with issues of public safety". Last week, members of the General Synod, the Church of England's decision-making body, outlined their concerns over the proposed mental health reforms at their annual meeting in London. They called on the Government to provide alternatives to prison for mentally ill offenders and legal protection for vulnerable patients incapable of choosing their own treatment. This is the first time in eight years that the issue of mental health has been debated at the Synod. So concerned are its members that they now plan to lobby senior ministers at the Department of Health and the Home Office to amend the Bill. The Ven Arthur Hawes, the Archdeacon of Lincoln, who opened the debate, said the Bill failed to recognise the link between social deprivation and mental illness."People with dangerous and severe personality disorders run the risk of being detained on the basis of perceived risk," said the archdeacon, a former Mental Health Act commissioner. "Not only will public safety overrule human rights, but people with learning disabilities will be liable to detention simply because they have learning disabilities." He said the area of greatest concern was that prisons were not suitable places to provide care for mentally disordered offenders. The Mental Health Alliance which is opposed to key aspects to the Bill said that it would continue to lobby the Government to amend its mental health proposals."We welcome the backing of the Church of England," said Paul Farmer the chairman of the Mental Health Alliance."We want a Bill but one that reflects the needs of the 21st century. The Government should realise that there is a lot of good will and desire to work with ministers on getting this right."

• Should psychiatrists protect the public? Editorials. BMJ 2003;326:406-407. ' The Royal College of Psychiatrists has stated unequivocally that the only rationale for psychiatric intervention is for the benefit of patients' health and public protection is secondary'.
• ‘Is Anyone Safe?’ VISITING PROFESSOR INAUGURAL LECTURE. (Real Player, Windows Media Player, PowerPoint) On Wednesday 13th November 2002, Professor Anselm Eldergill, Visiting Professor in Mental Health Law at Northumbria University delivered his inaugural lecture - ‘Is Anyone Safe?’Professor Anselm Eldergill is a solicitor who specialises in mental health law. He writes extensively on the subject, and is regularly invited both to speak at conferences and to lecture to professionals working in the field. His most well-known publication is the book, “Mental Health Review Tribunals – Law and Practice”, published in 1998 by Sweet and Maxwell. Other publications include “The Falling Shadow and the Deteriorating Patient” (a Mental Health Act Commission Discussion Paper (1998)), “Psychopathy, the law and individual rights” (Princeton University Law Journal (1999)), “Reforming Inquiries following Homicides” (Journal of Mental Health Law (1999)) and “White Paper: Reform of the Mental Health Act” (Journal of Forensic Psychiatry (2001)). In recent years Professor Eldergill has chaired eight independent NHS and Social Services inquiries into homicides committed by psychiatric patients. He was a Mental Health Act Commissioner from 1992 – 2000. He has been accorded ‘top billing’ in the mental health law section of Chambers’ Guide to the Legal Profession (2001 – 2002), and has an entry in the American publication, Who’s Who in Science.
• Milburn promises Mental Health Bill. BBC News 14 Nov 2002. A new Mental Health Bill will be brought before parliament in the coming months, Health Secretary Alan Milburn has insisted. There has been speculation that plans to overhaul existing legislation had been shelved after it was omitted from the Queen's Speech. However, Health Secretary Alan Milburn told MPs on Thursday that a Bill would be introduced in the current parliamentary session.Ministers have faced fierce opposition from doctors, patient groups and campaigners over their plans to reform mental health laws. A draft Bill, published in June, promised the biggest shake up of the sector in England and Wales for decades. However, two proposals in particular sparked an outcry. These included plans to force mentally ill people living in the community to take their medication; and proposals to detain dangerous people with severe personality disorders even if they have not committed a crime. The Department of Health has received around 2,000 responses to the draft Bill. Mr Milburn said proposed legislation would be drawn up after these submissions had been considered. "When we have finished considering those responses we will be bring forward a bill in the course of this session," he told MPs. "Reform has to happen in mental health services just as they have to happen in the rest of the health service." He added: "We will press ahead with reform of the mental health laws. The current laws are rooted in the 1950s." Earlier this week, doctors and campaigners expressed their hope that ministers would think again about some of the proposed reforms. The Mental Health Alliance, an umbrella organisation bringing together over 50 different groups, had spearheaded a campaign against the proposals. The British Medical Association has warned that if the proposals outlined in the draft Bill were implemented they could cause mental health services to collapse. Speaking on Wednesday, Dr Robin Arnold of the BMA said: "We have serious concerns about the Bill in its draft form and believe that if implemented could result in the collapse of mental health services in England and Wales." The BMA and other groups said they hoped ministers would enter discussions on any new legislation.
• Mental health rights fears. BBC News 11 Nov 2002. The government has been warned that proposals in its Draft Mental Health Bill could infringe the human rights of patients. The joint House of Commons and House of Lords committee on Human Rights say they have "serious reservations" about some aspects of the draft measures which would in general improve safeguards on the human rights of patients.
• Houses of Parliament. Joint Committee on Human Rights: The Draft Mental Health Bill. Twenty-fifth Report. Report together with Proceedings of the Committee and Appendices. 11 November
• Ministers rethink Bill to lock up mentally ill. The Independent. 3 Nov. Ministers are being forced into an embarrassing climbdown over a proposed new law to lock up mentally disordered people who have committed no offence. In the face of unprecedented opposition from professionals, patients and their own officials, and a five-month campaign by The Independent on Sunday, the Government has been forced to rethink the most controversial aspects of the Mental Health Bill. The stakes are now so high that Professor Louis Appleby, the Government's mental health tsar, has indicated to colleagues he will resign if concessions are not made. The Government has drawn up plans to refer the controversial Bill to a special "standing committee", set up to deal with complicated or troublesome Bills, before it is formally debated by MPs. Ministers have been shaken by the strength of the opposition, which has united the Church, the medical and legal professions and patients' organisations who believe it is unworkable, unethical and inhumane. Tories, Liberal Democrats and backbench Labour MPs are expected to oppose it. The King's Fund, the leading health think-tank, will warn this week that compulsory treatment will "turn back the clock" and deter vulnerable people with severe mental illness from seeking help. But the Home Office believes it is a popular Bill aimed at protecting the public from dangerous psychopaths, and is determined to press ahead. On Thursday representatives of the Mental Health Alliance, a coalition of more than 50 groups opposed to the Bill, are to meet officials to discuss concessions that would be necessary to win their support. The sticking point for opponents is the plan to incarcerate people with severe personality disorders who are judged to be dangerous. Early Home Office estimates put the number that could be pulled in at more than 14,000, which would overwhelm the psychiatric services and raise serious civil liberty issues. Professor Appleby insisted at a meeting with Home Office officials on 23 October that the criteria must be drawn tightly so that only the most dangerous individuals, numbering a few hundred not already in prison or mental hospital, would be included. He also argued that only those who had committed a crime should be detained. If that was achieved, Department of Health officials believe opposition to the Bill would wilt. But his stance inflamed David Blunkett, the Home Secretary, who accused health professionals and civil servants of trying to wreck the Government's plans. In a speech to the Zito Trust, Mr Blunkett said: "There has been a tradition of people thinking they can have a separate policy to the ministers they serve. They can't."

• INCREASING PROTECTION FOR PATIENTS, VICTIMS AND THE PUBLIC
  Reference: 284/2002 - Date: 30 Oct 2002 10:10
  New mental health legislation will improve safeguards for patients and the community, and introduce new rights for victims, the Home Secretary said today.

  Speaking at the Zito Trust Conference in London, David Blunkett said he wanted to dispel the myths surrounding the draft mental health bill. He stressed that balancing the rights and safety of the community and victims with the rights of individuals with mental health problems were not only compatible, but complementary aims.

  David Blunkett said:

  "The position of Alan Milburn and myself is very clear; getting it right for the victim is the same as getting it right for those with a mental disorder. The philosophy behind the mental health bill is that public protection is best served by ensuring that everyone who needs treatment, either for their own safety or the protection of others, is able to receive it.

  "I know that is the philosophy of the Zito Trust too and is best encapsulated in Jayne Zito’s own words; ‘Since the day that Jonathan died my position has been that Christopher Clunis was a victim who had the right to be detained and treated.’"

  Acknowledging that mental health is one of the most sensitive and difficult issues that society has to deal with, the Home Secretary said it was understandable that the prospect of the first major overhaul of the system since the 1950s had given rise to concerns. But he said reform was designed to deliver both greater protection and better services by bringing the current system up to date and into line with new patterns of care and treatment.

  Mr Blunkett said:

  "Those who work in mental health come into the profession to treat and help individuals and any mental health legislation must back up that principle. It is also important to stress that the vast majority of people with mental health problems are not a risk to anyone, except sometimes themselves, and only a small minority require compulsory treatment.

  "But we do no favours to anyone, the public, the patients themselves, or those who work with them, if we ignore the fact that a small minority of individuals pose a serious risk to the public as a result of their mental disorder. "

  Taking key concerns head on the Home Secretary sought to separate fact from the misunderstandings that exist. He emphasised that the new legislation will include:

  Important new safeguards for patients who are subject to compulsion: these will include clear criteria for compulsory treatment with the use of these powers dependent on clinical evidence and authorised by an independent tribunal.
  No new power to lock people up without committing a crime. It has been possible to detain people with a mental disorder for treatment if there is a risk they will harm themselves or others since 1959.
  A single definition of mental disorder, which will mean personality disordered people will not be excluded from compulsory treatment on the grounds that they are "untreatable" provided they meet the tight criteria for compulsion, including medical evidence that they are mentally disordered and treatment is available.
  No-one will be detained without treatment - one of the conditions of the Bill is that appropriate medical treatment must be available in the patient’s case.
  A new compulsory treatment order will mean for the first time someone who needs compulsory treatment will not necessarily have to be detained in hospital
  

  Turning to those who are dangerous as a result of a severe personality disorder, Mr Blunkett said:

  "People who are dangerous as a result of severe personality disorder are a difficult and challenging group whose needs in the past have been neglected. Typically they end up not in hospital but in prison and are released back into the community untreated and still highly dangerous at the end of their sentence. This is a ridiculous situation, which we are determined to bring to an end by developing new treatments, establishing specialist treatment units and a sound evidence base on which further services will be based. Appropriate treatment programmes must be available to help improve and manage the individual’s condition.

  "This work is already underway and will be helped by removing the so-called ‘treatability test’ which has sometimes been used by dangerous people with a psychopathic disorder to secure discharge from hospital simply by refusing to engage with the treatment offered to them and arguing it is no benefit."

  Mr Blunkett said the Government was not asking psychiatrists to manage the problem of dangerousness in its entirety. The provisions in the mental health bill are a small but vital part of the Government’s overall approach to dangerous offenders which includes measures outlined in the criminal justice white paper ‘Justice for All’ such as new longer sentences for dangerous violent and sexual offenders and better assessment and management of the risk they pose.

  Mr Blunkett concluded:

  "The mental health bill is not primarily about dangerousness, but it will support other measures by ensuring those who are dangerous as a result of a mental disorder receive the treatment they need. The Bill will also bring the rights of victims of mentally disordered offenders into line with the rights of other victims and crucially, seek to avoid victims being created in the first place."

  Speaking at the same conference, Home Office Minister Hilary Benn said that extending the rights of victims of mentally disordered offenders was part of the Government’s wider strategy of making sure the needs and views of victims are addressed.

  Mr Benn used his speech to announce the start of an advertising campaign to recruit victims of crime to sit on a new Victims Advisory Panel.

  Hilary Benn said;

  "Victims and the general public often feel let down by the system, especially when victims’ views are treated with disrespect or condescension. The Government is committed to putting the needs of victims of all crime at the heart of our criminal justice system, and one of the measures the Home Secretary announced earlier this year was our intention to set up a Victims’ Advisory Panel to give victims a greater voice.

  "Today we have begun advertising for members of the public, who have been a victim of crime, who would like to apply to be a member of the Panel. It will give them the opportunity to comment on the criminal justice system and other issues affecting victims and give advice and suggestions on how services and support for victims and witnesses can be improved".

  Notes to Editors:

  The Home Secretary and Hilary Benn were speaking at the Zito Trust Conference held at the Queen Elizabeth II Conference Centre.
  The draft mental health bill was published on 25 June 2002. It can be found on the Department of Health website www.doh.gov.uk
  The Victims Advisory Panel was announced by the Home Secretary on 21 March 2002, Home Office press notice number: 083/2002
  The telephone number for members interested in applying is 0845 974 5286
  The Panel will be responsible for advising the Home Secretary and other Government Ministers on all aspects of services and support for victims of crime by drawing on their experience of the criminal justice system. The Panel will give advice on crime prevention matters from a victim’s perspective.
  The Panel, which will meet three times a year, will be chaired by Lord Falconer, Home Office Minister, and will be attended by the Lord Chancellor and the Attorney General or their representatives.
  The Panel is intended to represent a diverse range of experiences and views from victims and family members or very close friends of those who have been killed, and including those who have experienced what it is like to give evidence in court. It is anticipated that the Panel will include ten members of the public who can speak from experience of being a victim of crime including: murder/manslaughter, rape or other serious sexual assault, road traffic incident resulting in fatality; racially motivated offence and burglary.
  

• Blair: grave concerns on mental health bill. The Independent. 27 Oct 2002. The Prime Minister, Tony Blair, has privately told ministers and senior Labour MPs that he has grave concerns about proposed mental health laws described as "draconian" by campaigners.
• Early Day Motion 1731. David Taylor. 15/10/02. 'That this House shares the widespread concern on the part of users, carers, providers of services, professionals, mental health organisations and others at proposals contained in the Government's Draft Mental Health Bill, which will increase the number of people subject to compulsory treatment and not provide the positive, enlightened legal framework required for mental healthcare and treatment into the 21st century; urges the Government to take full account of the responses to the consultation launched in June; congratulates the Mental Health Alliance and all its members for campaigning so effectively and constructively around mental health care reform; welcomes the lobby of Parliament on 23rd October; and urges honourable Members to meet their constituents to discuss the issues and to visit the exhibition of work by users of the Grange Day Centre in Coalville (North West Leicestershire) in the Upper Waiting Hall to mark World Mental Health Week and to further their understanding of mental health issues.'
• Mental health tsar remains bullish in the face of criticism of draft bill. Community Care. 3 Oct 2002.
• Mental health tsar pledges to amend Bill. The Independent. 6 Oct 2002
• Louis Appleby was interviewed by Community Care reporter Katie Leason, who put questions to him regarding the draft mental health bill sent in from visitors to communitycare.co.uk and readers of Community Care magazine.
• Specialist registrars' views on the proposed reform of the Mental Health Act (1983) Psychiatric Bulletin (2002) 26: 374-377 Potential impact on recruitment and retention of consultant psychiatrists. AIMS AND METHOD A postal questionnaire was sent to specialist registrars (SpRs) in the Wessex Region to evaluate senior trainees' reactions to information about the proposed changes in mental health legislation and to ascertain if the information had adversely affected their view of their future careers as consultants. RESULTS A high level of concern about the proposed changes and their potential impact on consultants was revealed. A majority of SpRs took a more negative view of their future career, especially those preparing a single Certificate of Completion of Specialist Training in general adult psychiatry, who were more likely to have adverse perceptions and to have thought of opting out. SERVICE IMPLICATIONS The legislative proposals have the potential for considerable impact on recruitment and retention of psychiatrists.
  
• MENTAL HEALTH LAWYERS ASSOCIATION CONSULTATION SUBMISSION IN RESPECT OF THE DRAFT MENTAL HEALTH BILL 2002 Submitted to the Department of Health - September 2002
• Press Release 27 Sept 2002: Mental Health Lawyers Association fear new Mental Health Act will increase risk. The Mental Health Lawyers Association has expressed grave concerns about the impact of the proposed Mental Health Act. The Association represents the majority of the specialist lawyers who assist the mentally unwell in hospital and on discharge. It has now completed its detailed examination of the new Bill and submitted its formal response to the Department of Health. (Word Document)
• END OF LEGAL ASSISTANCE FOR THE MENTALLY ILL? Press Release. Mental Health Lawyers. 6 Sept 2002.
  
• Parents may face jail over compulsory drug orders. The Independent 29 Sept 2002. Parents of children diagnosed with attention deficit hyperactivity disorder (ADHD) will face jail under proposals in the new Mental Health Bill if they refuse to drug their children, a psychiatrist has warned. Dr Bob Johnson, who is at the forefront of a campaign against the increasing reliance on drugs to treat hyperactive children, said the wide-ranging powers of the Bill would over-rule the wishes of parents. "The Bill is so punitive it dispenses with all civil and human rights. Parents who have reservations about pumping their children full of drugs to control them would be classed as denying their children treatment," he said. "It's only a matter of time before parents find themselves in breach of such orders which are fully backed by the courts." Dr Johnson, a clinical psychiatrist for 40 years, said the huge rise in the use of drugs was worrying. The number of prescriptions of the most popular ADHD drug, Ritalin, stood at 208,000 last year, up from just 2,000 a decade earlier. Some parents say they have little choice but to use drugs for their children. Andrea Bilbow, who runs the Attention Deficit Disorder Information and Support Service (Addiss), has given her 15-year-old son Ritalin for nearly a decade. "If there was another way I would take it, but at the moment it's the only treatment which gives him any quality of life," she said. The Department of Health dismissed claims that new legislation would lead to parents being jailed, but admitted the proposals would extend compulsory treatment orders.
• Mental health bill is the 'worst'.Community Care. 27 Sept 2002. The Liberal Democrats health spokesperson described the government's mental health proposals as the worst bill he had ever seen. Dr Evan Harris told the Liberal Democrat conference in Brighton the government’s reform of mental health legislation had given rise to ‘a poor green paper, an even poorer white paper and an abominable draft bill’.
  
• Critics force Milburn to rewrite Bill. The Independent 22 Sept 2002. Ministers are prepared to rewrite the most controversial parts of their draft mental health Bill, after a barrage of complaints from Britain's most senior medical bodies. The Royal College of Psychiatrists and the British Medical Association warned last week they had "extreme anxieties" about the Government's proposals for a sweeping reform of mental health legislation. The BMA, in its formal response to the proposals, said the Bill presented a "fundamental threat" to civil liberties and could be used as an "instrument of social control", because its definition of mental illness was too vague. Whitehall sources have indicated for the first time that Alan Milburn, Secretary of State for Health, could compromise on the most contentious areas of the Bill – a victory for The Independent on Sunday's campaign for reconsideration. "Our over-riding interest is in getting it right, so that the safety of the community is reflected in the way that the Bill is drafted," said one source. Medical experts claim the Bill's failure to exclude certain illnesses means alcoholics, drug addicts and people with personality disorders are at real risk of being compulsorily detained unfairly. But Mr Milburn will reject calls from the Royal College for the draft Bill to be substantially rewritten or even scrapped. After a series of scandals involving mentally ill offenders such as Michael Stone, who murdered Lin Russell and her daughter Megan after being released into the community, the minister is adamant that tougher mental health legislation will be introduced.
  
• Psychiatrists raise racism fears over English mental health bill. BMA News 28 Sept 2002. Proposed mental health legislation for England would be the most racially discriminatory law seen in the UK, Royal College of Psychiatrists president Mike Shooter has said. Cultural misunderstandings between doctors and patients could lead to mistaken diagnoses of personality disorder and result in an increased number of people from ethnic minority backgrounds being sectioned, he said. The English mental health bill defines personality disorder as a mental illness.
• Mental health law fears played down. BBC News. 17 Sept 2002. The rights of mentally ill people will not be undermined by proposed legislation being published in Scotland, the health minister has promised.
• New mental health bill may conflict with advice from the GMC. BMJ News Extra Sept 2002. The BMA and the Medical Defence Union have added their concerns to those of more than 50 organisations opposed to draft mental health legislation under which people with mental disorders could be detained and forced to have treatment that is unlikely to help them. Mental health services in England and Wales could come to a standstill if the draft mental health bill, due to go before ministers next month, is made law, the BMA warned last week. The wider scope of the new proposals would lead to increased pressure on services that are already over-stretched and under-resourced, the association said. Although it welcomes certain aspects of the bill, the association has urged the government to reconsider other key elements. It is particularly concerned about the broad definition of mental disorder in the draft bill, which it says "means that there are no clear boundaries as to who can be detained under what circumstances." It fears the legislation will be used "as a vehicle for social control" rather than a way of helping people. Dr Robin Arnold, chairman of the BMAs psychiatry committee, said: "As it stands, the draft mental health bill is fundamentally flawed. The bill is so broadly drafted that it threatens the civil liberties of the whole population and the professional boundaries of psychiatrists." The Medical Defence Union has also expressed concerns that doctors could be jeopardising their own position by detaining people under the Mental Health Act who cannot be treated. "The [Medical Defence Unions] interpretation of the relevant GMC guidance is that doctors have a positive obligation to provide treatment that is in the patients best interest, based on a doctors judgment of the patients needs and the likely effectiveness of the treatment," said Dr Tom Leigh, a senior medical claims handler. The Department of Health is currently consulting interested parties on the bill, and Dr Leigh helped to draw up the unions submission. "If they dont think treatment will be effective, then they do not have to give it," he said. "However, if the bill proceeds as proposed, they may be required by law to give certain kinds of health careeven if they know it will not do any goodas the legislation may require them." The Mental Health Alliance, an umbrella group for over 50 organisations with an interest in mental health, including the Royal College of Psychiatrists, the NHS Confederation, and the Royal College of GPs, has organised a lobby of parliament on 23 October to show ministers the degree of opposition to the planned reforms. "We want MPs and peers to tell ministers that the draft bill in its present form stands no chance of an easy ride through parliament. The next key date will be around the Queens speech in November. Then we will know whether or not the government intends to press on with this bill in the next parliamentary session or will take the time to reflect on the breadth and depth of opposition and seek the consensus needed for a new Mental Health Act fit for the 21st century," said Paul Farmer, chair of the alliance. The Disability Rights Commission (DRC) has also warned the Government that the bill will lead to more discrimination for people with mental health problems.
• Mental health proposals may put doctors at odds with GMC says MDU. The MDU is concerned that the Mental Health proposals may place doctors at odds with the General Medical Council by abolishing the "treatability test". Under the current Act, people with mental impairment or a psychopathic disorder need to fulfill a requirement that "treatment is likely to alleviate or prevent a deterioration of this condition" (the so-called "treatability" test). The consultation document proposes that this will be abolished. The MDU outlines this and other concerns in its submission on behalf of members to the Department of Healths consultation on the bill. Dr Tom Leigh, a senior medical claims handler and co-author of the MDUs submission, said the MDU was concerned about the implications. "If such a policy were implemented it could place clinicians in a difficult medico-legal position. In some circumstances they would have a legal duty to act in one way, but their ethical duty would require them to act in another way. We have pointed out that these duties could be extremely difficult to reconcile," Dr Leigh said. "The MDUs interpretation of the relevant GMC guidance is that doctors have a positive obligation to provide treatment that is in the patients best interest, based on a doctors judgement of the patients needs and the likely effectiveness of the treatment. "If they dont think treatment will be effective, then they do not have to give it. However, if the bill proceeds as proposed, they may be required by law to give certain kinds of healthcare - even if they know it will not do any good - as the legislation may require them to." The MDU also provided the Department of Health with a series of other concerns about the draft Mental Health bill including: The wide scope of powers of compulsion under the proposed bill. The potentially large number of people who could be detained under the Act without medical benefit. In some cases, this may contravene Article 5 of the European Convention on Human Rights. The provisions which would allow patients who are considered a danger to the public to be the subject to compulsory treatment solely on the basis that they are considered to pose a danger to the public or compulsory detention despite a willingness to undergo treatment for their mental disorder.
  
• The Law Society: Response to the Draft Mental Health Bill. Sept 2002
• APPROVED SOCIAL WORK INTEREST GROUP RESPONSE TO THE MENTAL HEALTH BILL. Sept 2002.
• bma response to consultation on the draft mental health bill. Sept 2002.
• mental health legislation in scotland is different from south of the border says bma scotland Press release date: Wednesday, 18 Sep 2002 (BMA Scotland) Following the publication of the BMAs response to the Mental Health Bill for England and Wales, it is important to recognise that Scotland has its own draft Bill that is different in significant respects from the one giving rise to concerns south of the Border. The BMA have welcomed many aspects of this Scottish Bill and still have some concerns, however there are some key differences between the two Bills. The Scottish Bill is closely based on the proposals of the Millan committee, which reviewed mental health issues and carried out wide consultation. This helped produce a large degree of consensus, although psychiatrists and GPs are concerned about manpower implications. Scottish proposals do allow for treatment without consent in the community. However, this is seen as a less restrictive alternative to hospital detention, rather than as a heavy-handed measure, since the Bill lacks the excessive public safety orientation of its English and Welsh counterpart.

• bma claims new draft mental health bill will bring mental health services to a standstill. Press Release 18 Sept. Mental health services will collapse if the proposed Mental Health Bill is passed in its current form says the BMA. The BMA has today released its response to the Draft Mental Health Bill. Although the BMA has welcomed many aspects of the Bill it is also strongly urging the Government to re-think several key elements of the proposed legislation. The most fundamental flaw of the draft Bill lies in the broad definition of mental disorder combined with the reduction in the severity threshold for compulsory detention. The BMAs main criticisms of the draft Bill are as follows:
  · The broad definition of mental disorder means that individuals with an untreatable learning disability or personality disorder are included within the scope of the Bill.
  · The changes to the definition of mental disorder means that there are no clear boundaries as to who can be detained under what circumstances. This represents a fundamental threat to civil liberties.
  · By including individuals with an untreatable personality disorder within the scope of a single procedure, legislation that is intended to help those who are ill may be used as a vehicle for social control.
  · The changes will divert already severely limited resources away from those people who could benefit from mental health services.
  · The proposed changes will increase workloads for a severely under-resourced service. According to the Royal College of Psychiatrists, just to administer the draft Mental Health Bill will require 600 more psychiatrists.

  Dr Robin Arnold, Chairman of the BMAs psychiatry committee, said today: "As it stands the draft Mental Health Bill is fundamentally flawed. The Bill is so broadly drafted that it threatens the civil liberties of the whole population and the professional boundaries of Psychiatrists." He added: "The Government is aware that there is strong opposition to the Bill in its current form. I hope we can work with Ministers to develop legislation that will take the best from this draft Bill whilst correcting the fundamental problems that cause everybody extreme concern."

• The Mental Health Foundations response to the Mental Health Bill. Sept 2002.
• MIND briefing on Mental Health reforms. Sept 2002. Word Document.
• The Mental Health Foundation today responded to mental health law reforms in Scotland with a warning that a lack of rights for service users leaves draft legislation open to failure. While broadly welcoming the Bill, experts warned that a number of omissions could undermine the reforms. The Foundation, a leading UK charity working in mental health and learning disabilities, said that the new legislation must include:
  • Clarification of the circumstances in which someone can be given compulsory treatment
  • Provision for a range of accessible community-based services to ensure that compulsion is only used where absolutely necessary
  • More access to advocacy for all users of mental health services.

  
  The Foundation also stated that there should be no Electro Convulsive Therapy without consent except in emergencies, and that there should be no pyschosurgery without consent under any circumstances. Maddy Halliday, Director, Scotland and UK Development at the Mental Health Foundation stated: "The reforms are based on sound principles, and many aspects of the Bill are most welcome. We certainly believe that its a much better example of how to tackle reforms than the Mental Health Bill for England and Wales, which is under heavy criticism from all sides. But more needs to be done to ensure that compulsion is used only when absolutely necessary. The Scottish Executive must address the fundamental need for good quality services that are available when people with mental health problems need them." The Foundation welcomed the extended powers of the Mental Welfare Commission and the introduction of an independent Mental Health Tribunal.

• Mental Health (Scotland) Bill. Sept 2002
  • Explanatory Notes (and other accompanying documents)
  • Policy Memorandum
    
• Royal College of Psychiatrists welcomes new Mental Health Bill for Scotland. Press Release 17 Sept 2002. The Royal College of Psychiatrists welcomes the new Mental Health Bill for Scotland as a well thought out piece of legislation based on the widespread consultation of The Review Committee under the Chairmanship of the Rt. Hon Bruce Millan. The Bill is based on principles which should underpin modern mental health services. Two fundamental principles are reciprocity and least restrictive alternative.
  Reciprocity underlines the importance of safeguarding patients rights and providing appropriate services for patients detained under The Bill. As psychiatrists we believe that protecting patients autonomy is vital in preventing the misuse of psychiatry to control social problems. One example of this is the introduction of Mental Health Tribunals as part of the process of detention and appeal against detention.

  Over the last 15 years there has been a move to reduce beds and treat people in the community, which is seen as a less restrictive alternative to hospital. This new Bill modernises thinking about detention by allowing for people to be cared for, under the provisions of The Bill, within the community when appropriate, rather than in hospital.

  These welcome innovations depend on considerable additional resources, particularly in staffing levels. This is important if services for non-detained patients (the vast majority) are not to be compromised.

  For further information contact Karen Addie, Administrator, The Royal College of Psychiatrists Scottish Division
  Email: k.addie@virgin.net
  

• Overhaul of mental health laws: Scotlands mental health laws are to be subject to their most fundamental reform for 40 years in a Bill published today. Key changes proposed are: New procedures for compulsory care and treatment, which will be tailored to meet the needs of the individual patient; A new mental health tribunal, involving doctors, lawyers and other experts, to make decisions about compulsory care; Stronger duties on local authorities to provide care and support services to people with mental health problems and learning disabilities; New rights for mental health service users to have their interests represented by independent advocates.
  The Bill also updates the arrangements for dealing with the small number of people with a mental disorder who become involved in criminal offences.
  Health and Community Care Minister Malcolm Chisholm said: "The Mental Health Bill is about protecting people when they are at their most vulnerable. It balances peoples rights to make their own choices, with the responsibility of society to help people when they may not be able to make decisions for themselves. "That is a complex and sensitive task, and we have been guided by the landmark report of the Millan Committee, which set out detailed proposals for reform, alongside ten key principles. "The Mental Health Act currently in place is largely based on reforms introduced in 1960: before the major shift to community-based care, and before the rights of people who use mental health services to have a greater say in their own care and treatment began to be recognised. Furthermore, this Mental Health Bill is specifically tailored to Scottish needs. "The Bill replaces the one-size fits all procedure for detaining people in hospital with a new, flexible, compulsory treatment order. For some people, that might mean that compulsory care could be delivered in the community. I know that some groups are concerned that this could result in too much power being taken from patients and given to doctors but the intention is the opposite: to ensure that patients can retain as much control over their own lives as possible. That is why the Bill greatly strengthens the legal safeguards for patients and their families. "Under the Bill, the new Mental Health Tribunal will have to be satisfied that compulsory powers are justified in the context of an agreed care plan. The Tribunal will be an accessible and user-friendly body, and patients will have the right to nominate a named person to represent their interests, and to make advance statements setting out their views on their own care and treatment. "The Bill is not just about compulsory treatment. It aims to make things better for everyone who uses mental health and learning disability services. For the first time, there will be a legal duty on local authorities and the NHS to ensure that independent advocacy services are available to people who need them. We are also updating the powers of the Mental Welfare Commission, which will have a general responsibility to promote good practice in the operation of the Act. "The Millan Committee were right to say that the aspirations of the Bill will not be met without substantial improvements in mental health services. The Executive is committing £17.1 million a year to implement the Bill, alongside anticipated additional NHS expenditure of £6 million a year." Mary Weir, Chief Executive of the National Schizophrenia Fellowship (Scotland), and a member of the Millan Committee, said: "Im delighted that so many of the Millan Committees recommendations have been taken on board by the Executive in a Bill which will culminate in a new mental health law in Scotland, fit for the 21st century. Adherence to the principles outlined by Millan should ensure that interventions under the Act, for people with serious mental illness, will be appropriate, effective and sensitive to their needs and those of their families. "During the life of the Millan Committee, the difficulty of disentangling problems with the present law from problems with current service provision became very clear. It is crucial that substantially increased resources accompany the introduction of the new Act; resources not only to implement the Act but to ensure that the right services are in place to prevent, as far as possible, the requirement to use the Act." Dr Jim Dyer, Director of the Mental Welfare Commission for Scotland and another member of the Millan Committee, said: "I warmly welcome the publication of a new Mental Health Bill for Scotland, which is extensively based on the proposals of the Millan Committee. That committee was broadly based and consulted widely, so there is likely to be a lot of consensus around the new Bill. It is different in important respects from the draft Bill for England and Wales. "This is a necessary updating of mental health law, allowing involuntary treatment, which is necessary in some cases, to take place without compulsory hospitalisation, in keeping with the move to community care and with modern principles. It will strengthen the rights of users and their carers while giving the right degree of attention to public safety." 17 Sept 2002.
  
  
• Mental Health Alliance Policy Paper: Nominated Person (Word Document)
• Mental Health Alliance Policy Paper: Independent Advocacy (Word Document)
• Critical Psychiatry Network: RESPONSE TO CONSULTATION ON DRAFT MENTAL HEALTH BILL. Sept 2002
• Reform of the Mental Health Act 1983:Response to the draft Mental Health Bill and consultation document. Royal College of Psychiatrists. Sept 2002
• Private beds for psychiatric care cost NHS £200m a year. The Independent 15 Sept 2002.
• The Mental Health Act Commission: Response to the Draft Mental Health Bill Consultation. Word Document
  
• Online chat on the draft mental health bill, 2pm on September 13 2002. Full Text. The Guardian.
• Mentally ill, not criminally delinquent. The Guardian, 13 Sept 2002. Margaret Clayton, chairwoman of the Mental Health Act Commission, writes on the problems faced by the government in framing mental health legislation
  
• Come back when youre really sick. The Guardian, 13 Sept 2002. The public is terrified of psycho killers, the government is anxious to reassure them - but does this make for good law or sensible spending?
• One in three put off by mental health reforms. The Guardian. 13 Sept 2002. Government proposals for changing mental health law would deter one in three people from seeking medical help for depression, according to a poll today for Mind, the mental health charity.
  
• Benign intentions. The Guardian 11 Sept 2002. Mental health tsar Louis Appleby defends the draft legislation
• Doctors threaten to quit over Bill. The Independent. 8 Sept 2002
• Submission from Greater London Mental Health Advocay Network re: Consultation to Draft Mental Health Bill 2002 and Consultation to Independent Specialist Advocay in Englans and Wales: Recommendations for Good Practice. Word Document. Sept 2002
• Care Programme Approach Association: Response to the Draft Mental Health Bill. Sept 2002
• Draft Mental Health Bill Roadshows: Presentations. DOH Aug 2002
  
• THE NEW MENTAL HEALTH ACT OR HOW NOT TO LEGISLATE. By Peter Edwards. Aug 2002
• Mental health on the psychiatrists couch. Letters. The Guardian. Aug 1 2002. From Louis Appleby. Your article (Psychiatrists to join protest over bill, July 29) misrepresents the intended role of the draft mental health bill. The bill proposes new safeguards for patients as well as new powers. The safeguards include an independent tribunal to scrutinise care plans and the right to independent advocacy. The new powers extend compulsory treatment from hospital to community to ensure that the most vulnerable and high-risk patients get proper treatment without repeated hospital admissions. A broader definition of mental disorder will prevent patients being excluded from care on grounds of diagnosis. However, before they can be treated involuntarily, tight criteria will have to be satisfied. As now, powers of compulsion will only be used for those who present a serious risk to themselves or others. The claim of the Royal College of Psychiatrists that the new legislation will "rope in your son who gets drunk on a Friday night" is irresponsible. We are now in a three-month period of consultation. All of us working in mental health want the best possible mental health bill. For this, we need rational and informed debate.
  Prof Louis Appleby
  National clinical director for mental health services, Department of Health
• Papers in relation to the draft Mental Health Bill to be considered at the BASW MHSIG Executive Committee meeting on August 22nd.
• Draft Mental Health Bill – Summary of main proposals, with focus on ASW perspectives
• The Draft Mental Health Bill, Clause 6(4), Lords Written Answers, 29th July 2002
• The Draft Mental Health Bill, Categories of Mental Disorder, Lords Written Answers, 23rd July 2002
• The Draft Mental Health Bill, Clause 6 (4) Lords Written Answers, 22nd July 2002
• Proceed with Caution. careand health.com. The new draft Mental Health Bill has been welcomed with almost universal scorn in the sector. However, there was at least hope that it would help close the so-called Bournewood Gap, now a cause célebre for campaigners on behalf of those with mental incapacity. Laurence Pollock investigates.
• The regulatory impact assessment: Consultation Document, DoH
• Reform of the Mental Health Act 1983: Letter to College Members. Royal College of Psychiatrists. Dr Mike Shooter, President, and Dr Tony Zigmond, College lead on the Mental Health Bill,
• Reform of the Mental Health Act 1983: Summary of Changes. Royal College of Psychiatrists
• Reform of the Mental Health Act 1983: Joint Statement by the Royal College of Psychiatrists and the Law Society.
• BRITISH ASSOCIATION OF SOCIAL WORKERS MENTAL HEALTH SPECIAL INTEREST GROUP. SUBMISSION TO THE JOINT COMMITTEE ON HUMAN RIGHTS IN RESPECT OF THE DRAFT MENTAL HEALTH BILL - JULY 2002. RTF format.
• Draft Mental Health Bill. Briefing from Mind
• Detaining dangerous people with mental disorders: Editorial BMJ 6 July. The draft mental health bill published last week introduces a new legal framework for the compulsory treatment of people with mental disorders in hospitals and in the community.1 On the day it was unveiled the bill was condemned and labelled as little more than a detention plan for dangerous mental patients.2 The white paper on reforming the Mental Health Act that preceded the draft bill attracted a great deal of attention because of its over-riding emphasis on public safety.3-5 The fact that it was not well received is hardly surprising given that it was born from an unpopular green paper and proposals for managing dangerous people with severe personality disorder described as glaringly wrong and unethical.
• Community injection orders. Far-reaching proposals in the Mental Health Bill published last week have been viewed as an assault on patients rights. Controversially, patients with untreatable severe personality disorders could be detained without doing anything wrong and other mentally ill patients in the community could be forced to take medication. Will the governments desire to appease public concerns following a few high profile tragedies leave it wide-open for human rights challenges and what incentive will there be for mentally ill patients to seek treatment? Chris Moller, solicitor specialising in mental health talks to Velida Pearce ...
• The treatment of the mentally ill that shames us all. Independent on Sunday, 30 June. "Today psychiatrists attack the draft Mental Health Bill as morally indefensible and ethically corrupt. For three weeks the IoS has campaigned on mental health issues, and we share their revulsion at plans for detention without trial and forcible injections. Britains mentally ill have a right to be heard. We will give them a voice."
• Have you any idea what kind of life someone detained in hospital leads? Independent on Sunday, 30 June. "Patients hoping for improved care from the new mental health laws are going to be disappointed. Instead they can look forward to forced injections or even internment,"
• Mental health proposals very harmful. Independent on Sunday, 30 June. "The former chief of Broadmoor yesterday branded the Governments new mental health proposals "harmful" and a "breach of human rights"."
• Least restrictive alternative — advance statements and the new mental health legislation Psychiatric Bulletin (2002) 26: 246-247
• Mad, bad and dangerous law: The mental health bill may be a crowd-pleaser, but it will not help as much as well-directed funding. The Guardian 27 June.
• Mental Health Act Commission Press Release. 26th June 2002
• Mental health overhaul impossible The Guardian 26 June. The governments plans to extend compulsory mental health treatment are unworkable because it would be impossible to recruit the hundreds of extra psychiatrists needed to implement the tough new legislation, according to the Royal College of Psychiatrists (RCPsych). The warning came after ministers unveiled a draft bill to overhaul the Mental Health Act, which would allow the compulsory treatment of people living in the community. Dr Tony Zigmond, chairman of the RCPsychs general adult faculty, said at least 600 extra psychiatrists would be needed to run the new mental health review tribunals, which will decide whether patients require prolonged detention in hospital. Dr Zigmond said: "It would be impossible to recruit such numbers. Theres already at least a 15% vacancy rate for consultant psychiatrists. The tribunals would divert those in post from direct patient care." In April, a Department of Health (DoH) report on the mental health review tribunal system warned that many medical members in the service had recently retired or were set to retire shortly. Dr Zigmond said the system would collapse without retired psychiatrists and their future involvement was in doubt because many would not wish to undergo revalidation, the new five-yearly "MoT" for doctors to prove they are fit to practise, simply to sit on tribunals. Health minister Jacqui Smith yesterday insisted that only another 100 psychiatrists will be needed to implement the bill. But the RCPsych said the DoH said it would require the services of 600. Dr Zigmond also warned that plans to detain people diagnosed with dangerous and severe personality disorder in special hospitals even if they have committed no crime would lead to thousands of people being locked up unnecessarily. He said techniques for predicting whether people were likely to commit a homicide were too crude to ensure those who posed no risk to the public were not detained indefinitely. "Predicting dangerousness is an imprecise art. Even if we had a test for dangerousness that was very specific and sensitive we would have to lock up 2,000-5,000 people to prevent a single homicide," said Dr Zigmond. "People should only be treated if they have a health need not as some sort of social control system. I do not want to be part of the police force," he said. The psychiatrist said that most people with mental disorders who posed a risk to others did so because of their illicit drug use. But he said the draft bills requirement on doctors to inform the police if a mental health patient was abusing drugs would put people off from seeking help.
  
• A case for treatment. The Guardian 26 June. The driving force behind yesterdays new mental health bill is not concern for patients rights, but a desire to appease a widespread media-inspired concern over the risks that mental patients pose in the community. The risks have been totally exaggerated. There has been no increase in killings by psychiatric patients in recent years. Statistically, you are 20 times more likely to be killed by a sane person than an insane one, and not very likely to be killed by either. By far the biggest threat posed by mentally ill patients is to themselves: over 1,000 commit suicide every year. Even so, the leaks that preceded yesterdays bill boasted of "tough rules requiring some mentally ill patients to be locked away in secure hospitals". Two particularly contentious issues are raised by the proposed legislation. The first is compulsory treatment in the community. Initially, the proposal was opposed by psychiatrists, community psychiatric nurses and mental patients. They rightly pointed to the low use of existing safeguards, such as supervised discharge. But the debate has moved on since community treatment orders were first floated almost 20 years ago. We have moved further down the "hospital without walls" road. It no longer makes sense to restrict compulsory treatment to patients recalled to an acute hospital bed. Yesterdays bill includes a number of safeguards - including a three-stage assessment and treatment process - that could be as much in the patients interests as the publics. The second issue concerns indefinite detention of people with severe personality disorders (psychopaths). Until now, compulsory detention of the mentally ill was based on them being treatable. The problem facing policy makers was the division within psychiatry over whether psychopaths were treatable or not. The new bill will allow them to be. But it will need to be tested by the courts.
  
• Speeches. House of Commons. Dr. Liam Fox. 25 June. "That this House expresses its deep concern at the plight of those who suffer mental ill-health and notes that almost every family will have experience of some form of mental illness; is concerned at the inadequate treatment so many receive, the shortages of staff and beds, the gaps in community provision and the lack of choice; condemns the lack of support and respite for carers, the lack of early intervention with the young and the unmet needs of the elderly; further notes that many vulnerable people with mental health problems are in prison and receiving inadequate medical care; expresses concern at the rise in the suicide rate of those suffering from mental illness; regrets the diversion of mental health funding into other clinical areas; and calls on Her Majestys Government to act to raise awareness of the scale of mental health problems and to ensure that patients are treated in an appropriate and dignified way."
• Storm of Protest Over Mental Health Bill: Bill contains fundamental flaws which will drive people away, says MHA. The governments draft Mental Health Bill published today has run into a storm of criticism from mental health organisations, including service user groups and professional agencies.
  The Mental Health Alliance, made up of more than 50 mental health groups, accused the government of not listening to the concerns which have been fed through to the Department of Health since it published its proposals for change in mental health legislation via the Green Paper, Reform of the Mental Health Act 1983 - Proposals for Consultation, and the 2000 White Paper, Reforming the Mental Health Act. MHA say there are key elements of the Bill that will make mental health services worse. The group said the Bill will backfire as more compulsory detentions and forced treatments in the community will drive people away from seeking services; there are no rights to services; and essential safeguards for detained patients are missing. The draft bill, which was presented jointly by health minister, Jacqui Smith, and home office minister, Hilary Benn, is intended eventually to supersede the Mental Health Act 1983. Ostensibly, the proposals bring mental health legislation into line with the service delivery objectives in the NHS Plan, and the National Service Framework for Mental Health, while at the same time bringing into a single definition of mental disorder those who were not covered by the 1983 Act, including patients with personality disorder, and mentally disordered defendants and offenders. The idea of a single definition of mental disorder has generally met with approval from mental health campaigners, who have argued for many years that the 1983 Act allowed too many people with mental health problems to receive little or no access to appropriate services. But the Alliance maintained that as the new proposals still provide no clear right to services ministers have failed to address this issue adequately. On the other hand, Andrew McCulloch, director of policy for the Sainsbury Centre for Mental Health, welcomed the draft bills inclusion of children and young people: We hope that the clear recognition of their rights and needs in these proposals will help to put a stop to what many of us have regarded as malpractice, he said. But he, and the Alliance, were extremely uneasy about the proposals for compulsory detentions and forced treatments. The introduction of community treatment orders and a new system of compulsion could, they maintained, drive people away from seeking services. Also, they argued, the criteria for compulsion were far too wide. There are clear and important human rights issues involved when were talking about people being detained and forcibly treated without giving their consent - these proposals are certain to give rise to a major controversy, he said. For these reasons the proposed abolition of the Mental Health Act Commission also came in for criticism. Campaigners argued that its tight brief, and relative independence, help to ensure that the exercise of compulsion under the 1983 Act was monitored closely. However, what most exercises mental health campaigners above all is the draft bills linking of detention and compulsion to public safety and public fears. Speaking at the Kings Funds second annual lecture today, Jeremy Laurance, health editor at The Independent said: The public and political focus on the tiny numbers who pose a risk has distracted attention from the plight of the huge majority of frightened, disturbed people whose suffering remains largely hidden from an uninterested world. The Funds chief executive Rabbi Julia Neuberger added that:Jeremy Laurances work brings in to sharp focus the increasing authoritarianism in mental health policy, and the damage it does to those on the receiving end ... it is clear that we need a radically different public debate about mental illness, built upon a genuine understanding of peoples needs and an appropriate response to those few people who do pose a risk to others. From careandhealth.com
  
• The draft Mental Health Bill: BBC Health Correspondent Chris Hogg examines the governments draft Mental Health Bill.
• Concern over mental health proposals. Tough new plans to detain mentally ill people in hospital if they do not take the treatment prescribed to them by doctors have provoked concern among campaigners and politicians. BBC News 25 June.
  
• Independent specialist advocacy in England and Wales: Recommendations for good practice. Patients and other users are at the very centre of government policy for the provision of health and social care services. Their views need to be heard and taken into account when services are being developed and in matters to do with their own care and treatment. The government attaches great importance to the development of advocacy services as one of the means that enable the views of patients to be represented. Those subject to compulsory powers under mental health legislation have need of effective advocacy services. Some may temporarily lose the freedom to make the choices they might otherwise make. Others, because of long term mental incapacity, may not able to make informed choices about their care and treatment. It is for this reason that the government included in the White Paper, Reforming the Mental Health Act, a proposal to introduce a specialist advocacy service for those who will come within a new Mental Health Act. At the request of the Department of Health Durham University has undertaken a study of current mental health advocacy services to assist the Department in developing this new specialist advocacy service. Its report contains a number of recommendations for good practice. We now wish to consult on a number of key issues set out in the attached list of questions. The closing date for replies to the consultation will be 30 September. Comments should be sent to
  Di Barnes,
  Centre for Applied Social Studies,
  University of Durham,
  Elvet Riverside 2,
  New Elvet,
  Durham, DH1 3JT
  or by e-mail to D.K.Barnes@durham.ac.uk.
  
  
• Consultation on draft Mental Health Bill. (DOH site)
  Draft Mental Health Bill, Consultation Document (from this site)
  Draft Mental Health Bill (from this site)
  Draft Mental Health Bill, Explanatory Notes (from this site)
  "We are pleased to be launching the consultation on the draft Mental Health Bill. This consultation process is intended to ensure that the proposals we are putting forward for the care and compulsory treatment of people with mental disorders is in the best interests of both patients and the public. The draft Bill develops the policy set out in our Manifesto, White Paper "Reforming the Mental Health Act". The draft Bill does not cover everything that will be in the final Bill we intend to introduce to Parliament. It is for this reason that the companion consultation document seeks views both on the operation of the proposed new system and on areas of policy which have been developed since the White Paper was published.

The consultation process will run for twelve weeks from Tuesday 25th June until Monday 16th September.

We would welcome your comments and suggestions on the proposals for the new legal framework set out in the draft Bill and on the other consultation issues we are raising. You may e-mail them to the Department of Health on mhbillconsultation@doh.gsi.gov.uk or fax them to 020 7972 4147. If you would like to write to us with your comments, then please send them to:
Sara Raisbeck
Room 318 Wellington House
133-155 Waterloo Road
London SE1 8UG
We look forward to hearing from you.
JACQUI SMITH. HILARY BENN. DON TOUHIG

• Action to lock up danger patients - even if unconvicted. People with dangerous personality disorders could be detained indefinitely in secure mental hospitals even if they have committed no crime, under plans published by the Government. Ministers said a draft Mental Health Bill will close a "loophole" which allows up to 600 people with severe personality disorders to refuse treatment. A new tribunal will be set up to decide if these patients can be forced to undergo treatment after an initial 28-day period, with reviews at six month intervals and then once a year. The Bill is the first major overhaul of mental health law since the 1950s. It contains a broad definition of mental disorder so that people with psychopathic disorders can no longer refuse treatment by arguing they are not getting any benefit from it. This loophole in the present law caused outrage in the case of Michael Stone, who was diagnosed with a severe personality disorder years before he murdered Lin Russell and her six-year-old daughter, Megan. Two doctors and a mental health professional will have to decide if someone meets the conditions for compulsory treatment. But after 28 days a new mental health tribunal will have to consider the case to decide whether to impose a treatment order for up to six months. After that, subsequent treatment orders can be made for periods up to a year. A mentally ill person who commits a crime may be forced to undergo treatment for up to six months by the court. The draft Bill, which will now go out for a 12 week consultation period, sets out four strict conditions on when somebody can be forced to have treatment. The person must have a mental disorder of a degree that needs specialist treatment. Appropriate treatment must be available and be necessary for the patients health and the protection of others. ANANOVA 25 June.
  

• Tough new approach to care of mentally ill draws criticism. Mentally ill people living in the community who fail to take prescribed medication could be forcibly detained and taken to hospital for prolonged treatment. The Guardian 24 June.

• Compulsory treatment in the community: current legal powers. Advances in Psychiatric Treatment (2002) 8: 180-188 Added 10 May 2002.
  
• Opinion article: We should abolish the Mental Health Act. by Jan Wallcraft, Senior Researcher, User Movement Survey, The Sainsbury Centre for Mental Health. I believe that any form of mental health law is discriminatory and undermines human rights. Added 23 March 2002.
  
• The White Paper "Reforming the Mental Health Act". Alternative Proposals by the Mental Health Special Interest Group of the British Association of Social Workers. Summary and full document. Added 4 Feb 2002
• Reforming the Mental Health Act Added 1 Nov 2001. The British Journal of Psychiatry (2001) 179: 387-389. We are set to embark on the third era of mental health law reform in half a century. In each case, in the 1950s, the 1970s and the late 1990s, those charged with the task of reviewing the law have recognised that legislation has to balance the rights of individual patients and the public, but the primary policy concerns driving reform on each occasion have been very different. A central purpose of the Percy Commission (1957) was to assess the extent to which people with mental disorders could be treated as voluntary patients. In summary, it concluded: "... that the law should be altered so that whenever possible suitable care may be provided for mentally disordered patients with no more restriction of liberty or legal formality than is applied to people who need care because of other types of illness, disability or social difficulty" (Percy Commission, 1957, para. 7).
• Care and compulsion in community psychiatric treatment Psychiatric Bulletin (2001) 25: 369-370. Involuntary out-patient treatment was introduced in many parts of the world in an attempt to slow the revolving door status of certain psychiatric patients and to permit effective community management. Involuntary out-patient treatment includes all forms of compulsory out-patient treatment, ranging from community treatment orders to conditional discharge and guardianship. Recent controversy has focused on community treatment orders and court ordered involuntary out-patient commitment. Proponents argue that such treatment reduces hospital recidivism, improves medication compliance and permits better use of community resources. It should be noted that few jurisdictions permit forced medication in the community as part of involuntary commitment.
• Does involuntary out-patient treatment work? Psychiatric Bulletin (2001) 25: 371-374. There has been considerable debate in the UK in recent years about the propriety of using various forms of involuntary out-patient treatment for some individuals with serious mental illness (Eastman, 1995; Dyre, 1998; Burns, 1999; Moncrieff & Smyth, 1999; Sugarman, 1999). While most jurisdictions in the US have statutes that support involuntary out-patient treatment (Torrey & Kaplan, 1995), its use remains controversial (Slobogin, 1994; Diamond, 1995; Torrey, 1997). Involuntary out-patient treatment was originally proposed as a solution to the revolving door syndrome (Geller, 1996). It has also been recognised, however, that it may provide a solution to the clinical and ethical dilemmas of allowing individuals who are incapable of making treatment decisions to discontinue treatment, with predictable deterioration to the point where they may harm themselves or others (Geller, 1990). This paper provides a review of controlled studies that have examined whether involuntary treatment in the community is effective.
• Juridogenic harm: statutory principles for the new mental health tribunals Psychiatric Bulletin (2001) 25: 331-333. Added 4 Sept 2001
• Plans to end the role of approved social workers in consenting to a patients compulsory admission to hospital have provoked fears that an important safety net will be removed. When the governments Reforming the Mental Health Act white paper was omitted from the Queens speech, many mental health social workers and organisations breathed a sigh of relief. Communiy Care 8 Aug 2001. Added 13 Aug 2001.
• CRITICAL MENTAL HEALTH FORUMS RESPONSE TO THE GOVERNMENT WHITE PAPERS COMPULSORY TREATMENT ORDER PROPOSALS. Added 9 July 2001
• Is compulsory community treatment ever justified? Psychiatric Bulletin (2001) 25: 268-270 Added 2 July 2001.
• The Royal College of Psychiatrists response to the white paper. Available in 3 parts:
  • Introductory letter from the President
  • Letter from the Registrar summarising the main issues of concern
  • Detailed response from the Mental Health Law Sub-Committee Added 30 June 2001
• Delay for controversial Mental Health Bill as it drops from Queens Speech: Issue date: 20 June 2001 By the Mental Health Alliance.
  The Mental Health Alliance of 50 leading organisations today expressed the hope that the decision to delay the reform of the controversial Mental Health Act will be used as an opportunity to take a second look at the proposals, to ensure that they will meet the needs of all those who experience mental health problems.
  However, the Alliance is now urging the government to confirm that their decision to drop the planned legislation from the Queens Speech does not indicate a lessening in its commitment to mental health.
  The white paper on reform of the Mental Health Act was published in December last year and a Bill was expected to be tabled later this year.
  Alliance chair Paul Farmer said: "We are concerned that this is being put back, but hope that this shows a government intention to look more closely at the ways in which a new Mental Health Act can be used to meet the needs of people in the 21st century.
  We hope that the decision to drop plans for early legislation does not mark a falling away from the governments commitment to make mental health one of its priorities for the next 10 years."
  Mr Farmer added: "We are ready to work closely with the government to make sure that the legislation when it comes is workable and in the interests of everyone affected by mental health issues."
  The Alliance welcomed the governments decision to separate the Mental Health Bill from legislation on Dangerous Severe Personality Disorder that will now be dealt with by the Home Office.
  Mr Farmer said: "This is a welcome recognition of the alliances concern that the issue of public safety and dangerousness, which are criminal justice issues, was being mixed up with health legislation aimed at ensuring a modern quality service for people in need."
  Mental Health Alliance press contacts:
  Sue Baker Mind 020 8522 1743/ 07850 788 514
  Simon Lawton-Smith MACA 020 7436 6194/ 07740 488 576
  Lesley Warner Mental Health Foundation 020 7535 7422
  Alice Griffiths SANE 020 7247 6647/ 07718 735 121
  Michelle Rowett Manic Depression Fellowship 020 7793 2617
  Paul Corry NSF 020 7330 9110/ 07775 585 178
  Antiona Hyde United Response 020 8246 5207 / 07787 806 724
  Mental Health Alliance membership:
  Core members: Afiya Trust, AWAAZ (Manchester), BASW, Common Agenda, CPNA, Critical Psychiatry Group, IMHAP, Kings Fund, MACA, MDF, MHF, Mind, NSF, Richmond Fellowship, RCN, SANE, SIRI, Turning Point, UKAN, United Response, UK Federation of Smaller Mental Health Agencies, Unison, US net, Voices Forum.
  Associate members: ACCI, Age Concern England, Age Concern (London), Alcohol Concern, ACHCEW, AWETU, British Deaf Association, British Psychological Society, Carers National Association, Church of England Board of Social Responsibility Home Affairs Committee, Confederation of Indian Organisations, Democratic Health Network (LGIU), Depression Alliance, Having a Voice Ltd., Greater London Mental Health Advocacy Network, Justice, Kente, Mencap, NACRO, National Autistic Society, Race on the Agenda, RADAR, Refugee Action, Royal College of GPs, Sign, Social Action for Health, Somali Mental Health Project, WISH, Young Minds. Source: The Mental Health Foundation
  

• The Governments proposals to reform the Mental Health Act. Psychiatric Bulletin (2001) 25: 237. Correspondence.
  
• Most psychiatrists oppose plans for new mental health act. Letters BMJ 2001;322:866 ( 7 April )
  
• The future (or not) of the medical member. Psychiatric Bulletin (2001) 25: 153-154 Correspondence
• The value of managers hearings. Psychiatric Bulletin (2001) 25: 153. Correspondence
• The future (or not) of the medical member. Psychiatric Bulletin (2001) 25: 8-9 Opinion and debate
• Concerns over reform of the Mental Health Act. The British Journal of Psychiatry (2000) 177: 563 Correspondence
• Concerns over reform of the Mental Health Act. The British Journal of Psychiatry (2000) 177: 563 Correspondence
• Review of Mental Health (Scotland) Act 1984 Millan Committee Second Consultation. Mental Health Foundation. Added 2 April 2001.
• Royal College of Psychiatrists: Manifesto for Change. Added 2 April 2001
• Sainsbury Centre for Mental Health: Executive Briefing on the White Paper. Added 2 April 2001
• Complexities surround treatment of personality disorders. Guardian Unlimited. 16 Feb. Added 21 Feb.
• Report raises concerns over compulsory mental health admissions. Guardian Unlimited. Feb 12. Added 21 Feb 2001
• Doctor stabbed by patient criticises lack of mental health professionals. Independent News 8 Feb. Added 19 Feb 2001
• SUMMARY OF PROPOSALS with comments from Mind. Added 12 Jan 2001.
• Press Release from the Mental Health Act Commission: White paper on Reforming the Mental Health Act. Added 4 Jan 2001
• The future (or not) of the medical member. An aspect of the 1983 Mental Health Act review. Psychiatric Bulletin (2001) 25: 8-9. Added 3 Jan 2001.
• Mental Health Review Tribunals. Special Report. The Council on Tribunals. Added 3 Jan 2001. The Council on Tribunals have prepared this Report on Mental Health Review Tribunals (MHRTs) to supplement their official response to the Governments proposals for consultation on Reform of the Mental Health Act 1983.
• My sick son needs a hospital, not a jail. The Times 28 Dec 2000. Added 1 Jan 2001
• Victims will be warned when attacker is to be released. The Times. 21 Dec 2000. Added 1 Jan 2001
• Experts response to mental health proposals Societyguardian 20 Dec 2000. Added 21 Dec 2000
• Mental health proposals flawed, says ex-psychiatric patient Societyguardian 21 Dec 2000. Added 21 Dec 2000
• White paper a worry to mental health professionals Societyguardian 20 Dec 2000. Added 21 Dec 2000
• House of Commons Debates 20 Dec. Added 21 Dec 2000.
• BBC Talking Point: Should people be detained against their will? Added 21 Dec
• Psychiatric patients will be given drugs by force. The Independent 21 Dec 2000
• Incarceration is no substitute for a mental health policy. The Independent 21 Dec 2000
• Nacro Comment on Government proposals on severe personality disorders. Added 21 dec 2000
• New compulsory treatment orders could deter people from seeking support says Mental Health Foundation Added 21 Dec 2000
• Government white paper on New Mental Health Act welcomed - with some reservations. Press release. Royal College of Psychiatrists.
• Mental health system set for shake-up BBC News 20 Dec. The government is revealing the biggest shake up of the mental health system in 40 years on Wednesday.
• Should people be detained against their will? BBC News 20 Dec. The government has unveiled plans to detain people with serious personality disorders who are thought to pose a risk to others. It also proposes powers to force mentally ill people to take their medication.
• Tougher controls for mentally ill BBC News 20 Dec. The government has unveiled plans for the biggest shake up of the mental health system in 40 years.
• Its wrong to lock up people against their will BBC News 20 Dec. A former psychiatric patient and a top doctor give their reaction to the plans.
• Mental health: Analysis BBC News 20 Dec. BBC Health Correspondent Richard Hannaford explains the thinking behind the governments plans for mental health reform.
• Mental health: Reaction BBC News 20 Dec. Here campaigners give their reaction.
• Insane fathers care questioned BBC News 20 Dec. A mental health charity has raised serious questions about the treatment of a father who stabbed his daughter through the heart.
• New Directions - Report on the Review of the Mental Health (Scotland) Act 1984 Added 19 March 2001 Executive summary Added 19 March 2001
• Reforming the Mental Health Act: The White Paper. - Both HTML and versions Added 20 Dec.
• For faster downloads try:
  
  • Summary
  • Part I - The new legal framework
  • Part II - High Risk Patients
  • Summary of consultation responses. DoH

• Mental health workload would double under draft bill. Community Care 19 Nov 2003. The proposals set out in the draft mental health bill could double the mental health workload for professionals and lead to a workforce crisis, a report by the NHS Confederation warns. The organisation for NHS employers warned that under the proposals, social workers, psychiatrists and administrative staff would have to spend double the amount of time they currently spend implementing the Mental Health Act 1983. An extra 1,000 staff would be needed just to manage existing caseloads. Clinicians could be forced into rationing resources and giving treatment to patients who are formally detained, to the disadvantage of those not subject to mental health legislation, the report added. It concluded: “Mental health services are already hard pressed and affected by staff shortages in key areas. We are not yet convinced that the benefits of new legislation, as currently drafted, are commensurate with the extra process time.” The increase is largely due to the proposal for all cases to go through a new mental health tribunal when requiring compulsory treatment beyond 28 days. Currently, a tribunal is only required if a service user applies. Estimates suggest there would be an immediate increase of between 60 and 100 per cent in the number of hearings. Paul Farmer, chairperson of the Mental Health Alliance, said that the draft bill threatens to “overwhelm” health and social care staff, and risks people who do not need compulsory treatment being neglected. 'Assessment of implications of new mental health legislation on mental health service organisations'
  
  
• Draft Mental Health Bill, letters from campaign headquarters. The Royal college of Psychiatrists. May 2003.
  • Letter 1
  • Letter 2
  • Letter 3
    
• House of Commons Written Answers, 13th March 2003. Tim Loughton: To ask the Secretary of State for Health what estimate he has made of the number of people who would be subject to compulsory t