Mental Health Bill13th March 2007
For the last nine years, the Government has been struggling to shape new mental health legislation. We take a look at where the draft bill is now, the contentious issues and what people think about the planned legislation.
1 What has happened so far?
For the last nine years the Government has been considering the best way of updating the Mental Health Act. In 1998, the then Secretary of Health, Frank Dobson, announced the first fundamental review of the legislation since 1959. This led to the preparation of a green paper, a white paper and a draft bill. However in 2006, after years of debate and strong opposition from mental health campaigners and professionals, the Government announced a change of plan. It decided that the existing legislation should be amended rather than replaced by a new act.
2 What changes does the Government want to make?
The stated objectives of the Government’s changes are to:
• Help ensure that people with serious mental health problems receive the treatment they need to protect themselves and the wider public from harm.
• Bring legislation in line with developments in the provision of mental health services, in particular the development of community based services and new ways of working.
• Strengthen patient safeguards, and remedy an incompatibility with Human Rights law.
To date this has involved drafting legislation which focuses on:
• Introducing supervised treatment in the community.
• Broadening the range of professionals who can take on key roles in the Mental Health Act.
• Improving patient safeguards by defining the timescales for referrals to the Mental Health Review Tribunal, for certain groups of patients.
• Establishing a simplified single definition of mental disorder throughout the Mental Health Act.
• Introducing a new requirement that appropriate treatment must be available if patients are to be subject to detention for treatment or the new supervised community treatment.
• Amending the definition of ‘nearest relative’ to allow them to be displaced in certain cases, and bring the legislation in line with the Civil Partnership Act 2004.
• Abolishing finite restriction orders to ensure that such orders remain in place for as long as an offender’s mental health poses a risk of harm to others.
3 So what is wrong with these changes?
However opinion is divided on some of these issues, in particular changes which would:
• Enable people who are mentally ill to be compulsorily detained, even if they have not committed any crime. This is aimed in particular at detaining people with a severe personality disorder which cannot be treated. Many argue this erodes the rights of patients without making the public any safer.
• Allow doctors to give patients ‘appropriate’ and ‘available’ treatment without their consent in certain circumstances. There is concern that these definitions are too general and subjective.
• Provide powers for compulsory treatment of patients in the community which impose unnecessary conditions and are not just confined to the small number of people who really need them.
• Fail to improve patients’ rights and safeguards by giving:
o Patients sectioned under the Act an advocate, and the right to choose who speaks up for them.
o Patients and carers the right to an assessment when they ask for it, before crisis point is reached.
4 What do people think about the current bill?
About the legislation as a whole………………The Mental Health Alliance, a coalition of 78 organisations committed to better mental health legislation, stated that it ‘does not address the shortcomings in mental health law that were identified as long ago as 1999 by the Government’s own expert committee. The legislation falls far short of what is needed and does not truly reflect the needs of those who have to live and work with it. It introduces new powers for services without the necessary safeguards for patients…… Health legislation should not be used to impose treatment that has no benefit on a patient under compulsion. What matters most is that people with mental health problems have access to decent services that work well."
The Welsh Assembly passed a resolution in January 2007 stating that 'The evidence to the Committee has demonstrated a consistent view that the proposed Mental Health legislation is deeply flawed. In the light of this evidence, the Committee’s view is that the Minister should request framework powers on the Mental Health Bill’. These Framework powers will give the Welsh Assembly greater discretion about how the Bill is implemented in Wales.
About detaining people with untreatable personality disorder………….Paul Farmer, Chief Executive of Mind, said ‘Under the current law, no mental disorder, including personality disorder, is classed as ‘untreatable’. But there is a desperate lack of ‘appropriate’ services for people with personality disorder and provision remains patchy. There are some very rare cases where a person might have a type of dangerous and severe personality disorder with no recognisable treatable 'health' problem, and has also been assessed as being ‘at risk’. But legislative solutions should not rest in mental health - you cannot ask doctors to act as jailers, detaining such a person in the health system. Health legislation must focus on health problems.’
About the compulsory treatment of patients…………..Broadcaster and writer Lord Bragg, who takes the Labour whip, said ‘People should retain as much autonomy as possible. People may have decision-making ability over many of the areas where decisions need to be made. It may be necessary for someone to receive treatment under compulsory powers, but they may have views and knowledge about which treatments have previously helped or harmed them…People should be supported to make their own decisions where possible and given the same choices as people with physical health conditions."
About the link between mental health and violence………….. Rethink, the charity focussing on severe mental illness notes that the Bill ‘has also fuelled prejudices about mental illness by connecting mental illness with violence and public protection. In reality, 95% of all homicides have absolutely nothing to do with people with mental illness. Most homicides are related to drugs and alcohol, but there are no plans to threaten the liberty of people who go to the pub on a Friday night just on the off chance that they will get involved in a fight at closing time. People with mental illness should not have their liberty threatened in this way either. The two most recent inquiries into homicides involving people with mental illness have not called for changes in the law, but changes in procedures and professional practice. There are problems in mental health services, but the changes proposed will not help. What we need is good quality mental health services that people want to use and which welcome people, rather than turning people away when they ask for help, support and treatment.’
5 What stage is the bill at now?
The Bill has passed through the Commons and is currently in the Committee stage of the House of Lords. On 19th February the House of Lords made crucial amendments to the Mental Health Bill. It voted to ensure that people are only detained if:
• Their mental health problems can actually be treated.
• They have a mental health condition. Ie they cannot be detained if they have solely a drug/alcohol condition, or because of sexual deviancy, cultural, religious or political beliefs.
It is anticipated that further changes will be made to the draft bill during the remainder of the Committee stage and Consideration stages in the House of Lords. It is hoped that these changes will focus on other contentious areas such as the right to mental health assessment when people first approach services and the right to an advocate when sectioned.
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Title: Mental Health Bill
Author: Sue Knights
Article Id: 2209
Date Added: 13th Mar 2007