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Tuesday, 13 August, 2002, 18:37 GMT 19:37 UK
Examining the Mental Health Bill
BBC Health Correspondent Chris Hogg
BBC Health Correspondent Chris Hogg examines government plans to allow people with severe personality disorders to be detained under its proposed Mental Health Bill.

How many people is the government planning to lock up on the basis that they might, one day, run amok and harm someone? The answer is about 124.

But do not tell the tabloids. Their attempts to whip up public hysteria about the hoards of sexual deviants and killers lurking on every street corner might fall a bit flat.

The figure of 124 is not my estimate. It comes from the Office for National Statistics Psychiatric Morbidity Survey of Prisoners (1997).

Lord Hunt, the junior health minister, released the figure in a written answer just before the House of Commons rose for the summer break.

It represents the best guess of the number of people who are dangerous by severe personality disorder (DSPD).

This group is not covered by current mental health legislation. However, they will be included in the new Act as part of a new multi-million pound programme to tackle DSPDs.

But why all the fuss? Why did the government make it a manifesto commitment to build 300 new places in secure units to lock these people up?

Why have they framed the first piece of new mental health legislation in nearly 20 years in a manner that some campaigners complain is more concerned with public protection than service provision?

This week, there is a rare opportunity to get straight answers to those questions as the Department Health and the Home Office launch a series of roadshows to try to persuade doctors, campaigners and others that the new Bill is a good thing.

Dispel myths

First off, officials from the Home Office are keen to dispel a few myths. They dismiss suggestions the DSPD programme is a knee jerk reaction to high profile killings like those committed by Michael Stone but has its roots in 1997 and problems at Ashworth Hospital.

They also reject criticism of the use of the term DSPD - it is not a clinical diagnosis. However, officials say it is convenient shorthand to describe a group of people for whom they want to develop services.

how much will that risk need to be reduced before they let you out

At present, they say, psychiatrists can argue that these people are not suffering from a mental disorder and cannot be treated. However, this means they cannot access services.

In the worst cases, that means waiting for them to commit an offence.

Under the government's plans there will be clear 'entry criteria' for DSPD including an assessment of how likely they are to offend against others.

An individual will be locked up if they are assessed as having more than a 50% chance of offending against others.

However, campaigners have raised doubts about these key criteria.

Risk assessment

If it is clear how much risk you will need to pose to others to be locked up, by how much will that risk need to be reduced before they let you out.

By 10%? Officials admit if they can reduce it by that amount they are doing well.

By 20%? That would be excellent work say doctors.

So where does that leave you? Still presenting a 30% risk of carrying out a serious offence. Will ministers and the tabloids find that acceptable?

If not, are we prepared to lock people up for decades?

And just how accurate are these tests anyway?

What happens if you are judged to be a 48% risk, and then you go and commit a crime?

By definition there will be a greater number of people just below the threshold than just over it.

The fundamental problem is that we still do not know enough about this area

And anyway we have seen in recent years a huge increase in the number of mentally ill people who are sectioned under the Mental Health Act.

Defensive medicine?

One doctor told the meeting that was due to defensive medicine. Psychiatrists were more likely than ever to section an individual because they were wary of being blamed if something went wrong.

Why should DSPD's be any different? Here of course we could be talking about removing someone's liberty for the rest of their life.

There was some measure of agreement on both sides that much of the coverage of this particular issue has been ill informed so far, worrying people with personality disorders who are not judged as dangerous.

But as the officials themselves admit, the fundamental problem is that we still do not know enough about this area.

Research is underway which they hope will make it clearer how to assess these people, and how to treat them.

But it is not nearly completed, and in the meantime, the politicians are anxious to be seen to be doing something before the next homicide is blamed on them for presiding over a system that just does not work.

See also:

25 Jun 02 | Health
25 Jun 02 | Health
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