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Thursday, April 15, 1999 Published at 17:24 GMT 18:24 UK


Health

Compulsory treatment moves a step nearer

Since 1983, many mental hospitals have closed

Community care patients should take their medication or risk being admitted to hospital, according to draft proposals by a government advisory body.

The Mental Health Expert Review Committee was set up by the government to review the Mental Health Act 1983 which applies to England and Wales.

On Thursday it released its draft proposals for consultation, the most contentious of which concerns compulsory treatment orders.

They include a recommendation that an independent body be set up to approve the imposition of compulsory treatment orders.

The committee also recommends advanced directives where mental health patients can state in advance what treatments they are prepared to accept.

And it calls for a system of trained advocates who can speak up on patients' behalf.

Health minister John Hutton said "radical changes" were needed in mental health care, including up-to-date legislation.

Mixed reaction

Mental health charities gave a mixed response to the proposals.

Mind expressed "deep regret" over the emphasis on compulsion.

Melba Wilson, the charity's policy director, said: "There is no indication or real evidence that increased compulsion reduces risk.

"On the contrary, there is a clear message from professionals and users that compulsory treatment in the community will drive people away from services."

Mind wants compulsion to be restricted to people deemed a risk to others.

It fears that the committee's interpretation is wider.

The charity also believes the orders could be in breach of the forthcoming Human Rights Act.

It wants to see a full right of appeal against compulsory treatment orders.

However, it welcomed the proposal on advanced directives, although it feared the stress on compulsion could mean these might be overriden.

And it was pleased with the recommendation on advocacy.

The National Schizophrenia Fellowship (NSF) said a third of its members believe introducing an element of compulsion will stop people seeking help.

Twenty-six per cent think compulsory treatment orders will increase the prescribing of older medication which has more unpleasant side effects than newer drugs.

This is because they can be injected and their effect lasts for up to a month. Newer drugs are taken orally on a daily basis.

Cliff Prior, chief executive of the NSF, said compulsory treatment orders should only be used as a last resort.

Modernisation

However, the Zito Trust, set up after the murder of Jonathan Zito by community care patient Christopher Clunis, welcomed the committee's proposals on compulsion.


[ image: Christopher Clunis killed Jonathan Zito in 1992]
Christopher Clunis killed Jonathan Zito in 1992
Director Michael Howlett said: "The problem of non-compliance in the community by mental patients has been seen to be quite significant over recent years and the legislation is clearly in need of reform."

SANE said the proposals reflected the need to modernise mental health legislation to reflect the fact that patients were now being treated in the community rather than in hospital.

Chief executive Majorie Wallace said: "We need a modern framework in which law and services work together rather than in conflict, ensuring positive rights to care and treatment and greater recognition of the role of carers and families."

Following a period of informal consulation, the Mental Health Expert Review Committee will publish a report in July.

This will then be subjected to formal consultation and the final recommendations will be revealed later in the year.



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