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Last Updated: Wednesday, 8 September, 2004, 08:35 GMT 09:35 UK
Mental health plans are 'diluted'
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The new draft clarifies who could be detained in hospital
The government has watered down its plans to allow the enforced treatment of potentially dangerous mental health patients.

The long-awaited re-draft of the Mental Health Bill, released on Wednesday, sets stricter criteria on which patients can be detained.

When the original draft was unveiled in 2002, psychiatrists and charities condemned it as unethical and inhumane.

They criticised the new draft for failing to resolve all of the issues.

'Inhumane and unethical'

Current laws make it impossible to detain people with personality disorders who have committed no offence.

The 2002 draft of the Mental Health Bill proposed measures to detain mentally ill patients for their own protection and the protection of others, even if their condition was not treatable.

THE MAIN CHANGES TO THE DRAFT
Those at "risk" can be detained
Doctors must justify planned treatment as clinically sound
Automatic review if detained past 28 days
A previous psychiatric admission required for Community Treatment Orders
Prisoners should not be treated under Community Treatment Orders
Patients who have capacity to make decisions about their care can refuse treatments
Doctors can over-ride refusals if treatment is in the patient's best interest
Designated carers no longer need to be the nearest relative
Carers consulted when there are changes to the patient's care

There were also proposals to allow compulsory treatment in the community under Community Treatment Orders.

If a patient did not stick to the treatment orders they could be detained in hospital.

The proposals prompted some 2,000 objections.

Critics were concerned doctors would turn into policing bodies rather than carers, and the net would be cast too wide meaning people posing no risk to others would be detained.

The re-worked draft aims to resolve these points of contention.

The changes

The criteria under which patients could be forced to be detained and treated in hospital have been tightened to those at highest "risk" - those who are suicidal, a risk to others or are at severe risk of neglect.

Like the original draft, this would continue to include people under the broad definition of "psychological dysfunction arising from any disorder of the mind or brain", such as depression or schizophrenia.

It would be up to three health professionals, which would no longer have to include a social worker, treating the patient to define this risk.

People with personality disorders could be detained for treatment if the doctors were able to justify that the planned treatment was clinically sound to a tribunal.

I genuinely think we have made changes that respond to the criticisms that were made
National Clinical Director for Mental Health Professor Louis Appleby

If treatment could not be justified but the person was deemed a danger to others, they should be referred to another appropriate agencies such as the police, says the draft.

Any patient detained for more than 28 days would automatically be reviewed by an independent tribunal to check whether the detention was still valid.

Currently, patients can request an independent review but will not get one automatically.

The criteria for Community Treatment Orders have also been tightened to apply to patients who relapse and are continually in and out of psychiatric hospital.

Prisoners should not be treated under these Orders. Instead, any in need of psychiatric care should be transferred to a hospital.

Empowerment

Patients who have the capacity to make decisions about their care would be able to refuse treatments such as ECT or shock therapy, even if they were detained in hospital.

However, doctors would be able to over-ride these refusals if they and a tribunal believed the treatment would be in the patient's best interest.

Patients would be able to nominate a person as their designated carer who would no longer need to be their nearest relative.

These carers would have to be consulted when there were changes to the patient's care, such as admissions to and discharges from hospital.

Families will have reduced rights and fewer opportunities to press for the best care and treatment for the person they care for
Cliff Prior, chief executive of Rethink

Health Minister, Rosie Winterton, said: "We believe that we now have a Bill that puts a new focus on the individual, allowing compulsory powers to be used in ways that fit with patients' changing needs."

National Clinical Director for Mental Health Professor Louis Appleby said: "I genuinely think we have made changes that respond to the criticisms that were made."

But The Royal College of Psychiatrists said it remained "very concerned" about the proposals saying they did not take into account the College's "grave anxieties in terms of civil liberties, ethics, practicality and effectiveness".

Mental health charity SANE said the new laws would not work without new provision for mental health services.

Cliff Prior, chief executive of Rethink, said: "We are being thrown back to an age where mental health law is based on prejudice, ignorance and fear rather than hope and recovery.

"Families will have reduced rights and fewer opportunities to press for the best care and treatment for the person they care for."

Liberal Democrat Shadow Health Secretary Paul Burstow MP, said: "A new Mental Health Act is desperately needed, but it must be a law to protect and improve services for patients, not a means to demonise those with mental health problems."

A spokesman for the Conservatives said: "The Government have still failed to grasp that mental illness is a medical condition requiring treatment like any other physical problem rather than a criminal offence demanding incarceration."


Your comments:

What about the community? I agree those persons with Mental Health issues should be protected and given the treatment they desperately need, but what about the victims in the community who suffer financial loss as a direct result of the patient's actions? What about the physical and mental care of the community which suffers from lack of care/treatment the patient is getting from the appropriate agencies. When do we get support?
Jim, Woking, Surrey

The revised draft bill does not go far enough. We need more provision of correctly trained staff to deal with the mentally ill who live in the community, and these people should be accessible 24 hours a day seven days a week for emergency situations, as our police force are really not equipped to deal with the mentally ill.
Anon, Oxford

To find out my mum could be given ECT without her consent, frightens me
Stacey, Kent

My mother has been under the care of mental health teams for at least 11 years - nine of which she was fine on her medication. She had a breakdown when my father had an affair with the 19-year-old neighbour and belittled her so badly that she had a re-lapse. This obviously distressed her a great deal. I found it hard that she was sedated against her will and strapped in a bare room for being emotional - losing days at a time. This gave her an overwhelming fear of those supposed to be caring for her - as it would cause me fear too. Sometimes I feel patients are sedated to make things easier for the professionals - to give them a break. This is clearly wrong. Then, to find out my mum could be given ECT without her consent, frightens me on her behalf.
Stacey, Kent

As someone who has had several years of experience at the hands of mental health professionals, I feel that the whole health system needs reworking. I have previously been detained under the Mental Health Act. I was amazed at how easily someone could have their liberty and freedom taken away from them. I sat in a room and watched a consultant piece together my history in order to form a diagnosis that would secure my imprisonment - I was shocked at how easily the system could be manipulated. I was ill and needed help and support but I did not need decisions to be taken away from me, nor did I need the continuous label that I now have attached to me. If life is about empowering, and if professionals and the government believe that empowering is the way to help people help themselves, then why is it so easy to take that power away from people? There needs to be more easy access to 24-hour help. I cannot guarantee that I will hit rock bottom between nine and five, Monday to Friday. In fact, for me, and a lot of other people, evenings and weekends are the worst times. People need help, not stigma.
Patricia, Weston-super-Mare, UK

My life is painful and full of grief because I am not treated by society and my professional carers as the person I truly am
Stuart, Dorset

I am a diagnosed Paranoid Schizophrenic. I have never hurt or attacked anyone. My life is painful and full of grief because I am not treated by society and my professional carers as the person I truly am. Because of my diagnosis I am treated as a person I am likely to never become. When will the NHS start to recognise that every diagnosis of Schizophrenia and severe mental illness is not a threat and that the majority of sufferers cope and live life peacefully rather than harming others. There needs to be a Grading System worked out and put into practice. Especially for sufferers diagnosed with Schizophrenia. This grading system should help fight against the discrimination that all sufferers of schizophrenia and severe mental illness are a possible threat to society. A system which can help prove to the public and all, who may be a danger to society and who isn't. I have had a mental illness for most of my life. Not once have I harmed. The general public is at a far greater risk from the general public than they are by sufferers of severe mental illness.
Stuart, Dorset

There is a lot of comment about patients' rights but what about the rights of others. I have the right to be protected from patients who are dangerous or alarming. There are too many cases of mental patients killing or injuring other people. Will this bill reduce the number of people killed or injured?
Steve, London

As someone who required treatment for a severe depressive episode, out of work for a year and then forced to either return to the position which helped spark the breakdown or find another job, to have had no help in keeping my house as I have a mortgage, having run up huge debt trying to keep, literally, body and soul together, this bill does not seem to tackle the inhumane and unjust treatment that can befall anyone, through no fault of their own. Back to the days of Bedlam? Seems so to me!
Andrew, West Lothian

Well, thank goodness something is being done
Denise, Staffs

Well, thank goodness something is being done. Even if it's not perfect it's a start. My son is mentally ill and for many years refused treatment and it could not be forced upon him unless he became a danger to himself or others. Had treatment and a hospital stay been forced then maybe we wouldn't have reached the stage where he assaulted me and my father and had to be taken away by police and sectioned on three separate occasions. Having said that, the hospital stays were largely a waste of time. The staff were useless and all I ever saw them doing was sitting in the office and I was there a lot! To the point about this being more to protect the public (I don't agree) well what's wrong with that for a change? I don't agree because, if a mentally ill person is detained in hospital, surely they are getting the help they need but won't take voluntarily? Unless, of course, they're somewhere similar to where my son goes.
Denise, Staffs

As an Approved Social Worker I remain concerned that the Government proposes to dilute this role. Most people don't realise that it is the ASW, not the Doctors, who decide whether someone should be detained under the current Mental Health Act, and this is in order that the decision to remove someone's liberty be taken by a professional independent of the medical establishment. This is an important safeguard, and in common with most ASWs I wonder how a nurse, accustomed to taking orders from Doctors, could challenge a Psychiatrist where they have doubts about their plans. In addition all the comments by relatives of people who find themselves enmeshed in the mental health system emphasise the importance of taking account of the social perspective as well as the medical.
Peter, Norwich, Norfolk.

There are many differing types of personality disorders, and it would be appreciated by those suffering from one of them if journalists did not seemingly lump them together into one dangerous and untreatable one.
Sue, UK

This Bill would worsen the stigma mentally ill have to face
A Rey, Edmonton, London

I think it's highly irresponsible of the Government to introduce stricter laws concerning mentally ill people when it threatens human rights and personal freedom. The redraft is no different to the 2002 original. Society often makes the mistake of stigmatising mentally ill people. This Bill would worsen the stigma mentally ill have to face and with the threat of personal freedom and enforced treatment, mentally ill people will be less likely to seek help.

As someone who suffers with depression, I find it quite worrying that I now suffer with the threat of confinement, because of this common illness. What we need to do is educate the public and expand the mental health services, rather than imprison people. Would anyone imprison a cancer sufferer? This Bill shows a high level of ignorance and lack of care on the government's part. We need more mental health services, not prisons. Is imprisonment society's answer for poor health services?
A Rey, Edmonton, London

This law is very dangerous. It will push those more able to deal with their condition away from care as they fear the possibility of the utterly inhumane ECT treatment. We will see an increase in the numbers of mentally ill people on the streets.
Lewis Gilmour, Leeds, UK

This bill does not sort out the severe problems in the mental health system but gives even more powers to doctors that quite often just don't listen or care
Anon, Cambridgeshire, England

My wife had to call upon treatment last year. She had a breakdown during a planned changed of her medication. The acute problems that my wife and I had with the medical services are just not covered in the bill.
The problems were:
- on lead up to breakdown (just days before), the consultant would not listen to me that my wife was getting considerably unstable.
- on day of breakdown (a Saturday), I could not contact the local mental health emergency line as it only operated Monday to Friday 9am to 5pm. I could not contact local doctor as the phones were not switch through to the on-call doctor. NHS Direct were of no help.
- Ambulance service had to be called but my wife was turned away from A & E as they had no mental health trained nurses there. She had to be taken to the police station to be locked in the cells. Grim police cells and holding areas are not the place for mentally ill patients.
- On call mental health doctor and social worker told me that as next of kin, I had no right to be consulted in my wife's treatment and I could not even authorise her sectioning (if it was required).

This bill does not sort out the severe problems in the mental health system but gives even more powers to doctors that quite often just don't listen or care.
If the government wants to make a real difference, it needs to:
- give next of kin some power over treatment
- publish 24 hour 7 days a week emergency contact numbers
- make it an offence for NHS A & E to turn away mentally ill patients.
Anon, Cambridgeshire, England

To Anon, Cambridgeshire: I concur wholly with you and I would urge all to ensure they read his comments. I am the father of two adult children with manic depression and am their carer. This is the reality of mental health care in the UK - a feeling of complete isolation for carers at times of crisis. Personally I feel that patients should be subject to detention in mental hospitals at times of risk, but much much more needs to be done in terms of treatment. I also agree with Ian of Hampshire - patients need protection from incurring debt whilst being treated as a patient. During a recent day leave from hospitalisation my son ran up debts of 750 - that he can ill afford to repay. The staff merely say "we have to respect the patients rights". My daughter has been allowed to form extremely ill-suited relationships (which she later deeply regrets) in hospital, at times when she has been very delusional; again we are told "we cannot interfere".
Anon, Derbyshire

Quote. Patients who have the capacity to make decisions about their care would be able to refuse treatments such as ECT or shock therapy, even if they were detained in hospital. However, doctors would be able to over-ride these refusals if they and a tribunal believed the treatment would be in the patient's best interest. End Quote. How can it ever be right to take away the decisions of the patient who is perfectly capable of making those decisions and giving it to anyone else, never mind a tribunal of strangers? This is not just an erosion of human rights but a complete removal of a section of them. Would some patients then be used as experimental subjects? I think this could happen under these new guidelines. This is very worrying. If this sets a precedent what powers might next the government give themselves? This section at least, must be scrapped immediately.
John Burke, Southend on Sea, Essex

If a persons mind snaps, this is unforeseeable. Therefore all people are at risk from these kind of draconian measures. Mental illness is not the kind of disease where one can say, "I saw it coming". Unfortunately.
Laurie Greenwood, Nelson, England

The new bill is still a long way from perfect. It is based on the rights of and safety for the public rather than the responsibilities of the public to care for those with mental illnesses and the rights of this with these illnesses. How about some legislation to make it harder for people to object to mental health projects in the community - two thirds of such innovative ideas are blocked or delayed by nimby attitudes.
Rob Waller, Leeds, UK

There are few enough opportunities for people with ADHD. Please do not make them less.
Jackie Gorvel, Jersey

Having previously been a carer for someone under the mental health system, this bill does not go far enough. For example, there is no facility for consultation with the carer if the treatment changes (only if the care changes), which happens often. In addition, there is no protection for the patient or patient's family for any debts incurred by the patient whilst they are under the care of the mental health services - in the US, there is protection, and it is the lenders responsibility to ensure the patient is not under mental health care, and their liability if this turns out to be the case.
Ian, Hampshire, UK




WATCH AND LISTEN
The BBC's Graham Satchell
"The new Mental Health Bill gives clear guidance on who can be forcibly detained"



SEE ALSO:
Viewpoints: Mental Health Bill
08 Sep 04  |  Health
Q&A: Mental health laws
08 Sep 04  |  Health
'No-one listens to the patients'
08 Sep 04  |  Health


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