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Monday, November 15, 1999 Published at 16:06 GMT


Mentally ill could face compulsory treatment

The government is likely to back compulsory treatment orders

Community care patients who do not take their medication are expected to face compulsory readmission to hospital.

The proposals, which cover England and Wales, were published by an advisory body in the summer. The government is expected to back them when it publishes its response in the autumn.

Mental Health
The most controversial of the Mental Health Expert Review Committee's proposals concerning the Mental Health Act 1983 concern compulsory treatment orders.

The advisory body says an independent body should be set up to approve the imposition of compulsory treatment orders.

It 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.

The government says "radical changes" are needed in mental health care, including up-to-date legislation.

Mixed reaction

Mental health charities have given a mixed response to the proposals.

Mind is worried about the emphasis on compulsion and says failure to take medication is not the main reason for community care killings.

It says research shows lack of coordination between the agencies responsible for community care patients and poor risk assessments are the priniciple reason for the deaths.

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

It fears that the committee's interpretation is wider and may put patients off seeking help.

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 welcomes the proposal on advanced directives, although it fears the stress on compulsion may mean these are overriden.

And it is pleased with the recommendation on advocacy.

The National Schizophrenia Fellowship (NSF) says 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.

The NSF believes compulsory treatment orders should only be used as a last resort.

However, some mental health charities, including the Zito Trust and SANE, back compulsory treatment orders.

SANE says the proposals represent a modern framework which balance the rights of patients and the public and give greater recognition of the role of carers and families.

Mental incapacity

Other big shake-ups in mental health law include a White Paper on mental incapacity, also expected in the autumn.

It is expected to include proposals which aim to clarify when a person is declared mentally incapable and to provide safeguards which empower those with mental illnesses.

There will be guidance promoting a "functional approach" to deciding if someone is incapable of making a decision and to protecting them from being unduly influenced by others.

The guidance will also stress that decisions should be taken in the best interests of the incapacitated person.

Other proposals are expected to cover care issues.

For example, there is likely to be a new Continuing Power of Attorney, which will allow a person to nominate a proxy to look after their healthcare and welfare concerns rather than just financial decisions.

Another plan is for a Court of Protection which can resolve disputes about a person's incapacity, best interests and other issues.

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