Page last updated at 01:05 GMT, Monday, 3 November 2008

Tougher mental health rules begin

Mental health patient
Many patients stop taking their medication after release

A controversial reform of mental health laws allowing compulsory treatment in the community has been launched.

Patients released from hospitals in England and Wales could be forced back if they do not take their medication.

Mental health charities say the powers are excessive, will not improve people's health and could be misused.

But the government's mental health "czar" said they had been successfully introduced in other countries and would raise the standard of care.

'Revolving door patients'

The changes in the Mental Health Act are an extension of the powers which already allow people whose mental illness makes them a threat to themselves or others to be detained and, if necessary, forcibly treated.

Some people have been termed "revolving door patients", as once allowed home, they stop taking their medication, and their symptoms worsen again.

They must not become the easy option or replace good mental health services that people want to use

Simon Lawton-Smith
Mental Health Foundation

From Monday, once someone detained under the act is sent home, they can be subject to "supervised community treatment".

While they cannot be forcibly treated in their own homes, if they do not comply with the recommended treatment, they can be recalled to hospital immediately without the need for a fresh order under the act.

A more extensive system is already in place in Scotland, where patients do not even need to be detained in hospital before compulsory treatment becomes an option.

Ethical question

Critics, however, have claimed the changes could be used to justify the closure of psychiatric beds in hospitals to save money.

They also suggest that the scheme is ethically dubious, and has not been shown to work in other countries.

Simon Lawton-Smith, of the Mental Health Foundation, said: "This may help a small number of individuals with complex needs to stay well rather than lose touch with services and become ill again - but taking away anyone's right to refuse treatment is questionable.

"No-one with a physical health problem is compelled to take their medication, even if not taking it might be life-threatening."

This is about how, as a responsible society, we can ensure that some of the vulnerable members of society receive the treatment they need
Professor Louis Appleby
National Clinical Director, Mental Health

He added: "There is no conclusive research to suggest this helps people with mental health problems to stay well any more than good local services.

"It will be important to keep a very close eye on how these new powers are being used. They must not become the easy option or replace good mental health services that people want to use."

However, Professor Louis Appleby, the national clinical director for mental health, and the man driving the introduction of the new powers, said it was "completely untrue" to suggest potential financial savings might have motivated them.

He said: "This is about how, as a responsible society, we can ensure that some of the vulnerable members of society receive the treatment they need."

He said the changes could improve the experience of some patients by giving psychiatrists the confidence to discharge them earlier, in the knowledge that they were more likely to take their medication.

The need to force mental health patients to take their drugs could not be compared to the physically ill who disregarded medical advice, he added.

Professor Appleby said: "Mental illness is different because it impairs your very ability to make a rational decision about your treatment.

"In other places where this kind of order has been introduced, it has been welcomed by clinicians, by the families of patients, and by patients themselves."

Marjorie Wallace of SANE said: "With the new Mental Health Act now in place, it is urgent that the government turns its attention to providing good quality mental health services so that crises are better prevented and coercion used only as a last resort.

"We do not yet know how often and in what ways supervised community treatment will be used, but we are aware of a number of people for whom it could provide a more acceptable means of providing sustained care and preventing self-neglect and suicide."

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