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Thursday, November 19, 1998 Published at 16:08 GMT

Mental health set for overhaul

Charities are eagerly awaiting details of the overhaul

Plans for a radical overhaul of mental health policy will be announced in the Queen's Speech next week.

The government announced its intention to set a "third way" for mental health in July, but a Green Paper setting out the plans in detail and, more crucially, how they will be funded, has been much delayed.

Health Secretary Frank Dobson promised an overhaul of mental health legislation, plans for crisis intervention and more support for the most seriously ill, some of whom have slipped through the community care net.

He said community care had failed. "Too many confused and sick people have been left wandering the streets and sleeping rough," he said.

"A small but significant minority have become a danger to the public as well as to themselves."

The third way involves:

  • a 24-hour crisis helpline
  • 24-hour crisis teams to respond to emergencies
  • more acute mental health beds
  • more hostels and support accommodation
  • improved mental training for GPs and others in primary care
  • extra counselling services in health centres
  • clear guidance on the most effective drugs and therapies
  • a new national framework for mental health
  • specialist secure units in each NHS region
  • assertive outreach teams to keep tabs on people discharged from hospital
  • short-term accommodation in every region to provide round-the-clock nursing care and supervision
  • changes in mental health legislation.

Law reform

Mr Dobson has suggested that the Mental Health Act 1983 needs urgent reform.

He said it was based on "the needs and therapies of a bygone age".

[ image: Mentally ill Christopher Clunis killed Jonathan Zito after being released into the community]
Mentally ill Christopher Clunis killed Jonathan Zito after being released into the community
The changes are likely to include plans to shift the balance more towards public protection by forcing patients to take their medication.

The government says this would be done in clinics and health units rather than at the patient's home.

There have been some notable cases where patients have committed violent acts, including murder, as a result of a failure to take their medication regularly on discharge from hospital.

Health ministers, however, recognise that part of the problem with community care is the lack of support for people who have been discharged from hospital and chronic underfunding of community care.

Extra cash

In July, there were rumours that the government was set to announce an extra £1bn investment in mental health to carry through the reforms.

However, there has been silence since then. It is expected to publish its Green Paper on mental health in the next month which will give more details on its strategy and how it plans to fund it.

It is expected that any extra cash will be tied to strict targets on clinical and cost effectiveness.

Mental health charities were broadly supportive of the proposals, although many are worried about plans to force patients to take medication in the community.

SANE say it is important that the changes cover all people with mental illness and not just those with the most serious problems.

The Mental Health Foundation (MHF) echoes her views.

"One in four people suffer from mental health problems every year. The government needs to look at the whole spectrum of services," said a spokeswoman for the MHF.

Others are worried about the level of funding the government will put into the reforms.

The Sainsbury Centre for Mental Health says the money would need to be recurring and not just a one-off.

The National Schizophrenia Fellowship wants the government to invest £500,000 a year in mental health over the next three years.

Civil liberties

A variety of charities, including Mind and SANE, have expressed concerns about the civil liberties' implications of compulsory medication.

SANE wants more funding put into support networks for community care patients with compulsory medication in clinics being used only as a last resort.

But the Zito Trust, set up after the killing of Jonathan Zito by former community care patient Christopher Clunis, says it is not just a question of more resources and support.

It says health workers have sometimes failed to detain people who are a risk to themselves and the community.

However, others say this is often down to lack of emergency beds and health workers being overloaded with work.

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