jcdmhb 07

Session 2004-05, 23 March 2005

Mental Health Bill Needs Radical Overhaul


Mental Health Bill Needs Radical Overhaul

Government plans to reform mental health provision will force too many people into compulsory treatment and will erode their civil liberties.

 That's the conclusion of a joint House of Commons and House of Lords Committee that recommends the draft Mental Health Bill gets a radical overhaul before it's put to the vote.

MPs and Lords believe the bill places too great an emphasis on protecting the public from a small minority of dangerous mentally ill people. The Committee believes this will be at the expense of the civil rights of the majority who pose no risk to others.

Compulsion

The Committee accepts the merits of having a broad definition of mental disorder, but the draft Bill needs to have clear exclusions ensuring that legislation cannot be used as a means of social control.

The Committee fears that the powers granted in the current bill could potentially be used as the equivalent of a mental health ASBO - enforcing treatment on those who might be a 'nuisance' but who don't pose any significant risk to the public.

Under current proposals, treatment can be enforced simply 'for the protection of other persons'. The Committee believes that conditions should be tightened to ensure that legislation cannot be used inappropriately. It concludes:

  • That people should only be forced into compulsory treatment if they pose a significant risk of serious harm to others.

  • That patients should never be treated under compulsion unless their decision making is impaired.

  • That compulsory treatment must be of therapeutic benefit to them.

The wide definition of treatment in the bill means people diagnosed with personality disorders or learning disabilities could be detained on the grounds of public safety rather than benefit to their health. Not all treatments may help a patient to recover from their mental illness, yet doctors may be forced to detain them regardless.

Separate Legislation

MPs and Lords also recommend that people who can't benefit from treatment - which includes dangerous and severe personality disorders (DSPD) - should be dealt with by separate legislation.

As a consequence of the inclusion of criteria of therapeutic benefit and impaired decision making (see above),  a small group of people with DSPD may not meet the conditions for the use of compulsory powers, hence the need for separate legislation.

What the Bill should focus on:

The primary purpose of mental health legislation should be to improve services and safeguards for patients and to reduce the stigma of mental disorder. The fundamental principles underpinning the legislation must be set out on the face of the Bill. This will provide clear guidance for professionals and tribunals and provide assurances to users of mental health services.

Whilst the committee supports compulsory treatment in the Community it believes it should be more restricted than under current proposals. There should be clear criteria about who can be treated at home and time limits should be set as to the length of their treatment. The Committee are concerned that people could be treated indefinitely with little hope of ending their compulsory treatment.

Finally, MPs and Lords also have major concerns about the resources needed to implement the Bill. Without adequate staffing and funding, the new tribunal, for example, will fail to improve patient safeguards, and mental health could remain the 'Cinderella service' of the NHS.

Lord Carlile said:

"This is an important reminder to the Government that the Bill is fundamentally flawed. It is too heavily focused on compulsion and currently there are neither the financial resources nor the workforce to implement it."

Far too many people could be forced into treatment unnecessarily.

 They can be detained even though the treatment they receive does not help their condition. And they can be detained compulsorily even if they are perfectly capable of making their own decisions.

This is well beyond what is required and the Committee believes that ministers should consider redrafting significant sections of the Bill.

At present, the draft Bill is too focused on addressing public misconception about violence and mental illness, and does not do enough to protect patients' rights."