The Mental Health Bill

By Elizabeth Winder


The draft Mental Health Bill published by the government this summer, has come to the end of its consultation period after receiving unanimous criticism. The Royal College of Psychiatrists, nursing organizations, mental health and other charities, and survivor organizations, united in opposition, formed the Mental Health Alliance to campaign against some provisions of the Bill.  

Responding to the criticism the Mental Health Tsar, Louis Appleby, has said alterations will be made. The major rewrite required would delay reform needed to ensure mental health legislation is compatible with Human Rights. It is not yet clear to what extent the government is prepared to rewrite the bill; further information is expected in the Queen's Speech. 

Two proposed measures, Compulsory Treatment Orders to enable patients to be forced to take medication while living in the community, and the invention of Dangerous Severe Personality Disorder to enable dangerous people to be detained indefinitely before they have committed any crime, have attracted the most criticism. Health professionals feel they are unworkable; attempts to implement Compulsory Treatment Orders would pull resources away from other vital mental health services that are already critically underfunded. There are no diagnostic criteria for Dangerous Severe Personality Disorder (DPSD), nor even any agreement about its existence; American psychiatrists have already refused to make predictions of dangerousness on the grounds that it is impossible to do so with any accuracy. For service users the prospect of increased coercion extending out from the hospital into their own homes makes mental illness even more frightening, whether or not they themselves have been subject to the existing legislation. The association of coercion and treatment may discourage patients from accepting psychological treatments if offered, or from seeking help with mental distress at all.   

The Bill's emphasis on containing violence works directly against the first National Service Framework Standard for mental health, directed at reducing the prejudice and discrimination which hinders recovery from mental illness.  It panders to media scaremongering and scapegoats the mentally ill for problems arising from successive governments' failure to provide sufficiently resourced support services in the community.  

One in four people in the UK suffer from some kind of mental health problem in the course of a year.  The services to support them are often inappropriate or inadequate and usually underfunded. Open acute wards, to which most people would be admitted if they needed hospital care for mental illness, are not staffed at a level that allows frequent interaction with nursing staff or specialized therapeutic input. Out-of-hours and crisis services for people outside hospital are not easily accessible everywhere. There are long waiting lists for NHS counselling or therapy, and the number of sessions may be determined before the client and counselor explore what work needs to be done.  Drawing resources away into unworkable measures is more than a financial drain; increased stress and demotivation of health workers will also have an adverse effect. 

Other important changes in the proposed legislation relate to the role of the 'nominated person' (replacing the 'nearest relative'), the provision of advocacy for anyone subject to detention under the Bill, the system for challenging detention, and the periods for which patients can be detained.  

The Mental Health Alliance, which arranged a lobby of Parliament on 23rd October, is calling for an Act that ensures:

*   A legal right to assessment, care and treatment as the first step to ensuring a reduction in the use of compulsory powers

*   The gateway to quality mental health support for all is centred on voluntary community based services

*   That care and treatment should take place in the least restrictive setting possible

*   Access for all to independent advocacy services - to help people negotiate the complex web of services and the law

*   Enforceable advance statement, which make a person's wishes clear to health services when that person has lost mental capacity

Further information and links to the text of the Draft Bill can be found on the Mental Health Alliance's website (


While training as an integrative psychotherapist, Elizabeth Winder helped to set up a user-led mental health day service and provided counseling within prison as a Probation Service volunteer.  She now runs an independent  service providing advocacy to psychiatric in-patients.