The Mental Health Bill
By Elizabeth Winder
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.
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.
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.
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.
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
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.
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
information and links to the text of the Draft Bill can be found on the Mental
Health Alliance's website (www.mind.org.uk/take_action/mha.asp).
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.