Openmind 17, Sept/Oct 2002
The draft Mental Health Bill represents the next stage in a process of public consultation which has included the Richardson Committee Report, the Government Green Paper, the Health Committee Report and finally the White Paper in December 2000.
Mind is most disappointed that the Government continues to push for legislation that ignores and overrides recommendations of the Richardson Committee, other expert opinions and our own responses. We have grave disquiet about its central provisions, which we consider unworkable and regressive....
The Government aims to use the new Mental Health Act to protect the public's safety from people who are dangerous and have personality disorders. People who fall into this category are often difficult to treat, so the definition of treatment has been limited or ineffective. It also covers 'care', which need not involve a therapeutic programme at all. While the Government's desire to protect the public from dangerous people is laudable, the proposals in the Bill have been widely condemned as unjust, expensive and unworkable.
The provisions are unworkable because they rely on a psychiatrist's prediction that someone poses a significant risk of serious harm. There is no accurate way of assessing risk other than the number of previous acts of violence or offences. To meet the aim of protecting the public from risk, large numbers would need to be detained. A conservative prediction is that six people would need to be detained to prevent one offence (The Lancet 2000), many of whom may have never harmed in the past nor would do so in the future.
There has been serious misreporting in the media of the risks represented by people with mental health problems. Home Office statistics for England and Wales between 1957 and 1995 show that despite media and public perceptions there had been little change in the number of homicides committed by people with mental illness [Taylor & Gunn 'Homicides by people with mental illness: myth and reality' (1999) British Journal of Psychiatry , 164]. The proposals on high risk people reinforce the common but false perception in the public's mind that people with a mental illness are dangerous.
There are other solutions; if improvements are made in services for early intervention, if greater training for the judiciary in sentencing options is provided, much could be achieved....The civil and criminal justice system could also be used more innovatively to bring dangerous people before the courts in other ways. The injunctions, restraining orders and criminal sentencing used in the field of domestic violence could provide a model.
Criminal justice legislation should be used to allow courts the option of imposing indeterminate sentences in appropriate cases involving violent offences related to a mental disorder.
What kinds of case might now be subject to compulsory powers? The elderly confused person in a nursing home who refuses to take his medication because of the side effects; the depressed woman who fails to keep her appointments with the psychiatrist because she doesn't think he's helping her; the lonely man with a personality disorder who is acting strangely and the neighbours want him out of the way 'just in case'; the black man who has been diagnosed with schizophrenia and argues with the police when he is arrested for an offence he claims he did not commit.
The patient will have the right to challenge the exercise of compulsory powers at a tribunal hearing. This is a welcome development, but the breadth of the conditions will limit the extent to which the tribunal can overturn the clinical supervisor's decision. Also a patient applying for a discharge will face difficulties in showing that s/he no longer meets the criteria if the clinical supervisor opposes the discharge.
We believe that the consequences of this Bill for the overall provision of mental health services are alarming. The staff resources are not available for it to work. Staff will need to be drawn from already overstretched general care into the compulsory provision of care. This, in turn could bring more people into the compulsory system because their condition will not be treated until it becomes acute, when compulsion may be necessary.
We hope at this late stage the Government may heed the warnings they are hearing from all sectors involved in mental health and reconsider the Bill.