Mental Health Patients Deserve a System That Is Humane, Ethical and Principled ; COMMENT & DEBATE

Article excerpt

The Mental Health Bill will be given its second reading in the House of Commons tomorrow. The main purpose of the Bill, which has been nine years in gestation, is to amend the Mental Health Act 1983, which sets out the circumstances in which a person with a mental disorder can be detained or treated compulsorily without his or her consent.

The Bill represents the biggest reform of mental health legislation in 50 years and, when passed, could be used for up to 25 years. The work on the Bill by the Royal College of Psychiatrists has focused on ensuring that the Bill is fit for the 21st century, that it has the care of patients at its centre, providing appropriate safeguards for patients, while at the same time ensuring public safety is protected as far as is possible.

The House of Lords has amended the Bill in several important respects, refocusing provisions so that patients' rights are properly safeguarded, and the Royal College of Psychiatrists and the Mental Health Alliance agree that this is now a Bill which can be supported. Unfortunately, the Government has declared its intention to overturn some of the Lords' amendments.

The introduction of supervised community treatment orders (SCTOs) is a key provision of the Bill. A recent international review of such orders carried out by the Institute of Psychiatry (which had been commissioned by the Department of Health) concluded that there was no evidence that SCTOs actually worked. Despite these findings, the Government is planning to proceed with SCTOs and to make provision in the Bill to the effect that patients who might fail to comply with their treatment following discharge could forcibly be returned to hospital. While the college supports the use of SCTOs, the Government needs to put clear limits on who can be given such an order and ensure that people do not get stuck on orders for years. The Lords have sought to address this in their amendments by restricting the use of SCTOs to genuine "revolving door patients" - those with a history of relapse and who may pose a danger to others.

The House of Lords have also reinstated the "treatability test" so that a person should be detained only if treatment is available which is likely to alleviate or prevent a deterioration of their condition. Furthermore, it has introduced a requirement that people who have full capacity to make their own decisions about their treatment cannot be forced to have treatment imposed on them against their will, unless they are being sent to hospital by a court. In so doing, the Lords have restored a more limited framework for the exercise of compulsory powers that redresses the balance between clinical discretion and patient safeguards. …