July 13, 2005
by Adam James

Ministers have today refused to add a "treatability" condition to a draft mental health bill, so increasing fears that more people will be compulsory treated under new planned mental health law.

The ministers' decision has angered mental health professionals who claim that plans laid out in the draft bill will mean they will be required to compulsory detain and treat people - particularly those diagnosed with a personality disorder - who would gain no therapeutic benefit.

A pre-legislative parliamentary scrutiny committee concluded earlier this year that new planned law - to replace the 1983 Mental Health Act - would erode civil liberties by imposing compulsory treatment on people who had done no wrong and would not benefit.

The committee, composed of MPs and peers, recommended inserting a "treatability" requirement as in the 1983 act, and similar to the "therapeutic benefit" requirement in Scottish law.

However, in a 57-page department of health response to the committee's recommendations, the government has said that compulsory treatment may need to be administered "even though the nature of the patient's condition means that the treatment is unlikely either to improve it or to prevent it worsening"

The report reads: "We do not believe that it would be appropriate to adopt the 'therapeutic benefit' test as used in the Scottish legislation."

The report also rejects a key committee recommendation to deal with people diagnosed with personality disorders under separate law.

The report states: "It is not, and has never been, the government's intention that the bill should be used to detain people solely for the purpose of taking them out of circulation without offering them appropriate treatment.

"It follows that we do not consider it necessary to introduce separate legislation for people with a mental disorder who pose a danger to the public but who cannot be treated. Increasingly, appropriate treatment is available."

The Mental Health Alliance, which represents around 70 mental health professional, charity, carer, law and service user organisations, said today that mental health workers would be "disappointed and angry" that the government intends to "broaden" compulsory treatment powers.

The alliance's chair Paul Farmer said: "By rejecting a test of 'therapeutic benefit' for people to be compelled, the government risks clogging up services with people who cannot be treated and should not be there."

The Royal College of Psychiatrists said it was "saddened" by the government's failure to adopt key recommendations of the committee.

Ministers have, however, accepted more than half of the committee's 107 recommendations.

These include a pledge to add "guiding principles" to the bill, and to add exclusions to the definition of what is a "mental disorder".

Psychiatrists will also not be required to compulsorily treat people whose sole mental disorder is dependency on drugs or alcohol. Patients will also be able to use advance statements on how they be treated in times of distress. Extra powers for advocates have also been granted.

The report also says it will "clearly define" which patients might be treated under compulsion in the community, known as community treatment orders.

Yet the government has firmly rejected the committee's view that the bill places too much emphasis on public safety and not enough on patient rights.

The report accuses the committee of failing to recognise the significance of the need for public protection.

It reads: "The great majority of evidence [used by the committee] came from stakeholders who represent health and social care professionals and service users, and relatively little from those with responsibility for protecting public or from the general public themselves."

The report did, however, recognise that media coverage of homicides leads to a distorted view of the risk that is posed by people with mental health problems.

Yet the report adds that of the 500 or so homicides each year, about 15% are committed by people diagnosed with a mental illness.

"Society has a reasonable expectation that the law will provide protection, as far as possible, from patients with a serious mental disorder who present a risk of harm to others," reads the report.

Dr Tony Zigmond, honorary vice president at the Royal College of Psychiatrists, said: "The committee received 450 written submissions and took oral evidence from 124 witnesses. Their report made proposals for a Mental Health Act which would enhance patient care and community, safety and command wide support from patients, their carers and professionals.

"The Royal College of Psychiatrists is saddened by the government's failure to adopt many of the central recommendations of the committee."

Read for yourself:
Government response to the report of the joint committee on the draft mental health bill 2004 (pdf)
The Joint Parliamentary Committee's report on the draft mental health bill

See also:
The government's draft mental health bill (pdf)

July 11, 2005: Mental health no longer the NHS Cinderella service, says government - upbeat message comes one month after Healthcare Commission highlighted a culture of violence on mental health wards
March 29, 2005: Government again under fire over plans to change mental health law - parliamentary committee warns that planned legislation would erode civil liberties

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