“tsar” accused of encouraging staff to unlawfully coerce
by Angela Hussain
mental health “tsar” Prof Louis Appleby has been accused
of encouraging staff to unlawfully coerce patients to adhere to
In a war of words between two leading
mental health figures, Chris Heginbotham, chief executive of the
Mental Health Act commission, wrote to Appleby complaining that
a recent report he produced may lead to more incidents of staff
coercing psychiatric patients to stay on wards and accept treatment.
The row has erupted as the government
endeavours, in a mental health bill, to extend powers of compulsory
detention over people diagnosed with a mental illness.
Heginbotham objected to Appleby's
referral of informal patients as “leaving a ward without permission”
and being guilty of "absconsion”. Appleby
used the terms in his December national confidential inquiry into
suicide and homicide by people with mental illness report.
Heginbotham told Appleby such a
“blurring” of distinction between informal and detained
patients may encourage "unlawful” coercion.
The commission has previously raised
concerns about the use of coercion in mental health units.
report assumes informal inpatients require "permission"
to leave a ward and have "absconded" if they leave without
such permission,” Heginbotham wrote in a letter to Appleby.
Health Act Commissioners… see examples of unlawful 'de facto'
detention on their visits…
is of great concern to the commission that the report’s blurring
of the distinction between informal and detained patients, and the
apparent assumptions regarding the powers over informal patients
as a consequence, may encourage such unlawful practices.”
response, Appleby wrote of his "surprise” that Heginbotham
should criticise a "choice of words”.
the government's national director for mental health, told Heginbotham
he did not use the term “permission” in a legal sense.
wrote: “A good care plan will include whether a [suicidal]
patient should spend time off the ward and it is in this context
that patients are often asked to check with staff before leaving
is the sense in which “permission” is used in this report,
not in a legal sense.
staff say that a patient may leave the ward, they are saying whether
it is safe or consistent with the care plan, not explaining the
patient’s legal entitlement.
suspect most people in clinical practice, and most patients, understand
of letters between Prof Louis Appleby and Prof Chris Heginbotham
12, 2007: Government set to win bid to extend compulsion powers
over mentally ill, says MP
- "I do not think there will be a major Labour rebellion,"
says Lynne Jones of group of MPs with previous "misgivings”
over mental health bill.
Dec 18: More than
40 psychiatric inpatients per year die of "unexplained”
causes - antipsychotic drugs, physical restraint and heart disease
could be causing such deaths, states new report
1, 2006: Government presses ahead to force some psychiatric patients
to take medication in community - plans in new mental health
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