nurses and occupational therapists to have new detention powers
by Chris George
This article was slightly modified on July 4, 2007)
nurses and occupational therapists are set to have new powers to
detain people diagnosed with a mental disorder.
mental health bill presently going through parliament will enable
non-psychiatrists to renew detentions, including community treatment
orders, on patients sectioned in psychiatric units. But such “responsible
clinicians” will not be able to implement a patient's initial
hospital detention. This must be implemented by two psychiatrists.
law states a psychiatrist - as a “registered medical practitioner”
- must be involved in renewing detention. But mental health minister
Rosie Winterton, after recent lobbying by a new coalition of non-psychiatrist
professionals, wants to enable non-psychiatrists to also have these
the House of Lords, where the bill is due to go next week, wants
law to specify that at least one psychiatrist is involved in renewing
a patient's detention.
the government's proposals, a responsible clinician will also have
powers to place a patient on a community treatment order. These
is when a hospital-detained patient can be ordered to live at a
designated place in the community and to accept medication.
"approved" clinicians will also be able to end a patient’s
detention. There would, unlike now, be no legal requirement for
a psychiatrist to be involved.
representing psychologists, nurses and occupational therapists say
these planned new powers reflect the true status of non-pharmacological
approaches, such as psychological therapy, in mental health work
psychologist Peter Kinderman of the Mental Health Coalition, a splinter
group from the campaigning group the Mental Health Alliance, said
the new powers would enable detained patients to benefit from multi-disciplinary
approaches to care.
we have got more powers, but it will be possible for clinicians
to use this power in the best interest of clients,” he said.
a separate development, the government has rejected calls for a
capacity test to be retained. The bill contains no condition that
a patient’s decision-making ability be "significantly
impaired” for them to be detained. This lack of a capacity
test could enable more people with a diagnosis of personality disorder
to be detained.
the government has shifted its position on a "treatability
test”. Ministers had argued they did not want such a test
as it may have prevented clinicians detaining dangerous people diagnosed
with personality disorder who some judge to be untreatable. The
bill now states that "appropriate medical treatment”
must be available for someone to be detained.
the Guardian newspaper reported that The Commission for Racial Equality
has warned ministers that the bill unlawfully discriminates against
Johnson, the commission's policy director, has said the bill could
be challenged by judicial review.
Matilda MacAttram, director of Black Mental Health UK, said: "Community
treatment orders are no more than psychiatric asbos, which have
no place in mental health legislation", and make "countless
numbers of black people becoming prisoners in their own homes".
The government's mental health bill,
as it stands (pdf)
May 24, 2007: Five professional organisations
leave Mental Health Alliance - psychologists, mental health
nurses and occupational therapists express frustration at how the
alliance has represented them
May 17, 2007: Leading psychiatrist
turns down OBE in protest at "deeply flawed" mental health
bill - Suman Fernando fears planned new law could exacerbate
discrimination of black people
March 15, 2007: Black patients
seeing psychiatrist for first time should have advocate, government
urges - ...meanwhile, the Commission for Racial Equality is
investigating whether the mental health bill might break race law
March 14, 2007: Treating psychiatric
patients under compulsion in community has no clinical benefit,
says report - there is no evidence for decreased hospital readmission,
improved medication compliance or patient quality of life, states
Institute of Psychiatry international review of CTOs.
Feb 28, 2007: Peers defeat government
over plans to extend compulsory plans of treatment over mentally
ill - controversial bill now due to go before MPs after Easter
Jan 25, 2007: Clinical
psychologists should refuse to detain patients, academic urges
- new government law means psychologists will be required to implement
“social control”, argues David Harper
Jan 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 12, 2006: CTOs do not
work...and that's according to the evidence base - Community
treatment orders will help protect the public from mentally people
who kill, says the government. But what of the evidence for such
1, 2006: Government presses ahead to force some psychiatric patients
to take medication in community - plans in new mental health
23, 2006: Government drops key proposals of draft mental health
bill - new "streamlined” bill will be an amendment
to the present mental health act, says mental health minister Rosie
11, 2005: We can do a power of good - Many clinical psychologists
welcome the draft mental health bill because it would give them
extra powers, such as preventing the use of ECT or the over-medication
of patients. Moreover, argues Peter Kinderman, it's time clinical
psychologists stopped clinging to the myth that, at present, they
have no power
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