Tuesday, 9 November 2004

Church Times article - Mental Health Bill

I had an article in the Church Times (subscribers only, and I'm not one) last week, on the Mental Health Bill. Infuriatingly, they managed to get my name wrong - I'm not Tom Wilkinson - so it's just as well from my perspective that I'm no longer in a world where success is closely related to the number of traceable publications you have.

Anyway, here it is:
A Bill that will make the situation worse

The draft Mental Health Bill will enable the Government to lock up more people for being ill

When the Government published its draft Mental Health Bill last month, the Sun welcomed the news with the headline ‘Maniacs To Be Caged’. The headline neatly summed up what is worst about the new proposed legislation, which would make many more people subject to compulsory treatment, and which tacitly accepts the tabloid-driven hysteria which routinely sees people with a mental illness as dangerous ‘maniacs’.

People with a mental illness sometimes need to be given compulsory treatment in a secure setting, to protect themselves or others. The law should recognise that, and set out clear criteria for its use. But compulsion should always be a last resort. A secure setting is seldom a therapeutic environment, and patients who are given forced treatment are unlikely to respond as well as patients who consent.

Compulsory admission can be a traumatic experience. It is humiliating, and can damage a patient’s condition and delay recovery. The new Bill – not to be confused with the Mental Capacity Bill – would make enforced treatment easier to impose. The Mental Health Alliance, a coalition of 64 organisations (including professional bodies, service-user groups, mental health charities and the Church of England Mission and Public Affairs Council), has mobilised to offer a united voice on mental health law reform. It will be giving evidence in Parliament on Wednesday to the Joint Committee scrutinising the Bill.

The Bill says that anyone who has a mental disorder can be given compulsory medical treatment if they are considered to be at risk of suicide, serious self-harm or serious self-neglect, or for the protection of others. Stated this baldly – mental disorder plus risk leads to compulsory treatment – it might seem reasonable. But each part of the equation is problematic.

The Bill’s definition of ‘mental disorder’ is so broad that it appears to include learning disabilities, epilepsy and autism. The definition of ‘treatment’ is so broad that it includes nursing, care, counselling, education and work training. Also, the risk that a patient will self-harm or harm others is extremely hard to predict. Predicting risk involves negotiating medical judgement, professional self-interest and media-driven public anxiety. Public fear of attacks by ‘mad axemen’ is high, but in fact such incidents are very rare.

A recent Social Exclusion Unit report says that fewer than 5 per cent of the small number of people who kill a stranger have symptoms of mental illness – even though common mental health problems affect up to one in six of the general population at any one time. Being a young man or being drunk both correlate with violent crime much more closely than does being mentally ill, but, quite rightly, nobody advocates preventive detention for young men or alcoholics.

Yet there is a popular association between mental illness and dangerousness. The negative professional consequences for a psychiatrist of failing to detain someone who turns out to be dangerous outweigh those for detaining someone who is not a risk – even though the personal consequences for a detained patient are severe.

So mental health professionals will be under pressure to practise defensively and, if in doubt, to detain. The broad definition of ‘treatment’ to include non-therapeutic methods, such as nursing and counselling, means that it will be possible to find a legal way to detain a person whose condition is unlikely to improve with treatment.

Another element of the Bill which has caused concern is the introduction for the first time of compulsory treatment in the community rather than in a secure hospital environment. This threatens to increase the overall number of people subject to compulsion – the number of available beds will no longer impose an upper limit on the number of people who can be given compulsory treatment.

Many mental-health service-users are worried that the threat of future detention will be used to encourage compliance with community-treatment orders. Increased use of compulsion in general may make people with mental-health problems more reluctant to seek treatment with mental-health services.

Access to mental health services is a real problem, which this Bill does nothing to address. A survey last year found that more than one in four people were turned away when they sought help from mental health professionals; a similar proportion took more than 18 months to get any sort of help. The longer people go without help, the more severe their mental illness can become, and the harder it is to treat them.

For far too many people, their first experience of mental health services comes through being given compulsory treatment. By increasing the scope of compulsion, without guaranteeing a legal right to care and treatment for mental illness, the new Bill makes this situation worse.

The proposed extension of compulsory treatment has meant that some of the undeniably good elements the Bill contains, such as the right to an advocate and the improved Mental Health Tribunal system, have generally gone unnoticed.

But an astonishing proposed cut has also been under-reported. This is the reduction in entitlement to free continuing care after a period of compulsory detention for treatment. Currently, this is available for as long as the patient needs it, and it is crucial in ensuring that people receive support after discharge and do not relapse. The draft Bill cuts this to just six weeks, far below current provisions, which could seriously endanger people’s recovery in the community.

All of this, though, has been relegated to the background by a single dominating fact: the Government is seeking to extend its ability to lock up people for being ill. In doing so, it has made a clear choice. Rather than focusing on the humanity of those with mental-health problems, and seeing them as autonomous individuals who might need help, the Government has drawn up legislation that frames them in terms of their strangeness. It sees them as threats from which the public needs protection.

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