On Friday 20th November the UK Government published its Mental Health Amending Bill. The Bill proposes changes to the 1983 Mental Health Act (England & Wales) which governs the admission of people to psychiatric hospital against their will, their rights while detained, and their discharge from hospital and aftercare.
Here we summarise the changes the Government proposes in its Amending Bill, and the reactions and concerns of the mental health community…
What the Government Proposes/Views from the mental health community
Supervised Community Treatment
The Government wants to introduce Supervised Community Treatment (SCT) for patients following a period of detention in hospital. It will mean patients can live in the community under the powers of the Mental Health Act. Only people who “would be a risk to their own health or safety or that of others if they did not continue to receive their treatment when discharged from hospital” can be considered for SCT.
Many from within the mental health community are not opposed in principle to the idea of SCT for those who have already received hospital treatment. However many believe that the powers to limit the behaviour of those subject to community treatment orders should be clearly defined and confined mainly to treatment compliance. And they should only be imposed for limited periods of time.
Definition of a mental disorder
The Government intends to introduce a new, simplified definition of mental disorder throughout the Act to make it “easier to use” and so that the definition “more straightforwardly covers all disorders and disabilities of the mind”.
While not opposed to a simplified definition of mental disorder, many feel that this should be accompanied by strict and tight conditions for compulsion. A major concern is that the Government is planning to remove most of the exclusions from the current Act which prevent behaviours such as ‘immoral conduct’ or ‘sexual deviance’ from being seen in themselves as mental disorders.
At the moment patients may be detained for treatment under section 3 of the Act if such treatment is likely to alleviate or prevent a deterioration of their condition (the ‘treatability test’). The Government proposes to replace this with a requirement that someone cannot be detained for treatment unless appropriate treatment is available (an ‘appropriate treatment’ test).
Critics say the ‘appropriate treatment’ test is too vague and therefore not adequate for use when considering coercion. If a person is detained for treatment, that treatment must provide a therapeutic benefit to the individual.
The Government wants to extend to patients the right to make an application to county courts to displace their nearest relative (NR). The provisions for determining the NR will be amended to include civil partners. In addition the patient, an Approved Mental Health Professional, any relative of a patient and anyone living with a patient will be able to apply to the county court to displace the NR.
Some patients will be concerned that they will have to go through the county courts to displace their NR, as this can be a stressful and protracted process.
Mental Health Review Tribunal
Currently people held under the Mental Health Act have a right to have their case reviewed by a Mental Health Review Tribunal after 6 months’ detention. The Government intends to take an order-making power which will allow them to vary the time limit for automatic referral by hospital managers to the Tribunal.
There has been a welcome for new powers which will allow the Government to reduce the time delay before patients get an automatic Tribunal. However some have also called for more powers for the Tribunal regarding the use of compulsory powers or further treatment. Others want clear targets in place for reducing the time patients must wait for a Tribunal.
The Government is broadening the group of practitioners who can take on the role of the approved social worker (ASW) and responsible medical officer (RMO) in the Mental Health Act. Under the proposed changes the ASW will be replaced with the role of Approved Mental Health Professional (AMHP), with the role opened up to a wider group of professionals such as nurses or occupational therapists. The RMO will be replaced with the role of Clinical Supervisor (CS) and the role, which has usually been taken by a consultant psychiatrist, will be open to professionals such as psychiatrists, psychologists, nurses, social workers and occupational therapists. It is also proposed that decisions about treatment can be given by the most appropriate professional (as opposed to the RMO).
Many have voiced their concern that these roles should be regulated and well resourced, with proper training provided.
What the Government is not proposing:
The Government is not offering new reciprocal rights to patients as a balance to the coercive elements of the Act.
Views from the mental health community:
It is widely felt that there should be a legal right for patients to obtain treatment which they ask for voluntarily before their illness increases to the point where compulsion may be necessary.
One of the key issues for people in Wales is how the amendments would affect the Assembly Government’s plans for improving mental health services in Wales.
Bill Walden-Jones, Chief Executive of Hafal, stated: “The Welsh Assembly Government has a sound programme to improve mental health services in Wales which is supported by Hafal and other user organisations. There is a real danger that this programme will be disrupted by the new Bill which, with its focus on extending compulsion, may undermine the partnership between patients and professionals which is so vital to successful mental health services.”
Finding out more
To read the Amending Bill, click here.
To read the response of the Mental Health Alliance, a coalition of 78 organisations working together to secure a better mental health legislation including Hafal, click here.
For the latest updates on the Amending Bill, keep visiting www.mentalhealthwales.net