POLITICS OF MENTAL HEALTH

Informally, the impetus to reform dates back over a decade to increasing government and media concern about the consequences of deinstitutionalisation. The perception was that the closing of the old asylums meant that people with mental illnesses were inadequately contained and were putting the community at risk. The new Labour Government continued to express these concerns and instructed the Richardson Committee, set up to make formal recommendations for new legislation, to consider how the ‘scope of legislation might be extended beyond the hospital to cover care and treatment provided in community settings’ ( Department of Health 1999a, p. 7).

Shortly after the Richardson Committee was set up the Home Office, in direct response to the case of Michael Stone, announced its concern to use psychiatric legislation to ensure the confinement of people with ‘dangerous severe personality disorders’. This term was coined for the first time in the Home Office report ( Joint Home Office & Department of Health Working Group, 1999).

IMPLICATIONS OF THE MENTAL HEALTH BILL

The Mental Health Bill published in July 2002 outlines a detailed framework for new legislation. The Appendix lists some of the main ways in which it differs from the Mental Health Act 1983. The general effect of the proposals is to increase the circumstances in which someone might be assessed and subjected to compulsory detention or treatment and to reduce avenues for discharge. It will be particularly difficult to argue for discharge from a non-resident or community order. There has been some debate about whether the new act will allow the preventive detention of people considered to be dangerous. Some have argued that the treatability of all conditions remains relevant because ‘appropriate medical treatment’ must be available ( Sugarman, 2002). However, the existence of a separate clause for people who pose a risk seems clearly to imply that there is no requirement or expectation, in these cases, that ‘treatment’ will benefit the patient.

Extension of compulsory powers into community settings inevitably means that use of the Mental Health Act will increase above current levels. Community orders will entail that the act is applied to people with lower levels of dysfunction than when it was applied only to people who required admission to hospital. The abolition of guardianship is an indication of the reorientation of legislation away from a concern with how to provide care towards a more exclusive focus on ‘treatment’.

The Mental Health Bill reduces the autonomy of psychiatrists in decisions about when to apply compulsion and what form treatment might take. It is not clear to what extent tribunals will engage in the details of treatment plans, but they will have the power to force doctors to ‘treat’ patients when the doctor feels that this is inappropriate. It seems therefore that the tribunal system has been designed to increase the use of compulsory powers rather than to act in patients’ interests. The lack of an independent review body and the abolition of the Mental Health Act Commission further erode mechanisms for protection of patients’ interests.