Why we should be scared of the latest mental health bill

The government is right to say that the draft Mental Health Bill, published this month, represents the most fundamental overhaul of the issue since the 1959 law that heralded the shift from institutions to care in the community. But the chorus of dissent that greeted the last draft bill, in 2002, has been repeated.

The 2002 draft bill united the factions in mental health like nothing before.

The main objection then was that the government planned to use mental health legislation to detain people with severe personality disorder on the basis of the risk they posed to society, even if they had committed no crime and could be offered no effective treatment.

The proposal, supposedly aimed at a relatively small group, prompted fear among many and the government has abandoned this approach. But the impact of what it is proposing now may not be very different.

The new draft suggests that patients with severe personality disorder who are judged to be a danger to themselves or others can be detained if “medical treatment is available that is appropriate”.

What does “appropriate” medical treatment mean? The answer will be left largely to psychiatrists. But crucially, it does not mean treatment of proven therapeutic value – that is, treatment that works.

So, you may have committed no crime, you may be in full possession of your faculties, yet you could be locked up without being offered treatment that would be of any value to you.

The second area of controversy relates to plans for compulsory treatment in the community. The aim is to tackle the so-called “revolving door” patient who is discharged and left in the community, where he or she may fail to take medication and then become so unwell that readmission is necessary.

There are those who still oppose the idea of orders outside institutions but, even among those who accept there may be some advantage from enforcing treatment in the community, there are concerns about the bill.

The government says these orders should usually only be used for patients after a proper assessment in hospital, but doctors argue that the new law will cover a wider group of patients than is medically necessary.

If the service is seen to be draconian and frightening, the fear must be that patients who might seek help will not – and will be driven back into isolation

Again, the concern must be that the new orders will be used too readily and the whole system could become more coercive, without saving the lives of patients at risk of self-harm or giving any greater protection to the public.

If the service is seen to be draconian and frightening, the fear must be that patients who might seek help will not do so. They will be driven back into isolation, making the whole process less safe.

The gloom is not unalloyed, however. There are safeguards in the draft bill that everyone should welcome: independent tribunals will review every detention beyond 28 days, there is a right to independent advocacy and new rights to refuse electroconvulsive therapy for anyone who still has mental capacity.

Also, the government is putting the bill through pre-legislative scrutiny by a joint committee of both houses of parliament.

And it’s worth remembering that new laws are not the most important thing for supporting people with mental health problems. It is high-quality, accessible services in hospitals and the community that make the difference.

There are still poor-quality environments in institutions, inadequate support networks in the community and unacceptable levels of housing and social support.

Most people want the same thing: high-quality services and real support for everyone with mental health problems.

We need more time to study the bill and its possible implications. Solutions are possible but the signs are that the government will have to make concessions if it is to help bring about a better and a safer service.