Striving for balance

Mental Health Nursing,  Nov 2004  by Brimblecombe, Neil

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The Mental Health Bill is a source of huge controversy and generates enormous passion. The acting mental health nursing officer at the Department of Health, Neil Brimblecombe gives his impression of the issues

Mental health legislation is only ever needed for a small proportion of people with mental health problems - however it is one of the most difficult pieces of legislation any society has to grapple with. It is very difficult to balance an individual's rights with the need to prevent harm to themselves or others. The draft Bill strives to achieve this balance. It is the first major overhaul of legislation since the 1950s and establishes a new legal framework more in line with new community-based patterns of care and with developments in human rights law. The Bill is now going through the process of prelegislative scrutiny, by a committee of members of the House of Commons and House of Lords, to ensure that all issues are fully discussed before the Bill becomes law.

A number of new safeguards are included in the Bill. There can be no compulsion without appropriate treatment being available for the individual patient - a clinical decision. Patients will be able to choose their own representative (the nominated person) to help them and to apply to the new Mental Health Tribunal on their behalf. Patients and their representatives will now have statutory access to specialist independent advocacy to help ensure that the clinical team knows their views. A written care plan must be provided to the patient and for the first time there is a requirement that use of compulsory powers beyond 28 days must be authorised by a new Mental Health Tribunal or the courts.

The draft legislation will also allow people to be treated in the community. Importantly, exactly the same conditions have to be met for community treatment as for inpatient treatment. Also, only individuals who have had a previous period of detention in hospital can be made subject to a community treatment order. The aim of such orders is to minimise disruption to the patient's life and help to tackle the 'revolving door' syndrome of admission, discharge, relapse and readmission to hospital. New extended hours community services make community treatment a realistic option in some cases now, whereas in the past such services were simply not available. If a patient does not follow the requirements attached to an order then they could be taken into hospital. There is no question of forced treatment in the community.

The Bill introduces a more competence-based approach to professional practice, which allows staff with the right skills and experience to carry out new key roles, instead of automatically restricting the statutory roles to particular professions. Nurses may be eligible to undertake new roles such as the Approved Mental Health Professional (similar to Approved Social Workers currently), the clinical member of the Tribunal or the Clinical Supervisor (the professional in charge of the care of a person detained under the Bill). Work will need to take place with professional representative organisations regarding the development of the new roles, to define the competencies required and to set eligibility criteria like qualifications, experience and training.

The Bill will undoubtedly produce a great deal of discussion amongst nurses regarding its implications. It is only right that nurses do discuss these important issues, but it is also important that the debate is an informed one. The NIMHE Development Centres are running roadshows to explain more about the Bill and, of course, details are available via the Department of Health at www.dh.gov.uk/publications. Also, comments and queries can be sent to the Department of Health Mental Health Bill team at mb_mental__health_bill@dh.gsi. gov.uk

Copyright Community Psychiatric Nurses Association Nov 2004
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