Criminalising the unwell

Mental Health Nursing,  Nov 2004  by Lauder, Andrew

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Two years on we have the second draft of the Mental Health Bill. Many would argue that little has changed following the protests of 2002.

What are the government hoping to achieve from this? Is it about providing the right treatment at the right time to the right people? Or on a more cynical note is it about 'social control'? It would seem that the intentions of certain sections of this bill are about detaining people who may harm others in order to prevent that harm. The power to detain people in situations where someone's history allows us to predict harm and know that 'treatment' is likely to prevent it already exists within the current act. What is new is that the powers can be applied to people who have not yet but 'may' harm others.

This is a frightening infringement on human rights and seems to be suggesting violence as a symptom and detention as a cure. Years of public education, attempting to give reassurance that the mentally ill are no more criminal than the rest of the population, are being thrown away. This is in sharp contrast with the current Social Inclusion Report from the Office of the Deputy Prime Minister.

The new bill does not contain the powers it does because of a new found faith in therapy for dealing with severe and dangerous personality disorder. If that were the case the change would need to come in the attitudes of medics so that the existing MHA was applied to PD as a treatable condition.

Some commentators have noted that the Community Treatment Order (CTO) would be seen as the power to intervene coercively in the lives of individuals. Mental health is almost unique in health care in this sense, and definitely is if you consider how regularly coercive power to detain is used. However, the idea of a CTO is to provide a less restrictive alternative than hospitalisation.

One of the strengths of the current MHA is that the approved social worker is independent of the medical team, acting in the interests of the client and society. Increasingly they seem to have been captured by the mental health system thus diluting their independence. The proposed approved mental health worker role puts nurses (seen as possibly the first to take on this role) in a dilemma, do they rubber stamp decisions made by medics or do they stand up and say no when they have to? It would take a brave nurse indeed, to remain independent at these times.

On the positive side of things though, the formalisation of legal powers for nurses (beyond those already existing) is a move to honesty in the nurse-service user relationship. No more hiding behind social workers and doctors, or the excuse of not wanting to damage the 'therapeutic relationship'.

Andrew Lauder

Andrew Lauder is a member of MHNA executive and a charge nurse

Copyright Community Psychiatric Nurses Association Nov 2004
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