long battle against unacceptable legislation, The

Mental Health Nursing,  Mar 2007  by Pulzer, Matthew

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The Mental Health Bill has been in development for eight years, but critics are still bitterly opposed to plans that would hit the human rights of mentally ill patients, reports Matthew Pulzer

The ongoing saga of the Mental Health Bill took another twist last month as the government faced the prospect of a House of Lords defeat over its controversial plans to allow people with mental illness to be detained even if this would be of no benefit to them.

The government has been quick to promote the Mental Health Bill as a piece of flagship legislation that is motivated by genuine concerns over protection for patients and the public.

But the bill has met with considerable opposition from mental health organisations, charities, user groups and professionals.

The bill is this government's third attempt in eight years to reform the 1983 Mental Health Act (see box). The government first proposed tough new mental health laws after the 1998 conviction of Michael Stone for the murders of Lin and Megan Russell. Stone was regarded as being dangerous, but because his condition was considered untreatable, he could not be held under existing mental health legislation.

Proposals to reform the 1983 Act were first published in 1999 and a draft bill of 2002 was strongly opposed by campaigners for being too focused on the concept of public safety and disregarding the human rights of people with mental illness. The second draft bill of 2004 was again widely opposed and the government finally abandoned it in March 2006 when it was heavily criticised by a parliamentary committee.

However, the government signalled its intention to press ahead with the most controversial aspects in shorter, streamlined legislation and a third bill was published in November 2006.

At that time health minister Rosie Winterton said: 1We want people to get the right treatment at the right time. We want to improve the safety of both patients and the public.

This bill will help ensure that people with serious mental health problems receive the treatment they need to protect them and others from harm.'

The changes would affect around 14,000 of the 600,000 people using mental health care each year.

But the Mental Health Alliance, the coalition of 78 organisations including the Mental Health Nurses Association working together to secure humane and effective mental health legislation, believes that the bill is still deeply flawed and represents a missed opportunity to improve mental health care.

So why is there so much opposition to the bill? Critics still view it as being too occupied with public safety rather than the needs of people who might require help from mental health services. Specifically, opponents are concerned about two areas of the bill.

First, at the moment people cannot be detained against their will, even if they are considered to represent a danger to themselves or others, if that detention and treatment could not be shown to benefit their condition.

The government wants to change this rule so that people can be detained and treated if medical treatment, which is appropriate to the patient's mental disorder 'and all other circumstances of their case', is available. If this becomes law, then psychiatrists say they would effectively become jailers of people with severe personality disorders.

Second, there are widespread concerns over measures to extend the use of compulsory treatment outside hospital to patients in the community. This will allow certain restrictions such as curfews to be imposed on patients in the community.

Opponents say these rules are too draconian and fear they may make people with mental health problems unwilling to seek help.

Despite making some revisions to its plans, the government is still facing a tough time getting the legislation through.

Earlier this year the government was defeated in the House of Lords when peers voted to amend the bill to stop people who have their full decisionmaking abilities and have committed no offence from being sectioned. The government's proposal was defeated by 106 peers.

After that defeat mental health charity Rethink's chief executive Paul Jenkins said: 'The scale of the government's defeat reflects the strength of opposition to its deeply unpopular plans for mental health law reform. We need mental health law that is fit for purpose, not the current proposals which are unfair and unworkable.

'Rethink wants everyone with mental health problems in England and Wales to have a right to assessment, treatment and support. If this can be done in Scotland, why not elsewhere in the UK?

We urge MPs and peers to continue this serious and diligent consideration of the government's proposals. This is a once-in-a-generation opportunity that will affect the lives of people living with severe mental illness for years to come.'

And Mental Health Alliance vice chair Rowena Daw said: The House of Lords has voted to end a major inequality for people with a mental illness. People with physical illnesses cannot be forced to take medical treatment if they have their full decisionmaking ability, and nor should those with a mental illness. We are heartened by the diligent and serious consideration the House of Lords is giving to this Bill. The Bill is in need of a complete overhaul. We hope that the vote marks the start of that process in parliament.'