BMJ  2006;332:748 (1 April), doi:10.1136/bmj.332.7544.748

News

UK government scraps mental health bill

BMJ

The UK government is to scrap a controversial draft bill to reform mental health law in England and Wales after eight years of opposition by psychiatrists, lawyers, and mental health charities. As set out by the BMJ in February (2006;332: 444, 25 Feb[Free Full Text]), the lengthy and complex draft mental health bill is to be dropped and a much shorter bill introduced to amend the existing Mental Health Act, which dates back to 1983. The decision to scrap the draft bill was welcomed by campaigners, although many voiced anxiety about what was to be put in its place.

The proposed reforms were triggered by the killing of Lin Russell and her daughter Megan by Michael Stone in a country lane in Kent in 1996. Mr Stone was diagnosed as having a dangerous severe personality disorder but could not be detained for the protection of others because the 1983 act allows compulsory detention only for the treatment of a mental disorder. The draft bill provided for compulsory detention of people who had committed no crime to prevent them harming others.

Outlining the proposals for the new shorter bill, health minister Rosie Winterton said that it would introduce a new simplified definition of mental disorder and remove the "treatability" test. Anyone for whom "appropriate treatment" is available could be detained if doctors feel that they pose a risk to themselves or others.

A second controversial proposal allowing compulsory treatment in the community will, under the new bill, apply only to people who have already been detained in hospital and released. Ms Winterton said that this was aimed at "revolving door" patients who fail to continue their treatment and have to be readmitted to hospital.

Lucy Scott-Moncrieff, a leading mental health solicitor, said that by amending the Mental Health Act, the government would be restoring the medical discretion that was absent from the draft bill.

"The really huge difference as far as I'm concerned is the maintenance of medical discretion. Under the draft mental health bill if certain criteria were met then certain consequences had to follow which entirely took away medical discretion."

She said that treatment did not have to mean treatment for the underlying condition but could include treatment for the manifestations, such as anger management training.

The new bill will also amend the Mental Capacity Act 2005 to close the "Bournewood gap," through which people with dementia and learning disabilities may be kept in hospitals and nursing homes indefinitely because they are unable to communicate their wishes (See p 737).

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