BMJ  2007;334:384-385 (24 February), doi:10.1136/bmj.39133.464444.DB

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Government suffers three defeats over Mental Health Bill

BMJ

The government suffered three crushing defeats in the House of Lords this week over the controversial Mental Health Bill. The bill would allow people with severe personality disorders who had committed no crime to be detained if they were judged a threat to themselves or others.

As the BMJ went to press on Tuesday, ministers were considering whether to try to reverse the defeats inflicted by peers from all sides during the report stage of the bill.

In the biggest setback for ministers, peers voted by a 71 vote majority to ensure that patients can be detained for treatment only if it is likely to alleviate their condition or prevent it getting worse.

The bill simply requires that "appropriate medical treatment" be available for the patient. This includes "nursing, psychological intervention, and specialist mental health habilitation, rehabilitation and care."

The government offered a compromise amendment, defining the purpose of treatment as "to alleviate, or prevent a worsening of, the disorder or one or more of its symptoms or effects." But the Liberal Democrat peer Lord Carlile successfully pressed his amendment to a vote.

"It is quite wrong that there should be compulsory detention in a hospital where there is no therapeutic benefit," he said. Doctors were being asked to behave unethically, and some would find themselves being asked to act as "turnkeys."

A second defeat came because of the definition of mental disorder in the bill. Peers voted by a majority of 88 to make specific exclusions for drug misuse; sexual identity or orientation; cultural, religious, or political beliefs; and disorderly conduct.

In a third defeat for the government, the lords voted by a majority of 39 to ensure that a doctor would take the final decision—rather than merely being consulted by a "clinician" who may not be medically qualified—on whether to renew a patient's detention.

The health minister Rosie Winterton said the government would "note" the outcome of the votes before deciding whether to try to overturn them when the bill goes to the House of Commons.

"Every barrier that is put in the way of getting treatment to people with serious mental health problems puts both patients and the public at risk," she said. "We believe that this bill strikes the right balance between getting treatment to those who need it, putting in place patient safeguards, and minimising the risk to the public."

The government proposed new legislation after Michael Stone, a psychopath who was thought undetainable under existing mental health powers, was convicted for the murders of Lin Russell and her daughter Megan in 1996.

The Mental Health Alliance, an umbrella group for 78 organisations, said the peers had made "a huge improvement" to the bill.

"People should not be at risk of being subjected to the Mental Health Act if they have no hope of benefiting from treatment given without their consent," a spokesman said. That was "a real, if unintended danger" of the bill.

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