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LETTERS: John Sharkey, Paul Johnstone, Chrissy Allot, Victoria Hawkins, Joanna Moncrieff, Philip Thomas, Mike Crawford, Claire Henderson, and Tim Johnston Modernising mental health services BMJ 1999; 318: 806a [Full text]

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Modernising mental health services

Patrick O'Brien   (31 March 1999)

Modernising mental health services 31 March 1999
Patrick O'Brien Send response to journal: Re: Modernising mental health services	Editor The fears of Moncrieff et al.(1) regarding Government proposals(2) to introduce community treatment orders for the mentally ill are un-founded. Severe mental illness especially, unlike appendicitis, cannot be cured but merely controlled by medical treatment, which must usually be maintained for life to prevent serious relapses. Up to 40% of patients fail to comply with continued treatment for a variety of reasons, but patient unwillingness to accept the inconvenience of treatment accounts for a sizeable percentage. The only mechanism at present for ensuring resumption of treatment in unwilling and relapsing patients is readmission under the Mental Health Act 1983, an unwieldy and very costly exercise which leads to much unnecessary and avoidable suffering for patients, their concerned carers and relatives. The Government proposals should close an important loophole in the law dating from the 1970's onwards when large numbers of such patients, hitherto subject to compulsory treatment under the Mental Health Act while resident on the longstay wards of mental hospitals, were discharged into the community, no longer subject to mental health law and free to reject the inconvenience of treatment which many did, and continue to do, outside of hospital. It should be feasible to update and amend the existing Mental Health Act to cater for these kinds of cases, by the introduction of community treatment orders and thus not only safeguard ordinary patient rights and freedoms but also to ensure that patients' rights to receive proper treatment are guaranteed. In addition, the exemption of psychotropic medication from prescription charges in situations where maintenance treatment was considered necessary, as currently obtains for chronic medical illnesses such as diabetes, could help to reinforce to the patient the need for continued treatment. The clinical application of existing mental health law is already subject to careful statutory checks and scrutiny from the Mental Health Act Commission and Mental Health Review Tribunal, thus providing proper safeguards for patient rights, to which any new community treatment orders could easily be made subject. Community treatment orders for this category of mental illness would transform adult psychiatry for the better overnight, to the enormous benefit of patients, their relatives and carers and society at large. 'Community psychiatry' would no longer be the 'dirty word' it has become but a caring and civilised goal for us all. Dr Patrick O'Brien Consultant in General Adult and Community Psychiatry Queen Elizabeth Psychiatric Hospital Edgbaston Birmingham B15 2QZ 1 Moncrieff J, Thomas P, Crawford M, Henderson C. Psychiatrists should oppose community orders. BMJ 1999;318:807(20 March.) 2. Marshall M. Modernising mental health services. BMJ 1999;318:3-4(2 January.)