Rapid Responses to:

EDITORIALS: Nigel Eastman Reforming mental health law in England and Wales BMJ 2006; 332: 737-738 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

The New Mental Health Bill and consent to treatment.

Claire Hilton   (3 April 2006)

The New Mental Health Bill and consent to treatment. 3 April 2006
Claire Hilton, Consultant Old Age Psychiatrist CNWL Mental Health NHS Trust, Northwick Park Hospital, Watford Road, Harrow HA13UJ Send response to journal: Re: The New Mental Health Bill and consent to treatment.	In 1982 the Mental Health (Amendment) Bill was criticised for its potential manpower implications, and it was considered that there would be considerable difficulty in implementing it (1). Nevertheless, it became the Mental Health Act 1983 as we know it today. The predecessor to this Act was the Mental Health Act 1959. It had assumed that anyone compulsorily detained also lacked capacity to consent to treatment. ‘Second opinions’ were informal and purely advisory, and the ultimate responsibility for psychiatric treatment rested with the patient’s own, not infrequently paternalistic, psychiatrist. The Royal College of Psychiatrists battled for the status quo of the 1959 Act, whilst MIND (National Association for Mental Health) under Tony Smythe and Larry Gostin argued for a more complex system akin to mental health review tribunals to make decisions on ‘suspect’ treatment(2), not dissimilar from the current proposals. The 1983 Act was a compromise. On consent issues, we need to take into account changes in the value system of society such as on autonomy, self determination, best interests and so on, and not just to discard a system because it is viewed as ‘unworkable’(3). Medical ethics and decision making have changed. No one would want to return to the pre 1983 requirements of consent to treatment, yet the establishment of the 1983 Act was controversial to say the least. In terms the new Bill and consent to treatment, we must not throw the baby out with the bath water. Claire Hilton claire.hilton@nhs.net (1). Beedie, M and Bluglass, R. Consent to psychiatric treatment: practical implications of the Mental Health (Amendment) Bill BMJ 1982; 284: 1613-1616 (2). Gostin, L. A Human Condition. The Mental Health Act from 1959 to 1975: observations, analysis and proposals for reform. Vol 1 London: MIND, 1975 (3). Eastman N. Reforming mental health law in England and Wales BMJ 2006; 332: 737-8 Competing interests: None declared