Mental health law to be tightened

BMJ 1998; 317 doi: (Published 08 August 1998) Cite this as: BMJ 1998;317:365
  1. John Warden, parliamentary correspondent
  1. BMJ

    Wide ranging changes in the mental health policy for England, including a review of the Mental Health Act, to give new powers of compulsion over patients who do not comply with their treatment, were foreshadowed last week by the health secretary, Frank Dobson.

    Admitting that care in the community had failed the most vulnerable people, Mr Dobson launched a programme with the twin objectives of changing both the practice and the law relating to mental illness. It will begin in the autumn and take several years to implement. Substantial extra funding is promised.

    New support services will include 24 hour helplines and crisis response teams; more acute mental health beds, hostels, home treatment teams, and counselling; and improved mental health training for GPs.

    Changes in the law are designed to give greater security for patients and the public. “Assertive outreach teams” will be formed to keep watch on discharged patients and people who shy away from getting help. Possible measures include compliance orders and community treatment orders to provide the legal basis to ensure that patients get supervised care if they do not take their drug treatment or if their condition deteriorates.

    Governments in the past have shied away from compulsory powers, but the current government now recognises a need to restore public confidence after a series of tragic incidents under the present system of community care.

    Junior health minister Paul Boateng, who has responsibility for mental health, said: “We must make sure we do not allow a culture of non-compliance with medication and therapy which precipitates breakdown. What we can say [to patients] is that if you are to remain in the community at large you must complete your medication and therapy. If you don't then the law must give clinicians the power to bring you back into a place of greater safety for yourself and the wider community.”

    Mr Dobson is setting up a review of the Mental Health Act 1983 by a group of lawyers, doctors, and others to report by next spring. The aim is to ensure that the legislation supports the safe and effective delivery of modern patterns of clinical and social care.

    Meanwhile, he has asked a new external reference group, under Professor Graham Thornicroft, to set national standards for mental health to bring about “dramatic changes for the better.”

    In a letter, Mr Dobson states: “Care in the community has failed. Discharging people from institutions has brought benefits to some. But it has left many vulnerable patients to try to cope on their own.”

    Outlining his proposals, Mr Dobson asked the new group to establish what the range of services in each locality should be, with specialist services at regional level. He wants the same priority given to mental health as to heart disease.

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