Editorials

Reforming mental health law in England and Wales

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7544.737 (Published 30 March 2006) Cite this as: BMJ 2006;332:737
  1. Nigel Eastman, professor of law and ethics in psychiatry (neastman@sgul.ac.uk)
  1. Division of Mental Health, St George's, University of London, London SW17 0RE

    The government's recent climb down is not a victory: the real battle is about to begin

    The UK government's announcement that it has abandoned its eight year attempt to achieve a new Mental Health Act for England and Wales1 is an apparent victory for patients, professionals, and liberal democracy. Faced with vehement, sustained, and almost unanimous opposition from those with an interest in mental health care, the government has stated that it will instead introduce a shortened and streamlined bill amending the 1983 Mental Health Act. This amending legislation will replace a draft mental health bill that had been described as a “public order bill,” which would be “unethical, unworkable, and also ineffective,” even in enhancing public safety.w1

    The draft bill had succeeded in turn an earlier draft bill,w2 a white paper,w3 a green paper,w4 and an expert scoping report.w5 Its most contentious proposals included widening the criteria for compulsory detention and treatment; removing exclusion clauses in the current law that prevent compulsion for people with disorders of substance misuse and sexual deviance; removing the “treatability test” for personality disorder (so that those with dangerous and severe personality disorder could be detained by doctors when not capable of being sentenced by criminal courts); and extending compulsion beyond detention in hospital, thus creating a community treatment order.

    The bill was also attacked in relation to the proposed new system for mental health tribunals. These tribunals would not merely have reviewed but would also have made all orders for care and treatment. The greatly increased number of hearings would have made them wholly unworkable given current manpower resources, as well as further diverting participating clinicians away from clinical care. Indeed, it seems to have been internal opposition from the Lord Chancellor's Department—which would have had …

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