Why after 10 years' effort has the latest Mental Health Bill published in November 2006 been damned as “stigmatising, illiberal and yet curiously timid … a little like a dying wasp which still has a sting in it”?1 In November 1999, the Richardson Committee2 reported on the reform of mental health law in England and Wales. Patients' rights would be safeguarded by balancing guiding principles and the adoption of capacity—the legal ability to make decisions about treatment—as a determinant of whether compulsory detention and treatment should take place. New law mirroring these key proposals has been successfully introduced in Scotland,3 but in England and Wales the path to reform has been tortuous (table⇓).

The current bill4 bears little resemblance to the proposals set out by the Richardson Committee. There is provision, as in Scotland, for supervised treatment in the community, but without the safeguards found in the Scottish act. Certain exclusions to compulsory detentions are removed: promiscuity, immoral conduct, and sexual deviance. Whereas the government sees the first two exclusions as redundant, they identify the third as a category for which compulsory treatment should be expanded. The bill positively endorses the compulsory treatment of people with sexual disorders such a paedophilia.5 The only remaining conditions to be excluded are drug and alcohol misuse.

The professional background of who has …