Community treatment orders stay in mental health bill

BMJ 2007; 334 doi: (Published 21 June 2007) Cite this as: BMJ 2007;334:1293
  1. Clare Dyer, legal correspondent
  1. BMJ

    The UK government made a final push to get controversial reforms to mental health laws through parliament this week after making a range of concessions to opponents after a series of defeats for the bill in the House of Lords.

    As the BMJ went to press on Tuesday, the mental health bill was entering the final day of its report stage in the House of Commons, and the government had survived a key vote the night before on safeguards attached to proposed new orders for compulsory treatment in the community.

    The health minister Rosie Winterton outlined the concessions that the government was prepared to make to allay criticism from opposition parties, backbench Labour MPs, mental health campaigners, and healthcare professionals.

    Detained patients, community patients, and patients subject to guardianship will be given access to advocacy services to speak up for them and champion their rights.

    For any patients under 18 years of age, mental health institutions for adults will be required to provide an age suitable environment and facilities for their “personal, social, and educational” needs. The Department of Health and local managers will have to be notified if a child younger than 16 years old is held in an adult institution, and children would not be expected to stay there longer than 48 hours, she said.

    A further amendment will spell out that any conditions attached to supervised community treatment must be for the purpose of ensuring that patients receive treatment to protect other people or to prevent the risk of harm to their own health or safety. This follows concerns that conditions could be used inappropriately to restrict a patient's behaviour and lifestyle.

    But Ms Winterton strongly defended community treatment orders, one of the most controversial elements in the bill, claiming that most mental health professionals supported them and arguing that they were “absolutely vital” in preventing relapse.

    She said the opposition amendments, imposing extra safeguards, would restrict the ability of doctors to treat their patients.

    The Conservative spokesman Tim Loughton MP opposed restricting the grounds on which the orders could be imposed, which he argued were “far too broad.” But the opposition amendments were later defeated by 277 votes to 211, a government majority of 66.

    The most controversial element of the bill would abolish the “treatability” test for detention under the 1983 Mental Health Act, to allow people thought to have a dangerous and severe personality disorder to be locked up even though they had committed no crime.

    The reform of the law was driven by the 1998 conviction of Michael Stone for the murders of Lyn Russell and her daughter Megan.

    The 1983 act requires that treatment under detention should be “likely to alleviate or prevent a deterioration” in the patient's condition. Instead the bill simply requires that “appropriate medical treatment” be available for the patient. This includes “nursing; psychological intervention; and specialist mental health habilitation, rehabilitation, and care.”

    An amendment passed in the Lords would allow detention only if the treatment was likely to alleviate the patient's condition. The “treatability” clause of the bill was due for debate as the BMJ went to press, but campaigners thought there was a good chance the government would accept a compromise amendment tabled by the backbench Labour MP Chris Bryant. This would permit detention for treatment “intended to alleviate a condition or prevent it from getting worse.”

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