Intended for healthcare professionals


Government launches green paper on mental health

BMJ 1999; 319 doi: (Published 20 November 1999) Cite this as: BMJ 1999;319:1322
  1. Gavin Yamey
  1. BMJ

    Health secretary Alan Milburn this week published proposals for a reform of the Mental Health Act 1983, as part of his plans to modernise the NHS in England and Wales.

    Patients discharged from psychiatric hospitals will be given orders specifying where they will live and what treatment they will have. If they break the terms of the order, they will be returned to hospital for compulsory treatment.

    Meanwhile the government's recent proposals for the permanent detention of people with personality disorder were heavily criticised by psychiatrists at a joint conference held by the Royal Society of Medicine and Royal College of Psychiatrists last week. Professor John Gunn, a professor of forensic psychiatry, suggested that these detention centres would criminalise individuals who needed treatment rather than punishment, and were a knee jerk response to calm public fear.

    The joint report from the Department of Health and the Home Office discussed the management of people with dangerous severe personality disorder (BMJ 1999;319:1146-7). “I don't know who such people are,” said Professor Gunn. “There is a lot of anger out there on the part of judges, probation officers, and now politicians, and this has led to conceptual confusion. My suggestion to Jack Straw is that if he is serious about wanting to treat this so called dangerous severe personality disorder, why not subject it to the National Institute for Clinical Excellence, the government body overseeing new treatments?”

    Professor Gunn condemned the report for implying that people could be labelled indefinitely as dangerous and for denying the utility of psychiatric treatment: “Dangerousness is something that gets attributed to someone permanently, like eye colour. It would be more helpful to talk about risk, which is manageable, predictable, treatable, and measurable.”

    Annual criminal statistics published by the Home Office show an increase in the number of people convicted of homicide from 1957 to 1995, but the number attributed to people with mental health problems has remained steady. Hence the proportionate contribution of people with mental disorder to homicide convictions has fallen (British Journal of Psychiatry 1999;174:9-14).

    Despite this fall, data were presented at the conference showing that the media overemphasised the link between mental illness and dangerousness.

    The 1994 Ritchie report, based on the inquiry into the care and treatment of Christopher Clunis, made recommendations on investing in the care and accommodation of people with mental health problems. “But there are now less psychiatric beds,” said Professor Gunn.

    A spokesperson from the Home Office said: “There is real public anxiety about the danger some severely personality disordered people present—and of course the government is responding to that. But it is seeking to do so in a calm and measured way which strikes the right balance between public safety and the therapeutic needs of the individual.”

    The Department of Health/Home Office report, Managing Dangerous People with Severe Personality Disorder, can be found on the internet at, and the green paper on mental health can be found at

    Embedded Image

    Contribution of people with mental disorder to homicide convictions