Government compromises on mental health bill

BMJ 2007; 334 doi: (Published 28 June 2007) Cite this as: BMJ 2007;334:1342
  1. Clare Dyer, legal correspondent
  1. BMJ

    The UK government last week gave in to demands from critics of its mental health bill, agreeing to a compromise amendment that imposes new safeguards on powers to detain mentally ill patients.

    The climbdown came over the most controversial clause in the bill, designed to permit patients with severe personality disorders to be detained if they are deemed to be a risk to themselves or others, even if they have committed no crime.

    Ministers wanted to scrap the “treatability” provision in existing legislation, which allows patients to be detained only if their condition is considered treatable and if locking them up will help them. They wanted a looser power to detain if “appropriate medical treatment” was available, but they were defeated on the issue when the bill went to the House of Lords.

    Last week the government accepted a compromise, proposed by the Labour backbencher Chris Bryant, that would permit enforced treatment if its purpose was “to alleviate, or prevent a worsening of, the disorder or one or more of its symptoms or manifestations.”

    The amendment, backed by the mental health charity Mind and the Mental Health Coalition, went through without a vote, and the bill received its third reading in the House of Commons. It will now go back to the Lords, where the government could be forced to make further concessions to get the bill on the statute book.

    Mr Bryant told MPs: “Any psychiatric unit cannot be prison by another name. It must be a therapeutic environment. Every person, whatever their mental condition—whether it is a mental condition which we presently believe is curable or not—must have the right to appropriate treatment.

    “We simply cannot wash our hands of them. We cannot just be detaining people for the purpose of detaining them. There has to be some kind of therapeutic benefit.”

    Tim Loughton MP, for the Tories, welcomed the concession. “To remove the treatability requirement, whatever the government's intention, is to permit indefinite preventative detention and to change the law from a health measure to one of social control, which is what we have been fearful of all along,” he said.

    The bill, which applies to England and Wales, was introduced after several murders involving people with dangerous personality disorders, some of whom had not been detained in hospital because their condition was not considered treatable. Opponents, however, have argued that its powers are too draconian.

    The government had previously accepted a number of amendments, including providing for mental health advocates to advise patients on their rights and to speak up for them. Another amendment specified that treatment for under-18s should be appropriate to their age.

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