Alan Milburn, Secretary of State for Health, has published the government's proposals for a radical reform of the Mental Health Act, as part of what he describes as "the biggest shake-up in mental health services for 40 years".
Mr Milburn said:
"For too many people care in the community has become 'couldn't care less in the community' sometimes with the most tragic consequences. I intend to change the law to give proper protection to the public and to patients.
"We will put in place more secure beds, more specialist crisis teams so that the severely mentally ill get the treatment they need and the public get the reassurances they expect. Modern mental health services must be fast and fair as well as safe and sound.
"When I became Secretary of State for Health I identified three priorities for modernisation - cancer, coronary heart disease and mental health. We have allocated extra money for fighting cancer and heart disease. Today I am giving the same commitment to modernise our mental health services.
"Millions of people in this country face mental illness at some point in their lives. We have already set out new national standards in the National Service Framework for Mental Health. It will tackle the lottery in care that means some patients in some areas are missing out on services and treatments that others receive.
"Today we take the modernisation of mental health services a stage further by announcing our plans to modernise mental health law."
The measures include:
Announcing the package, at a visit to the Ealing, Hammersmith and Fulham Mental Health NHS Trust, Mr Milburn said:
"The Green Paper represents the biggest shake up in mental health legislation for 40 years. We want modern mental health services which protect the public and the patient.
"The current mental health laws have failed. They have failed to properly protect the public, patients or staff. They were devised for a time when most patients were treated in hospital. The only powers to compulsory treat patients were if they were in hospital.
"It is the community as well as these patients who have paid a very heavy price indeed. The tragic toll of suicides and homicides graphically illustrates the failure of the old system. Our new proposals will fundamentally overhaul our mental health services.
"We will deliver modern services backed by modern laws; and safe and sound protection for the public."
Responses to the Green Paper have to be made by 31st March 2000.
The Green Paper is based upon a report of the expert committee which ministers established to advise them on the shape of future legislation, chaired by Genevra Richardson, Professor of Law at Queen Mary and Westfield College, London University. This site includes the original consultation document issued by her committee.
The full text of the GREEN PAPER has been published at the Department of Health Web site.
Many practitioners in mental health law rely on the Mental Health Act Manual by Richard Jones as their main reference source. The new, sixth, edition has just been published and incorporates the 1999 Code of Practice and the implications of the 1998 Memorandum to the Mental Health Act.
This publication is available from the HyperGUIDE BookShop.
The Mental Health Act Commission yesterday made its second National Visit.
The Commission simultaneously visited 110 psychiatric hospitals. including the three high security hospitals, and mental nursing homes throughout England and Wales to collect information about aspects of the care and treatment of patients from black and ethnic minority communities who are detained under the Mental Health Act 1983. Commissioners examine policy and practice issues around three key areas; ethnic monitoring, racial harassment, and the use of interpreters, as well as certain aspects of the care provided for black and minority ethnic patients who are detained under the Mental Health Act. The Commission will identify examples of good practice for subsequent dissemination throughout Mental Health Services.
The Commission is collaborating on this project with the Sainsbury Centre for Mental Health and the Faculty of Health at the University of Central Lancashire. A report of the initial findings will be published in October 1999.
Gordon Lakes, Acting Chairman of the Mental Health Act Commission said:
"It is widely recognised that people from black and ethnic minority groups are over-represented amongst those detained under the Mental Health Act. Much work needs to be done to ensure Mental Health Services adequately meet their needs, in its second National Visit the Commission seeks to obtain a unique snapshot of how the Mental Health Services in England and Wales are addressing three very important aspects of the care and treatment of people from black and ethnic minority groups. The National Visit reflects the Commission's continuing commitment to identifying and addressing inequalities of treatment in the mental health field."
The initial proposals of the Mental Health Act Review Expert Committee were issued for informal consultation on 15 April.
The Committee was established by Ministers at the Department of Health in October 1998 to advise the Government on how mental health legislation should be shaped to reflect contemporary patterns of care and treatment. A report will be sent to Ministers in July. Then a formal consultation document will be published by the Government later in the year.
Professor Genevra Richardson, Chair of the Committee
said:
"In reaching our preliminary recommendations, we have been
conscious of the need to reflect the demands of modern service
provision, to improve public confidence in the system, to
strengthen the principle of non-discrimination, to enhance the
position of patient autonomy. At the same time we need as simple
a structure as is practicable.
These draft proposals represent our initial ideas and we would
be most grateful to receive views as to their practicality."
The Committee's provisional recommendations include:
The Expert Committee has issued their draft proposals to all those who responded to the first round of consultation. This included over 260 individuals and organisations. In addition the Committee commissioned a number of expert papers, met key organisations and visited a number of sites in England and Wales to hear the views of users and carers, front line mental health and social services staff and other providers of services.
This site contains the Full Proposals and details of how to comment.
The new Code of Practice - the third edition since the Mental Health Act 1983 came into force - has finally been published 2 years after consultation ended on the draft version.
The Code is published by The Stationery Office and is available from the BookShop at this site.
Ministers are determined to press ahead with radical changes in mental health and make no apologies for their emphasis on safety, Health Minister John Hutton has said. Speaking at a London conference on the implementation of the Government's new Mental Health Strategy, John Hutton responded to recent claims that care in the community had not failed. He also argued for a change to mental health law to allow compulsory treatment in the community. He said:
" I know some organisations have expressed concern about the emphasis which we have placed on safety. A recent article in the British Journal of Psychiatry is being used by some to argue that this emphasis is misplaced. The authors concluded that there has been little fluctuation in the numbers of homicides committed by people with mental illness over the last 38 years while the number of homicides overall has increased.
But I make no apologies about our stance on safety both for service users, carers and the wider public. "
Mr Hutton cited failures which had emerged from national research and local independent inquiries: failure to comply with medication; patients assessed as low risk of harming themselves or others; inadequate implementation of the Care Programme Approach; poor communications and sharing of information both within and between agencies. He said:
" No wonder that service users, carers, professionals and the wider public have lost confidence in mental health services. That is not to say that we do not recognise that the care in the community policy benefited some people. But we are also in no doubt that it failed too many vulnerable people who found it difficult to cope - in particular it often failed to deal effectively with those with the most severe mental illness and other complex problems.
We are clear that it is time for change. We believe that radical changes are needed to three key components: investment, care processes and legislation. "
Ministers remain firm in their view that the existing laws on mental health, designed for hospital based treatment. are now out of date. Mr Hutton has asked the review team, led by Professor Genevra Richardson, to report by the end of June with advice. It has been tasked with looking at issues such as compulsory treatment in the community. Mr. Hutton said:
" I know that there has been a fair degree of speculation about compulsory treatment in community settings. What is clear is that compliance is not necessarily to be confined to medication, and that where medication is involved, its administration should not take place in the individual's own home, but in an appropriate clinical setting.
The introduction of some form of compulsion which is not necessarily coupled to detention is an important step in providing safe, sound and supportive services. It will help prevent, among other things, detention in hospital for a few of the individuals to whom it would apply. Moreover, it is entirely consistent with our overall aim to ensure that compliance with treatment should occur in the least restrictive environment.
International experience has shown that community treatment and supervision is workable and benefits particularly the so-called "revolving doors" patients. They are detained, respond to treatment, are discharged, fail to comply with care plan and deteriorate. And then have to be all too often formally re-admitted to hospital again.
Our modernisation plans are supported by the largest increase in mental health services resources for 50 years. An extra £ 700 million will be invested in reforming health and social care over the next 3 years, targeted on making good the failures of the existing system. But this is just the start. The programme of change will continue after that. "
In recognition of the particular problems London faces, in this first year, London health authorities have been allocated over 60 per cent of the £ 19 million direct allocation to health authorities. London's social services will receive £ 17 million of the Mental Health Grant.