Bottomley promises better supervision of mentally ill: Linking care worker to patient 'central to any solution'. Celia Hall reports

NEW guidelines to strengthen the supervision of mentally ill people living in the community were promised yesterday by Virginia Bottomley, the Secretary of State for Health.

She was speaking at the launch of a Department of Health national survey of attitudes towards mentally ill people. The survey was published yesterday in the wake of publicity surrounding the random killings by two schizophrenics.

Mrs Bottomley said she intended to make sure that all the provisions of the Mental Health Act were being used 'effectively and more appropriately'.

She added that the lack of a 'key responsible' person designated to supervise particular discharged patients was central to the problems.

Leaving open the possibility of new legislation, she said: 'There will be a new code of practice to make sure that all who use it (the Act) do understand it. There may be scope for additional powers to address the problems that arise in a small group of patients.'

But she indicated that she was opposed to compulsory community supervision orders, in line with the view of the all-party Select Committee on Health, published in a report on Wednesday.

The Royal College of Psychiatrists has called on the Government to introduce supervision orders that would compel a patient to return to hospital after discharge if circumstances made their removal from the community necessary.

Mrs Bottomley said the problem was to prevent a small group of discharged patients from 'falling through the net' without jeopardising the freedom of the majority who were not dangerous. She said her own review of the working of the Mental Health Act would address this and would be completed soon.

She repeated her opposition to another measure - compulsory treatment orders - saying: 'I do not anticipate circumstances where a team of psychiatric nurses go around forcibly injecting patients. There is a

difference between this and some form of agreed treatment programme.'

The survey of 2,000 adults showed that most - 92 per cent - thought they should be more tolerant towards the mentally ill, but only 19 per cent would trust a woman who had a previous mental illness to baby-sit.

It found that while a more benevolent attitude towards people with mental illness was becoming the norm, 'worrying' stereotypes about the mentally ill continued to exist.

At the same time, people are divided over the best methods of treatment and whether the public needs protection from individuals who are mentally ill; 18 per cent agreed that 'people with a mental illness should not be given any responsibility', but 86 per cent felt that the mentally ill 'have too long been the subject of ridicule'.

Fewer than half - 46 per cent - disagreed with the statement that anyone with a history of mental illness should be excluded from public office; 39 per cent agreed that less emphasis should be placed on protecting the public from people with mental illness, while 31 per cent disagreed.

Similarly, four in ten adults believe mental hospitals are outdated while three in ten believe they should remain.

Mrs Bottomley said that the survey showed 'very encouraging signs' that positive attitudes towards the mentally ill were developing. However, she warned that there was 'no room for complacency'.