Bottomley seeks change in mental care

VIRGINIA BOTTOMLEY, the Secretary of State for Health, is considering fundamental changes to the Government's Care in the Community policy for the mentally ill so that more seriously disturbed patients are kept in hospital.

She is concerned that the programme of emptying asylums and caring for most psychiatric cases in the community has gone too far, and that there should be a shift in emphasis, moving some care back to the hospitals.

In an exclusive interview with the Independent on Sunday, she criticised the 'excessive reluctance' of some doctors and social workers to compulsorily commit mentally ill patients to hospital.

She said that, after a largely successful modernisation programme, she was concerned that 'the pendulum has swung too far' and it was time to 'take stock'. There was reluctance and misunderstanding about the legal procedures available, under the 1983 Mental Health Act, to make orders for detaining patients in hospital for their health and safety and the protection of others.

Mrs Bottomley has already announced that she is considering emergency legislation to introduce community supervision orders compelling discharged psychiatric patients to continue treatment and medication. This came after Ben Silcock, a schizophrenic, was badly mauled after climbing into the lions' den at London Zoo last month. Such orders would affect only a small proportion of the 7 per cent of mentally ill people who are compulsorily detained in hospital.

Mrs Bottomley's suggestion that doctors and social services should more often use the powers available to them to detain more serious cases in psychiatric hospitals goes much further.

Her comments came after being told of the harrowing case of a woman who last week attempted suicide, as she had repeatedly threatened to do, on the anniversary of her husband's death. Although she survived, all the authorities seemed powerless to stop her trying again. Social services and police had tried to persuade her to seek psychiatric help in hospital, but she refused.

Shocked by the story, Mrs Bottomley said she was concerned that suicidal people have often previously contacted health and social services. 'In this particular case it is very important that social services departments and local doctors talk through together the procedures and the criteria for making a mental health order. One of the aspects that I am looking at, in deciding whether we need community supervision orders, is whether the present legal powers are being used sufficiently effectively.'

She made no mention of committing new resources to treat more people in hospital. But, she said, a new handbook on care of the mentally ill showed attitudes needed to change.

Marjorie Wallace, chief executive of the charity Sane - Schizophrenia A National Emergency - said Mrs Bottomley's comments indicated 'an important change in attitude and policy'.

She said: 'It is significant that having had, for years and years, a government not criticising doctors and saying the sectioning procedures are perfectly

adequate, for the first time you have a Secretary of State saying the pendulum has swung too far and there needs to be more use of powers, and that doctors and social workers are not interpreting the Mental Health Act correctly.

'Mrs Bottomley is the first secretary of state in ten years who understands that there needs to be a change in attitude and culture, that when someone is irrational there should be intervention.'

Ms Wallace added: 'There needs to be new central money from the Government to give doctors and health authorities the incentive to provide more psychiatric beds and follow-up.'

(Photograph omitted)