Mental health review follows attack by lion

PLANS to review the Mental Health Act and increase its powers, revealed by Virginia Bottomley, Secretary of State for Health, yesterday sparked a bitter argument over civil liberties.

Mrs Bottomley said she was considering the creation of a compulsory community treatment order and last night called for an 'urgent shake-up of the Act'.

She acknowledged that the case of Ben Silcock, the man with schizophrenia who was mauled by a lion at London Zoo after climbing into its cage, highlighted the need for action.

Mr Silcock, 27, whose father has said his son was denied hospital treatment after begging to be admitted, was in a stable condition in hospital last night.

The charity, Sane, which provides a helpline for schizophrenics and their families, welcomed the proposals. Marjorie Wallace, its chief executive, said: 'Mr Silcock had turned to official channels for help but had effectively been thrown back on to the streets where his condition worsened.'

Mrs Bottomley told the Independent: 'Once again a case has hit the public eye which can be used responsibly to take forward the debate.'

Her concern, she said, was over the small number of patients slipping through the net. 'Many fail to comply with their treatment programmes and their families repeatedly complain that they (the patients) need help.' Others move, change their doctors and 'give all sorts of reasons' why they should not be treated.

The situation she is seeking to prevent arises when people stop taking their treatment once they have been discharged from hospital, and become disturbed - but not sufficiently disturbed to justify an order to detain them in hospital compulsorily.

Talks will be held this week with psychiatrists and voluntary groups on amending legislation.

Mrs Bottomley said: 'We have to do more for this needy group. I want to examine whether there is a place for compulsory treatment orders for patients (currently) in the community.'

She said that when the 1983 Mental Health Act was passed the pendulum swung strongly in the direction of civil liberties. 'Today only 7 per cent of in-patients are detained on court orders and we need to ask if the pendulum has swung too far.'

She said she was against compulsory treatment in the community and would prefer a system in which a patient agreed to regular treatment following discharge - or was returned to hospital - in much the same way as the probation service works.

Other areas to be considered were whether existing powers were sufficient, and the little-used guardianship provision in which the local authority can take legal responsibility for a mentally ill adult, she said.

The Royal College of Psychiatrists has its own working party on amending the Act, which is due to report this month. The college is expected to recommend to the Government that a less draconian 'supervision' order be considered which would give a community psychiatric nurse power to return a patient to hospital. Professor Andrew Sims, president of the college, said: 'Everyone has been frightened by the spectre of a community nurse attacking a patient with a syringe on the kitchen table. This is why we are likely to recommend a supervision order rather than a treatment order.'

He said not all members of the college held the same view.

Ian Bynoe, legal director of the mental health charity Mind, said: 'The law needs changing but not in this way. Mrs Bottomley is proposing measures, resting on doubtful assumptions about the benefits of drug treatment, which take away important civil rights of patients,' he said.