It is increasingly obvious that in Britain we accept a quality of care for those with mental illness that we would find totally unacceptable for most other types of illness. That has to change if we are to be able to call ourselves a civilised, modern society. But that change will have to be based on a widespread review of mental health legislation.
What a tragedy it therefore is that the Government's draft Bill is such a wasted opportunity. At a time when we need a thorough and sensitive review, updating legislation to reflect the experiences and problems of care in the community, what the Government presents us with is not a comprehensive analysis, but merely a personality disorder Bill dressed up to look like a mental health Bill.
The Government's obsession with personality disorder has resulted in a draft Bill based more on prejudice than compassion. Its lack of perspective poses a risk of lumping together a small number of untreatable, potentially dangerous patients with a larger number of patients who will pose little risk to anyone, except perhaps themselves.
There is an urgent need to understand the scale of the problem. According to the National Schizophrenia Fellowship, a third of those seeking help are turned away, and a quarter of those asking to be admitted to hospital are refused. Yet despite this, the Government's approach is more about compulsion than meeting the demands for treatment. Indeed, many believe that the effect of the proposed changes will, perversely, be to drive people away from seeking services.
Under the 1983 Act, people suffering a personality disorder could not be detained in hospital (even if they were thought to pose a threat to themselves or others) unless treatment was likely to alleviate or prevent a deterioration in their condition. Traditionally, we have not detained people who have committed no offence, unless it was for the purpose of treatment which was likely to do some good. The new draft Bill would change that. The old "treatability test", as it was known, would go. Henceforth, a person could be detained if doctors felt the disorder warranted it and that the person was a substantial risk to himself or to others.
This requires a great deal of our doctors. The Royal College of Psychiatrists has rejected the proposals as "fundamentally flawed", and the Law Society has voiced its concern about significant numbers of people being detained, describing the measures as "draconian". It can't be acceptable to put the liberties of the many at risk in order to close a loophole affecting very few.
Another proposal is that a tribunal would be created to consider applications to conduct compulsory treatment beyond 28 days for those in detention and for those in the community.
It is hard to see why this power should be necessary. If we had a proper balance of care in place, which enabled those who need treatment in hospital to receive it, and those who can cope in the community to be placed there, there should be few cases where compulsion in the community would be needed. We need to have enough capacity in the system to allow people to receive the care they need, when they ask for it.
The main thrust of the new Bill should be to provide the conditions in which consent to treatment can flourish and the need for compulsory powers is reduced. Patients should be encouraged to seek assessment and treatment, and there should be rights to this enshrined in law. Patients' views on treatment should be treated with respect. Public concern about mental illness has been heightened by both high-profile cases in the media and a feeling that we are failing both patients and the public with our current approach.
There is a desperate need for change. Yet after five years of promises, all we have from the Government is a Bill which is hugely disappointing, if not downright dishonest. I know from the campaign which The Independent on Sunday has been conducting that the paper agrees that it is important to deal fairly and compassionately with mental health issues. I commend it for its commitment. The Conservative Party will press this Government to very significantly improve the draft Bill."
Dr Liam Fox is shadow Secretary of State for Health.
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