TREATABILITY
54. The Government's proposals envisage removing the
statutory requirement of "likely to benefit from hospital
treatment" for anyone detained under the Mental Health Act
1983. This is designed to deal with the problem that if someone
is dangerous but untreatable they cannot be detained. This appears
to apply particularly to people who are already detained in hospital
and are then deemed to be untreatable and have to be released.
We understand an individual in the community who seeks help can
be admitted voluntarily to hospital even if the condition is thought
untreatable.
55. It has been put to us that there is an underlying
assumption that people detained under the Mental Health Act without
having been convicted of a crime will receive treatment for their
illness:
"when somebody is being detained because
they are dangerous to themselves or to others the agreement, so
to speak, between society and the individual in those circumstances
is "You do not know what you are doing, you are going to
be a risk to the public and we are going to make you better".
That is why people are put into the Health Service".[50]
56. The evidence we have received suggests that treatability
is an issue in terms of medical ethics but not a problem in terms
of managing dangerous people. Medical witnesses mentioned the
ethical dilemma these proposals raise for them in their professional
work:
"one of the sticking points for psychiatrists
... is the civil commitment process ... the right framework ethically
... should be ... that you are doing it in order to offer some
sort of treatment to the person. To be used solely as a means
towards civil detention in the absence of any benefit for the
person, I think that raises huge medical ethical problems".[51]
57. There are differing views and approaches among
medical professionals about treatment of dangerous people with
severe personality disorder. Some psychiatrists in the UK
do not regard severe personality disorder as a condition which
they can treat.[52]
There is therefore a reluctance to admit individuals to secure
units under the Mental Health Act 1983. Any available beds might
better be given to those with a treatable mental illness. Others
have argued that it is the availability of resources for treatment
rather than the individual's susceptibility to treatment which
is critical.[53]
The Home Office acknowledge that it does not know how many dangerous
people with a severe personality disorder who are in prison might
benefit from treatment.[54]
58. In contrast, others do not accept that people
with severe personality disorder are completely untreatable.[55]
In the Netherlands, medical experts do not endorse the division
of opinion which appears to exist between psychiatrists in the
UK. The treatments which some regard as available for dangerous
people with severe personality disorder fall into three categories:
- drugs—which cannot generally be used to
treat the disorder but may reduce the dangerousness
- cognitive methods, such as anger management
- psychotherapy, such as group behaviour or community
living.
59. It is not clear whether the current treatability
test which the Government proposes to remove is still a problem.
The House of Lords has recently held that "the wide meaning
of 'medical treatment' [in the Mental Health Act] was wide enough
to include treatment which alleviated or prevented a deterioration
of the symptoms of the mental disorder rather than the disorder
itself.".[56]
One lawyer told us:
"an incredibly broad definition. Nursing
care or, simply, the fact that somebody is in a hospital where
they are receiving the kind of care available—not necessarily
therapeutic care at all—can amount to treatment because
it can prevent the condition from deteriorating in a way that
their being in the community would not prevent".[57]
60. We conclude that if these proposals were confined
to dealing with people who have been found guilty of serious criminal
offences—as they are in the TBS system in the Netherlands—the
resistance to them from the medical professions would be significantly
less. Such a restriction would not, however, address the Government's
desire to protect the public from the risk presented by some people
with personality disorder who are currently living in the community.
50 Q24
(Mr Wadham). Back
51 Q185
(Dr Shooter). Back
52 Appendix
4, page 25, para 22 (Mind), Q177 (Dr Eastman), Q122 (Mr Boateng). Back
53 QQ74,83
(Mind). Back
54 Q126
(Mr Boyle). Back
55 Q95
(National Schizophrenia Fellowship). Back
56 Reid
v Secretary of State for Scotland [1998] 1 All ER 481. Back
57 Q16
(Ms Kaufmann). Back
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