DMH 300 Alcohol Concern
Waterbridge House, 32-36 Loman Street,
London SE1 0EE
Tel: 020 7928 7377 Fax: 020 7928 4644
Email: contact@alcoholconcern.org.uk
Draft Mental Health Bill 2004
Submission of evidence to the Joint Committee
by Alcohol Concern
28/10/2004
Introduction
Alcohol Concern is the national agency on alcohol
misuse. It works to reduce the level of alcohol misuse, and to
develop the range and quality of helping services available to
problem drinkers and their families. Alcohol Concern's Mental
Health and Alcohol Misuse Project aims to influence mental health
policies and develop the capacity of mental health and alcohol
services to take account of the impact of alcohol on mental health.
Dual diagnosis (co-existing substance misuse and
mental health problems) is common and increasing. One third of
psychiatric patients with a severe mental illness have a substance
misuse problem (most commonly alcohol), and half of clients in
alcohol and drugs services also have another mental health problem.
Having more than one period of detention under the Mental Health
Act (1983) is a risk factor for dual diagnosis.
Alcohol Concern is an associate member of the Mental
Health Alliance.
Summary
- The definition of mental disorder should be clarified,
to make explicit that intoxication is not in itself a mental disorder.
- The Bill should make it clear that people who
are intoxicated should not be excluded from assessment.
- The concept of acute risk should be introduced
into the conditions for compulsory treatment, in order to prevent
inappropriate use of the Act to address chronic risk behaviours
(such as alcohol dependency).
- Where there is no acute risk, people who are
alcohol dependent, but have no other mental disorder, should not
be subject to compulsion.
- The compulsory treatment of addiction for people
with a dual diagnosis should be excluded, except insofar as this
treatment is necessary to enable treatment of the mental illness.
- There should be an emphasis on co-ordinated treatment
between alcohol and mental health services, in line with other
Government alcohol and dual diagnosis policy.
- There is an urgent need for adequate resources,
training and increased capacity to cope with the inevitable increase
in people with a dual diagnosis in the mental health system.
Evidence
Theme 2. Is the definition of Mental Disorder
appropriate and unambiguous? Are the conditions for treatment
and care under compulsion sufficiently stringent? Are the provisions
for assessment and treatment in the Community adequate and sufficient?
1.1 Alcohol Concern welcomes the removal of the exclusion
relating to alcohol misuse in the definition of Mental Disorder.
We believe that this exclusion in the 1983 Act led to the inappropriate
exclusion of people with a dual diagnosis from the protective,
often lifesaving, provisions of the Act. In our view, there should
be powers to detain for assessment people who are intoxicated
or alcohol dependent, when they pose an acute risk to themselves
or others. There should be powers to detain for treatment people
who have co-existing mental health and alcohol problems, where
appropriate.
1.2 The definition of mental disorder needs further
clarification to remove ambiguity. We would recommend that it
is made explicit that intoxication alone should not be viewed
as a mental disorder; it was clearly not the intention that being
drunk and being reckless should bring an individual under the
scope of the Mental Health Act.
1.3 In addition, the Bill should make it clear that
intoxication, although not a mental disorder in itself, should
not be a reason to deny an individual assessment under the Act
if there is suspicion of other mental disorder. It is important
that individuals who are experiencing mental disorder and are
posing an acute risk to themselves or others, do not fall through
the net of the Act simply because they are intoxicated.
1.4 In the case that an intoxicated person is detained
for assessment, assessment periods should be sufficiently brief
to allow quick exit from the system if it becomes apparent that
conditions for compulsion are not met.
1.5 The definition of mental disorder would include
alcohol dependency (which appears in the 'Diagnostic and Statistical
Manual of Mental Disorders'), which creates the possibility of
the Act being applied to people on the basis of their drink problem
alone, rather than only in the case of a drink problem and mental
illness (caused by alcohol or otherwise).
1.6 In view of this, although the raised threshold
of harm to self is an improvement on the looser definition in
the previous draft, the conditions for treatment and care under
compulsion are still not stringent enough. Alcohol dependency
in itself could be viewed as serious neglect by someone of their
health and safety, and under these conditions could be seen as
a basis for compulsory treatment.
1.7 Alcohol Concern would strongly argue that there
should not be compulsory treatment of addiction for people with
alcohol problems alone. This would cast the net of the Mental
Health Act impossibly broadly, potentially to 2.9 million dependent
drinkers in England. There is also a risk that fear of compulsory
treatment would prevent many people with alcohol problems from
seeking help.
1.8 When considering in which circumstances people
with alcohol problems should be subject to compulsion, we would
like to see a distinction made between acute and chronic risk.
Alcohol dependence is in itself a chronic risk taking behaviour.
The intent of the Act is to intervene in acute risk situations.
We would argue that where there is not an acute risk of harm to
self or others, alcohol dependency alone should be excluded as
a condition for compulsion.
1.9 Where there is an acute risk of harm, and the
conditions are met, we support the protective provision of compulsory
treatment for those who have co-existing alcohol and mental health
problems. However, the compulsory treatment of addiction for people
with a dual diagnosis should be excluded, except insofar as this
treatment is necessary to enable treatment of the mental illness.
Similarly, there should not be compulsory treatment of addiction
in the community.
Theme 3. Does the draft bill achieve
the right balance between protecting the personal and human rights
of the mentally ill on one hand, and concerns for public and personal
safety on the other?
2.1 Alcohol Concern believes that the human rights
of alcohol dependent people would be contravened if they were
forced into compulsory treatment solely on the basis of their
alcohol problem.
2.2 However, alcohol dependent and intoxicated
people have the right to assessment to ensure that, where appropriate,
they receive the protection of the Act.
Theme 5. Is the proposed institutional
framework appropriate and sufficient for the enforcement of measures
contained in the draft bill?
3.1 Removing the exclusion of substance misuse is
likely to lead to an increase in compulsory treatment of people
with dual diagnosis. To deal with this effectively, Alcohol Concern
would like to see more emphasis on joint working between mental
health and specialist alcohol treatment services, as highlighted
in other Government policies. The Department of Health's Dual
Diagnosis Good Practice Guide stresses the importance of liaison
between alcohol and mental health services, for example when developing
care plans. The Alcohol Harm Reduction Strategy for England identifies
'a risk that alcohol treatment for vulnerable groups [including
people with mental health problems] might fail due to lack of
co-ordination of treatments and services'. There should be an
emphasis on co-ordinated treatment to avoid this.
Theme 10. What are likely to be the human and
financial resource implications of the draft bill? What will be
the effect on the roles of professionals? Has the Government analysed
the effects of the Bill adequately, and will sufficient resources
be available to cover any costs arising from implementation of
the Bill?
4.1 Removing the exclusion of substance misuse is
likely to lead to an increase in compulsory treatment of people
with dual diagnosis. This will exacerbate the current lack of
knowledge in the mental health field on dealing with alcohol problems.
4.2 For the mental health service system to be able
to cope with this, there is an urgent need for adequate resources,
training and increased capacity. Without this, in-patient services,
for example, are likely to struggle to treat people with dual
diagnosis, and the treatment of other patients (who may have very
different needs) may also suffer.
- The accreditation and training criteria to be
developed for the new Approved Mental Health Professional role
must include alcohol misuse and dual diagnosis. Knowledge of dual
diagnosis is also essential for the other new roles being created.
| 
