DMH 120 Bexley Mind
Richard Dawson
(Draft Mental Health Bill)
Committee Office Scrutiny Unit
House of Commons
London SW1A 0PW
27th October 2004
Dear Mr Dawson,
Memorandum of evidence to the Joint
Committee on the Draft Mental Health Bill from Mind in Bexley.
Mind in Bexley is a local charitable organisation,
aiming to provide support to residents of the London Borough of
Bexley who have mental health problems. I am writing on behalf
of the organisation with regard to the Draft Mental Health Bill,
which is currently undergoing pre-legislative scrutiny by a Joint
Committee of Parliament, and would wish this memorandum to be
treated as evidence to this Committee.
1. Firstly, we would like to suggest that this
proposed Bill appears to increase the medical, or clinical, dominance
of the approach to mental health and mental health service users,
while seeking to diminish the ability of service users to assert
their own views with regard to their treatment. It is alarming
to discover that an individual has no recourse under the proposed
Bill to the resources of an organisation, e.g. for independent
advocacy at the 'examination stage'. This, in effect, dis-empowers
the service user by not providing the opportunity to be fully
informed of their position. In addition, the proposed Bill does
not appear to allow for social or environmental solutions within
the therapeutic process, concentrating as it does increasingly
on compulsion to medical treatment.
2. Secondly, it appears to us somewhat ironic,
that while the Office of the Deputy Prime Minister, via the Social
Exclusion Unit, is currently issuing guidelines promoting the
'social inclusion' of 'people affected by mental health
problems', the proposed Bill, in effect, seeks to promote their
social exclusion. This can be seen in the discussion in
the above paragraph (1), where people with mental health problems
are not given the right as citizens to access advocacy services
for support. In addition Mind in Bexley feels that the proposed
'compulsory treatment orders' socially excludes people with mental
health problems by the act of compulsion to treatment, an approach
no other section of society (with the possible exception of those
within the criminal justice system) is expected to endure. Indeed
the proposed Bill appears to establish mental health service users
as being on a par with those found guilty within the criminal
justice system, by suggesting that those with mental health problems
are dangerous and need to be compelled to take medical treatment
either at home, or to be forcibly removed to a hospital setting
should they continue to refuse. This appears to be based solely
upon whether the individual is complying with taking their medication,
and not whether the individual is actually suffering from
an acute mental health problem at the time of compulsion. Thus,
the service user could be well enough but simply refuses to comply
with medical treatment. Currently that would not be enough to
admit them to hospital under section. This appears to us to equate
refusal to comply with a criminal act, further marginalizing mental
health service users within their community, and within society
as a whole.
3. Furthermore, it is understood that the intention
of the draft bill is for criminal courts to have similar powers
to mental health tribunals so that the detention under a criminal
section should be subject to the same degree of scrutiny as that
under a civil section. In itself this is a sensible and fair approach,
however Mind in Bexley would ask the committee to consider how
the proposed criminal sections would work in practice. Lay justices,
District Judges (Magistrates' Courts) and their legal advisers
have no particular expertise in mental health neither do most
advocates appearing in criminal courts. Further, hearings in which
a defendant may wish to contest his/her care plan must be accommodated
in magistrates' court lists. Mind in Bexley is concerned the result
will be that defendants are not properly represented and their
cases are considered by those with no proper training and insufficient
time to time to devote to difficult cases. It appears that in
a magistrates' court could even be asked to authorise care plans,
as part of a final disposal, which include electro convulsive
therapy (clause 79 (4)) there is a clear danger that defendants
could see such treatment as part of a punishment for an offence.
4. Following on from this Mind in Bexley believe
that the proposed Bill will reinforce the prejudice and stigma
associated with mental health, and therefore, with people
with mental health problems. The proposed Bill appears to suggest
a link between mental health and 'dangerousness', especially regarding
those diagnosed has having a 'personality disorder'. As outlined
above (paragraph 2), the proposed Bill appears to criminalize
mental health service users through the use of compulsory treatment
and forcible removal to hospital. In addition it is noted that
the proposed Bill seeks to extend the powers of the police, by
allowing them to enter an individuals private premises in an emergency
without a warrant (our emphasis) where it is believed that
someone is in urgent need of treatment. This only serves to reinforce
the prejudice and stigma associated with mental health in wider
society, suggesting the dangers of those with mental health problems,
implying a threat to the wider community. It also appears to reinforce
the popular, or tabloid view, that people with mental health problems
need to be 'locked up' for the safety of others. It is our experience
that the reality is quite the opposite, with people with mental
health problems being vulnerable, frightened, bullied, and becoming,
as a result, socially isolated. Thus it is not the behaviour of
people with mental health problems, or even the refusal to comply
with medication, that leads to social exclusion and stigma, but
the imagined threat, subsequent attitude, and resultant
behaviour of society to mental health issues and those with support
needs. We believe that this proposed Bill, if accepted, will only
reinforce these attitudes, leading to the further exclusion of
mental health service users within British society.
5. For all of the above reasons (paragraphs 1-3)
Mind in Bexley believes the proposed Bill to be regressive in
its approach to mental health in the United Kingdom. A lot of
work has been done, and continues to be done, in the mental health
field over the past years to bring mental health, and mental health
service users, in from the outer edges of society toward a more
socially inclusive position. Within this, and of great importance,
has been the efforts to develop trust with people who have mental
health support needs and who therefore use mental health services,
both statutory and voluntary provision. In addition, work has
been done to educate wider society concerning the reality of mental
health issues, and the reality of people with mental health problems.
Our concern is that areas of this proposed Bill will seek to undo
this work, leading to the marginalisation, and social exclusion,
of people with mental health support needs once more. To introduce
compulsion to treatment, reduce people's access to support and
advocacy, suggest that people are dangerous, extend police powers,
and introduce time-limited aftercare, can only take mental health
back a couple of decades, as opposed to moving it forward in the
21st century.
6. Mind in Bexley believes, therefore, that the
implications of the proposed Bill have not been fully considered
with regard to new and existing users of mental health services.
As outlined above, we feel that the proposed Bill is medically
dominated, would lead to social exclusion, promote negative attitudes,
reinforce the stigma associated with mental health, and be regressive
in its approach. This being the case, we feel it is inevitable
that, as a consequence of this proposed Bill, many existing
and potentially new users of mental health services will decide
not to seek help with their problems. This would be
due directly to the perception of service users to the implications
for their rights as individual citizens should they enter into
the statutory mental health system. This could lead to many vulnerable
people not receiving the care they need, and could have a far-reaching
impact, not only with regard to people not receiving the care
and support they need, but also with regard to professional crisis
management, hospital bed pressures through increased emergency
admissions, and the local economy as people's income reduces due
to unclaimed welfare benefits.
The above constitutes Mind in Bexley's evidence to
the Joint Committee. We trust that these views will be considered
by them, and we thank you for your attention.
Yours sincerely,
On behalf of Mind in Bexley,
Ross Milne
Director
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