DMH 182 Leeds Consultant Psychiatrists
Memorandum from the Committee of Leeds
Consultant Psychiatrists
The Committee of Leeds Consultant Psychiatrists (CLCP)
responded to the draft Mental Health Bill of 2002 and welcomes
the opportunity to respond again.
We recognise and welcome the fact that the Government
have listened to concerns expressed, and have made some changes
to the proposed legislation, but feel that significant areas of
concern remain.
These fall broadly into two groups
- difficulties with the ethos of the Bill itself
- practical difficulties with implementation
We recognise and welcome the proposal for new legislation;
much has changed since 1983. There is pressure from users and
carers, from service providers and from society for improving
access to a full range of evidence based psychological and medical
treatments from an adequate and trained workforce, and for improving
awareness of Mental Health issues within society whilst reducing
stigma and discrimination. Legislation must be a part of this
but only a part.
In the absence of draft Codes of Practice for England
and for Wales, it is difficult to understand fully how a new Act
based on the draft Bill might work in practice.
CLCP were particularly concerned about conditions
for compulsion. We feel that the definition of mental disorder
would be satisfactory if combined with much tighter conditions
and limitations. As it stands, we feel that the numbers of people
subject to compulsion under the new Act would be significantly
greater than under the 1983 Act, where already the numbers of
people subject to compulsion have risen substantially over the
years.
We would wish to see on the face of the Act itself,
clear exclusions for people presenting only with promiscuity or
sexual deviancy, alcohol or drug misuse, or the commission, or
threat of illegal/disorderly behaviour.
We would wish to see a Capacity based Act. In the
absence of that, we believe that people with capacity who consent
to a full assessment and/or treatment plan should not be subject
to compulsion (the fourth condition, patients at substantial risk
of causing harm to others). We are not clear if the draft Bill
is suggesting that dangerousness is of itself mental disorder,
a concept we see as very inappropriate.
In relation to Community Treatment Orders, (CTOs),
we welcome the removal of compulsion in prison. We believe however
that CTOs in the community should only continue to be appropriate
whilst the person continues to have impaired decision-making capacity
by reason of mental disorder. The full conditions relating to
CTOs are not made explicit, which makes it difficult to comment
further, and it is not clear why these conditions have not been
included in the Bill itself.
In connection with ECT, we feel very strongly that
ECT should never be given to capacitous refusers, and that it
should not be authorised for use in such people 'in an emergency'
as at present in the draft Bill.
In general, we welcome increased access to Tribunals
(though there are serious issues around workforce, see below),
and we welcome the abolition of Managers' Appeals, which duplicate
appeals processes currently. We would like to see no limitation
of the right to discharge by the Clinical Supervisor for those
detained under civil sections. We hope that the rights currently
available to the Nearest Relative will continue to be open to
the Nominated Person.
The role of the Clinical Supervisor replaces that
of the RMO, and is open to qualified practitioners of mental health
professions other than psychiatrists alone. We have seen the memorandum
from the British Psychological Society, which discusses the possible
role of psychologists in this capacity. They recognise some of
the difficulties introduced into the therapeutic relationship
in relation to being able to detain patients (a problem which
also arises for CPNs, as the ASW role in detentions is replaced
by the Approved Mental Health Professional). There are also serious
issues regarding non-medical Clinical Supervisors and prescribing
of medication and ECT, which are unclear in the Bill.
We fear that the draft Bill will result in more patients
having greater fears of being subject to compulsion, with a corresponding
fear of accessing services and the concern that people will therefore
remain untreated, with all the risks that this entails.
We would like to see the same rights and safeguards
for patients in the Mental Capacity and Mental Health Bills. The
draft Bill should be fully compliant with the European Convention
on Human Rights, and with recommendations of the Council of Europe.
The recent judgement in relation to Bournewood must be reflected
in the Bill.
We are concerned that the greatly increased workload
for practitioners will result in worse services for those subject
to compulsion (because timeframes in the new Bill cannot be met)
and for those willingly accepting assessment and treatment (because
of a disproportionate redirection of services to those subject
to compulsion, away from voluntary patients). We feel that the
figures for extra workforce quoted are firstly a serious underestimate
of the numbers required, and secondly that the necessary expansion,
even to numbers predicted in the draft Bill, is unachievable.
This alone might render the new Act unworkable. There is already
a severe lack of psychiatrists and other mental health professionals,
and major issues around recruitment and retention nationwide.
If the new Act is perceived as ethically unsound and practically
unworkable, issues of recruitment and retention will get worse,
not better.
We hope that the Government will continue to listen
to users, carers, Mental Health professionals and voluntary service
providers, and deliver a new Mental Health Act that will be ethically
sound, practically workable, and a major part of developing excellent
mental health services for the twenty first century.
Dr Vivien Deacon
Chair, Committee of Leeds Consultant Psychiatrists
| 
