DMH 294 Leeds North West Primary Care
Trust
Telephone enquiries, please contacTabitha Arulampalam
on direct line 0113 305 7150
or e-mail: tabitha.arulampalam@leedsnorthwest-pct.nhs.uk
Our ref LJS/GM Your ref:
| Richard Dawson |
| Committee Office Scrutiny Unit |
| House of Commons |
| LONDON |
| SW1P 3JA |
|
|
24 November 2004
Dear Mr Dawson
Re: Draft Mental Health Bill
This response to the Draft Mental Health
Bill has been put together by Leeds North West Primary Care Trust
(Leeds NW PCT). Leeds NW PCT co-ordinates adult mental health
issues on behalf of other PCTs in Leeds.
1. Definition of 'mental disorder'
The broadening of the definition of 'mental disorder'
within the draft Bill and the removal of all exclusions is very
worrying. The Act could potentially apply to a large proportion
of the public who hitherto have not come under the mental health
system, and for whom the application of the Act could be counterproductive.
In order to provide safety to individuals and the community the
draft Bill is attempting to cast a very wide net to detain a very
small number of people. The wide net will inevitably draw in a
large number of people who really do not need to be detained.
The consequence of this pattern of detention is that people will
lose faith in the system, and services will not be able cope with
the inflation in numbers. It could also be argued that individual
human rights might be jeopardised as a result of the application
of the Bill.
Compulsory powers
Despite the stated aim to reduce the amount
of compulsion used under the current Bill the draft Bill greatly
broadens the grounds for compulsory detention. This results from
the broader definition of 'mental disorder' and the broader set
of criteria for compulsory detention. The requirement for hospital
admission has been removed; the requirement of treatability has
been removed; there is no requirement to exhaust less restrictive
options first if the person is considered a danger to others.
The removal of these exceptions and exclusions extends the criteria
for compulsory detention and removes key safeguards that currently
exist within the Bill. We would therefore like the Department
to reconsider this clause.
The draft Bill seems to impose treatment on
people who have the capacity to decide for themselves. We are
aware that this is no change from the current Bill, however the
Richardson Committee proposed a capacity based test which could
be applied, and which is supported by MIND and the Mental Health
Alliance. Given the progress of the Mental Capacity Bill through
parliament it would make more sense to look at both Bills in tandem,
the timing of this Bill does not make that possible.
3. Non resident treatment orders
Non resident treatment orders are a
major concern to service users. The fear is that the threat of
these orders will drive people away from the treatment that they
need. It may also prevent service users being able to disagree
with clinicians and negotiate a more effective treatment regime.
It could potentially destroy any chance of a therapeutic relationship
between service user and clinician. The fact that these orders
can be made in the community greatly expands the number of people
who could be under compulsion. This has grave consequences on
resources as well as the dignity and human rights of individuals.
It is not clear how non resident treatment
orders will work. The lack of a code of practice to go with this
Bill makes it more difficult to understand how some of this detail
will work.
4. The negative impact on people from Black and
Minority Ethnic Communities
The draft Bill potentially increases the likely abuse
of power as stated earlier. An expansion on the grounds of compulsion
is a cause for concern for minority ethnic people, and the extension
of powers into community settings could further increase the negative
impact on these communities. Evidence suggests that a larger proportion
of people from Black and Minority Ethnic communities are being
detained under the Mental Health Act, and a larger proportion
of people from these communities enter the mental health system
via the criminal justice system. Increased police powers will
put people in these communities at increased risk of detention
and loss of civil liberties.
5. Advocacy
The draft Bill introduces the principle that service
users subject to compulsory powers should have access to an independent
advocacy service. We welcome this, but would ask you to consider
strengthening the provision for this in the Bill and make it an
enforceable right. Advocacy is too attached to stages of compulsion
as described in the draft Bill, it should be avaiable earlier
on in the process.
6. Staff training and preparation
We are concerned that the lead in time for the implementation
of any new legislation is thought through carefully. The change
in staff roles and the impact on certain professionals will be
immense. Discussions need to be conducted with the Royal College
of Psychiatry, the Royal College of Nursing and the National Institute
for Social Work and their training bodies about how such changes
could be implemented.
7. Code of practice
The absense of a code of practice makes it very difficult
to consider the full extent of the imapct this Bill could have
on local services and service users. We would strongly recommend
that a code of practice is produced before any new Bill is implemented.
8. Implications for service commissioning
As a commissioning organisation speaking on behalf
of other commissioners we would be very concernd about the impact
the implementation of the draft Bill could have. If the use of
compulsion increases then in patient bed use could increase, going
against all the work that has been done in recent years to reduce
bed use. This in turn could increase service demand in primary
care. The commissionng implications for planning as well as purchasing
services need to be considered before a new Bill is implemented.
9. Resources
We are very concerned about the level of resources
that will be needed to implement the Act as outlined in the draft
Bill. If extra resources are not made available then the implementation
of the legislation could seriously impede the delivery of new
service that have been set up as a response to the NSF and NHS
Plan. We suggest that the Department give due consideration to
this issue, as it will be impossible to implement the proposed
legislation without the right level of funding made available.
Yours sincerely
Tabitha Arulampalam
Head of Strategic Planning and Development (Mental
Health)
Leeds NW PCT
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