DMH 203 Service Users Hambleton &
Richmondshire
Mr Richard Dawson
Committee Office Scrutiny Unit
House of Commons
London
SW1P 3JA 25.10.2004
Dear Mr Dawson,
Re: Draft Mental Health Bill 2004
I have set out below the written evidence for consideration
by the joint committee from the service users and clinicians associated
with the mental health services provided by Hambleton and Richmondshire
Primary Care Trust.
It should be recognised that the 2004 Draft Mental
Health Bill has undergone some changes following the 2002 consultation.
However, it is difficult to ascertain what changes have been made
in response to the consultation, as the responses have never been
published. Also it does not approach the guiding principles proposed
by Professor Genevra Richardson's original work.
Theme 1 - Unambiguous basic principles
- Concern that the Bill is more aimed at societies
protection than treatment of patients
- Concern that the Bill increases stigma by emphasising
dangerousness
Theme 2 - Definition of Mental Disorder
- Definition of mental disorder considered too
broad, as the current exclusions of promiscuity, immoral conduct,
sexual deviancy, or dependence on alcohol or drugs are not included.
Theme 3 - Balance between public protection
and individual human rights
- "Treatability test" disappears and
is replaced by "appropriate medical treatment is available"
- Medical treatment definition widened to include
education or work training
- Because of this widening of the definition clinicians
may be pressurised by public safety concerns to hold people with
no mental illness, but may fit the wider definitions of mental
disorder and medical treatment
- The Bill does not identify who might detain on
short-term powers
- The Bill allows one doctor to admit a patient
if they determine that an assessment is urgently required
- The reliance on regulation rather than statute
allows changes to be made to the Bill without return to Parliament
Theme 4 - Proposals workable
- A complex Bill that will lead to further clarification
being sought by legal challenges
- Shortage of professionals to make the Bill workable
- Greater requirement for Tribunals that already
are difficult to deliver
- Greater requirement upon production of reports
and care plans in a short time frame potentially before assessments
are completed
- Lack of accommodation in hospitals for a greater
number of tribunals
Theme 5 - Institutional framework
- It remains to be see whether the current problems
with adequate staffing for tribunals can be overcome for the greatly
increased number of tribunals proposed which may lead to a centralisation
of tribunals as in employment tribunals making attendance by patients
and staff difficult
Theme 6 - Safeguards
- The Bill removes the right of patients who do
not consent to treatment to an independent second opinion
- Definition of hospital setting has not been made
so unclear where medication can be given
- Clarification is required over medication without
consent in peoples homes
- Power to regulate ECT stays with Secretary of
State not statute
- Allows patients to select own nominated person
rather than have nearest relative selected for them
- Cancels powers of nearest relative to object
to admission and to request discharge
- Provides for specific advocacy, but only after
section applied
- Removes payment for aftercare, currently section
117
- Reduces the powers of Hospital Managers
- Possible loss of independence when all three
examinations are performed by employees of one authority
- Possible loss of social care view when approved
social worker becomes an approved health professional
Theme 7 - Statute versus Regulation and
Code of Practice
- Difficult to comment on as the regulations have
not been produced
- Easier to change regulations than to change the
new Bill
Theme 8 - Integrated with Mental Capacity
Bill
- Apparently no mention of the Mental Capacity
Bill
- "Bournewood" decision by European Court
requires clarity on the usage of Mental Capacity Bill or Mental
Health Bill
Theme 9 - Compliance with Human Rights
Act
- Our legal advice is that the Bill is not in full
compliance with the Human Rights Act, particularly sections 3
and 5, and this will lead to legal challenges and possible litigation
claims
Theme 10 - Human and Financial Resources
implications
- There are major workload implications in the
Bill and therefore financial and human resources implications
- Estimated that double the Mental Health Act administrative
staff will be required
- The tribunals will require an increase of legal
and consultant staff that are currently not available and both
have nation-wide vacancies in this field
- The change of Approved Mental Health Workers
to Approved Health Professional and Responsible Medical Officer
to Clinical Supervisor may spread the responsibility across other
professions. However, other professions may not wish to accept
those responsibilities and would also require extensive training
- Training at all levels will be required, although
extent remains unclear without having seen the regulations and
code of practice
- New specific advocacy will require funding, training
and recruitment
- The tribunals will require support arrangements
when visiting hospital sites in terms of parking, accommodation,
administration that are not available currently
The general concern of the service users and clinicians
mainly relate to the approach the bill has taken with regard to
dangerousness and the resultant impact on stigma, the over inclusivity
of definitions both for the people that may be held under the
bill and the wider understanding of treatment, and lastly the
reliance on regulation rather than statute for important sections
of the bill. This leads service users and clinicians to regard
the bill as one for social control rather than treatment.
Yours sincerely,
Paul Farrimond
Director mental Health and Integration
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