Published: 03/10/2002 Volume II2, No.5825 Page 10 11
Has vociferous opposition to the draft mental health bill made the government think again? Paul Smith reports on signs of a change of heart
In any league table of recent health controversies, plans to revamp the current mental health laws would surely be up there with the best of them.
It is four years since work began on proposals to introduce forcible treatment in the community and bring dangerous people with severe personality disorder (DSPD) under the mental health umbrella.
Plenty of time for listening.Yet it appears that now - just after the close of consultation on the draft Mental Health Bill - the government is at last taking steps to address the anger and fears that have been unleashed by psychiatrists and mental health charities and user groups.
Certainly, in the last four weeks, the government has been fighting back in a bid to deal with what is widely regarded as a public relations disaster.
In particular, the Department of Health is trying to tackle the way coverage of the draft bill has been 'hijacked' by discussions about DSPD, while other proposals to safeguard the rights of patients subject to compulsory treatment - like the new mental health tribunals - have been neglected.
Last month, journalists were called to the DoH for an off-therecord briefing at which they were advised that much of their coverage had been either inaccurate or misleading.
And national director for mental health Professor Louis Appleby has been doing the media rounds in an attempt to stress that DSPD measures will primarily be a 'criminal justice measure', which will 'rarely' apply to anyone who is not before the courts or in prison.
He has also said that detention, on the basis of a DSPD diagnosis, of people who have never carried out 'a violent act' would be 'virtually impossible', though 'theoretically a possibility'.
Whether or not this is a reference to the 300-600 DSPD patients health minister Jacqui Smith described as living in the community when the draft was published in June remains unclear.
For many critics, DSPD is a side issue, especially for the vast majority of the 26,000 people suffering mental health problems likely to come under the draft bill's powers. The main concern is the broadened criteria to define mental ill-health.
In its official response to the consultation, the Royal College of Psychiatrists claimed that the draft bill would mean that people with Parkinson's disease, multiple sclerosis, learning difficulties and those addicted to drugs or alcohol could theoretically be sectioned.
And it is on areas like this which David Joannides, chair of the Association of Directors of Social Services'mental health committee (and also director of social services at Dorset county council), believes there could yet be movement from the government.
Having sat down with ministers to discuss the proposals just over two weeks ago, he told HSJ: 'I believe there is a genuine desire on behalf of ministers to get this right. They will get rid of what they are calling the 'unintended consequences' of the draft bill and I think they will look again at who comes under the powers of any future legislation.'
He added: 'There is no point any government pushing this forward when it could mean many more people detained within a service which in some areas is facing a bed crisis.'
Publicly, the DoH is keeping silent on which sections of the draft are being examined and whether they could be dropped.
Yet HSJ sources have said there are reservations at senior levels within the DoH.
One source says: 'They are facing a difficult choice, to be honest.
People on the outside may not understand this, but they have decided their arguments [against aspects of this bill] would be better served if they were made on the inside.'
According to Mr Joannides, the strength of feeling aroused by the proposals comes from the mistake of assessing future legislation while working within today's mental health services.
'The problem is that the bill envisages a service where the investment and national service framework are already in place.
There is no question there need to be more mental health teams available, more beds, more staff and more resources. But then you have to remember that this bill will probably become law as late as 2005, by which time the services underpinning it will be more developed.'
Whether that is true, huge numbers of those opposed to the draft bill in its current form will still be hoping that the government has a change of heart.
And the biggest clue to whether their prayers will be answered is due in November with the Queen's Speech, reckons Dr Tony Zigmond, lead on the bill for the Royal College of Psychiatrists.
'This is a personal view, but I think if the bill doesn't appear in the Queen's Speech we can be fairly sure that the government is taking seriously the concerns that have been expressed and it will give them time to make alterations.
'If it does appear, I think many people will say that it will not give them enough time to take on board what everyone has been saying.'