news focus

Published: 21/11/2002, Volume II2, No. 5832 Page 10 11

The draft Mental Health Bill, one of the most controversial pieces of legislation of recent times, was conspicuous by its absence from the Queen's Speech. Paul Smith reports on its likely fate

The draft Mental Health Bill may be buried, but is it dead?

Its absence from last week's Queen's Speech came as a shock, even to those who had been embroiled in the long-running consultation with ministers and Department of Health officials.

Many had assumed that the government would push ahead, hoping to deal with the wide-ranging criticisms through the unusual promise of a pre-legislative review carried out by MPs as it went through Parliament.

With a huge sigh of relief from psychiatrists, user groups and lawyers, it now looks as though there will be time for a considered rethink.

But though there will be celebrations among those who were horrified by the proposals when they were published in June, there remains the vexed question of what action the government will ultimately take.

And the end results may not put minds at rest.

The night before the Queen's Speech, health minister Jacqui Smith told delegates at the annual Mind conference in Cardiff that the bill would not be scrapped.

Unlike home secretary David Blunkett, who chose to make his views on the draft bill known before the pro-bill Zito Trust speaker addressed the meeting, Ms Smith walked into the lions' den and braved the wrath of 500 people, many of whom will come directly under the shadow of the bill.

On her arrival at the conference platform, Ms Smith was suddenly flanked by a dozen protesters draped in banners expressing their fear of the government's plans.

Undaunted, she gave an impressive performance, particularly in the question-and-answer session to which she subjected herself after her speech.

Despite her uncompromising message on the bill, she elicited widespread respect from the audience for her speech.

'We are not going to scrap this bill, ' she said. 'It would be dishonest of me to say that we were. We have, quite rightly, seen the need to reform the current act which was drawn up in the 1950s. I do not subscribe to the view that there is nothing important or positive about this bill.'

Crucially, she defended the criminal justice elements of the bill - particularly the controversial move to detain indefinitely people suffering from severe personality disorders who are considered a danger to the public.

For her, the proposals were 'humane' in they allowed those with mental disorders to get the treatment they need.

And answering claims from the audience that the bill would stigmatise the mentally ill as paedophiles or psychopaths in the eyes of an ignorant and tabloidobsessed public, she said: 'The stigma comes from the system rather than this legislation.We are already reforming the system.'

And health secretary Alan Milburn stressed in the Commons that the bill will be brought forward during this session, once 2,000 responses to the consultation have been considered.

But why the delay?

As reported in HSJ ('Loud and clear', news focus, pages 10-11, 3 October), the sticking point is the entry criteria used to define those who can come under compulsory orders.

Opponents claim they are simply too widely defined, sucking in anyone from those with learning disabilities to epilepsy.

As the Commons joint committee on human rights said, the definition of mental disorder outlined in the draft proposals went 'much further than necessary to ensure that dangerous people can be removed'.

One senior source, a key figure in the negotiations, told HSJ: 'Put it like this - there is no doubt that the entry criteria will be tightened up.

'There has been a lot of discussion about from ministers, from the DoH. The possibility that the bill would allow the detention of people with learning disability or epilepsy, for instance, will be removed.'

The other reasons for the delay may be less down to sudden doubts among ministers about the principals of the proposals, and more about practicalities.

Association of Directors of Social Services mental health committee chair David Joannides says: 'Obviously, we have had the national service framework for mental health and the promise of more resources.

'But in many areas, the level of service improvement is simply not good enough. The idea is that a new [mental health] bill will operate in a system which has been reformed and for some the money has not made a real difference.'

South London and Maudsley trust chief executive Stuart Bell drew attention to staffing issues in his trust's formal response to the draft bill: 'At a time when 15 per cent of consultant psychiatrists posts are vacant, the lack of any estimate of the implications of the proposals for staffing time and costs is a notable omission.

'The need for contributions from other mental health professions to the tribunals will, unless balanced by an increase in numbers nationally, reduce staff time for direct patient care.'

But whether the latest twist in the long-running mental health bill saga is described as a climbdown, a U-turn, or the actions of a listening government, when the bill does eventually become law the elements which have provoked so much anger look likely to remain.