This Week

The government has come under fire over claims that its proposals to reform the Mental Health Act may be carried out 'on the cheap'.

The Reform of the Mental Health Act 1983 green paper - on which consultation ends next month - proposes the introduction of compulsory treatment in the community.

Patients who fail to adhere to treatment regimes could be recalled to a hospital or clinical setting.

Julian Oliver, head of the Department of Health's mental health legislation branch, this week confirmed speculation that the introduction of compulsory treatment had been costed at 'no more than£10m' a year.

This, he told an Institute of Mental Health Act Practitioners conference, was the 'top end of the envelope'.

The green paper puts forward three possible types of tribunals that could impose compulsory treatment orders - ranging from a four-strong to a singleperson panel.

It also questions 'whether there is a real need' for treatment reviews at both seven and 28 days - a recommendation of the independent Richardson review which preceded the green paper.

H S J sources said estimates for the cheapest options could bring costs down further to£6m, and expressed concern that the government might opt for 'reforms on the cheap' by choosing options 'with the least safeguards attached'.

The DoH dismissed widespread claims that current figures - from a 'quick study' by Martin Knapp, professor of social policy at the London School of Economics - marked a dramatic departure from 'initial cost assumptions' before the review.

These are understood to have put the total price at£50m.

A DoH spokesperson said: 'We don't know where that figure has come from.'

But Professor Knapp said that 'costs had turned out to be far less than original assumptions, which were probably somewhat unrealistic'.

He said his figures included the costs of running new tribunal systems, 'the hope that they would reduce the need for people to stay as inpatients', and additional issues such as 'the ability to find enough psychiatrists to sit on the tribunals'.

But mental health legal experts suggested that the green paper's proposals to abolish current systems of 'hospital managers' hearings' - in which panels of lay members including trust non-executive directors can review detention orders - could explain 'a large part' of such a drop in cost.

Under the plans, the panel's duties would be passed on to a 'registered person' who would take legal responsibility for compulsion - usually the trust chief executive, although the function could be delegated.

IMHAP chief executive Prof-essor Yens MarsenLuther said: 'Clearly, the major financial savings have come from abolishing managers' hearings - which do have substantial costs in terms of the numbers of professionals, the managers and solicitors who attend.

We have serious reservations about their abolition.

'The new tribunals may be able to examine the care of the patient detained but they will not be able to examine the functioning of the organisation itself, as managers' hearings can.'

He said the hearings could detect 'more fundamental' and repeated weaknesses in services.

At the conference, Barbara Chaffey, founder of the Association of Mental Health Act Administrators, questioned the ability of trust chief executives to take on duties currently carried out by larger lay panels.

'Somebody had better make sure the chief executive knows all about the legislation in that case - or indeed that they know there is legislation at all.'