Concessions in the government's mental health white paper do not go far enough to balance the rights of the individual against powers for compulsory treatment, charities have warned.
The paper - Reforming the Mental Health Act - promises a right to independent advocacy services for mentally ill people, a new independent tribunal to determine all longer-term use of compulsory powers, and a new Commission for Mental Health to replace the existing Mental Health Act Commission. The replacement body will not have a duty to inspect services.
The paper also lays out a statutory right to develop care plans for those patients treated under compulsory orders. But leading charities, including Mind and the National Schizophrenia Fellowship, have criticised the paper's failure to guarantee service users a right to assessment.
An NSF spokesperson said its own research had found that one in three service users seeking help had been turned away from services, a situation which the new legislation would not address.
The paper says specialist advocates will represent any concerns patients have about care or treatment. The new Commission for Mental Health will be 'responsible for monitoring the quality and overseeing the operation of these specialist advocacy services'. They will be accessed through the new patient advocacy liaison service for patients cared for in trusts in England.
Patients' forums, to be established in every trust and primary care trust, will monitor arrangements. In Wales, the All Wales Strategy will spell out details of access to advocacy.
Dr Matt Muijen, director of the Sainsbury Centre for Mental Health, said he was worried about where the specialist advocacy services were going to come from, but welcomed the white paper, saying 'never have more resources been promised'.
He called for compulsory treatment in the community to be coupled with the provision of intensive community support services, and said: 'Where compulsory community powers are applied there must be intensive community services, such as assertive outreach or home treatment, to provide care in the patient's home.'
The paper allows for compulsory powers to be used to treat those 'resisting care and treatment needed either in their best interests or because without care and treatment they will pose a significant risk of serious harm to other people'.
A preliminary examination will determine whether to begin assessment and initial treatment of a patient under compulsory powers. This will be done by two doctors and a social worker or another suitably trained mental health professional.
The white paper also allows for the indefinite detention of those who are dangerous and have severe personality disorders. The coupling of general legislation for mental health service users with specific measures addressing this much smaller group was also attacked by many charities.