From 3 November, most parts of the long-awaited and often feared 2007 Mental Health Act will be implemented. For the NHS, the new act presents major challenges by extending the scope of compulsory powers and by creating some new safeguards for those subject to them.
The most visible immediate change will be the arrival of supervised community treatment. This will give professionals the power to discharge a person who is detained for treatment from hospital but continue to exercise compulsory powers in the community.
The new power means people will be given a community treatment order setting out the conditions with which they have to comply. These will include not just the requirement to undergo treatment but also any additional restrictions their responsible clinician believes to be necessary. If they do not comply with these conditions, the clinician has the power to recall them to hospital.
There are many different estimates of the number of people who could be placed on supervised community treatment and, just as crucially, how long they would be kept on it. For a small number of people, this type of treatment may be a genuinely less restrictive alternative to relapse and hospitalisation. It is vital, however, to ensure that it is not a default form of discharge from detention for everyone, when regular contact with a crisis resolution or assertive outreach team would be appropriate and less restrictive.
Ending supervised treatment
We also need to consider how and when it will be deemed appropriate to end a period of supervised community treatment. If professionals and services take a highly risk-averse approach, it may prove difficult to demonstrate that people whose lives are being structured around the conditions of their community treatment orders no longer require them. Being on supervised community treatment should be the exception, not the norm, in people’s lives.
The use of conditions beyond mental health treatment will also determine how the new system is experienced. The code of practice makes it clear that conditions should, where possible, be agreed with the service user and their carers; but they have no legal right to challenge those conditions. It is important that agreement is achieved in practice and that supervised community treatment does not become needlessly restrictive of people wanting to get their lives back after being detained in hospital.
Independent advocacy on hold
We will wait at least another six months for one of the other very important provisions of the 2007 act. The hard-won new right to independent advocacy has been delayed until April 2009 in England to give services sufficient time to build up provision. While this delay is understandable, it creates a serious gap in the network of support available. Initially, people will be subject to the additional powers of the new act but will not have the reciprocal right to advocacy to negotiate the system.
It is up to the NHS locally to do all it can to close this gap and ensure that people who are subject to the new powers are offered advocacy as a priority, whether it is a statutory duty or not.
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