After nine years of trying, the government has finally passed its Mental Health Bill. The reason it has taken so long, and been considerably amended, is that many of the government’s plans have been strongly opposed from the start by mental health professionals, service users and charities.
Many consider the bill at best as a missed opportunity, and at worst a frightening attack on civil liberties.
Certainly, the government has done nothing to remove the stigma of having mental health problems, and has once again attached the label of dangerous to those experiencing mental illness.
Time and again the government has focused on high profile cases, such as Michael Stone’s murder of Lin Russell and her daughter in 1996, as a justification for some of the repressive elements of the new legislation.
These include removing the “treatability” criteria which, the government claimed, prevented people with “severe personality disorders” from being detained before they had committed an offence, because their condition wasn’t treatable.
The government has intentionally inflated the figures for how many people were considered to be a risk to the public, and ignored the fact that 95 percent of murders are committed by those without a mental illness.
They have also ignored the fact that no inquiry has cited weakness in the legislation as a reason why people have been able to carry out murders.
The same level of dishonesty has been used to justify the introduction of community treatment orders (CTOs), which some campaigners describe as “psychiatric Asbos”.
CTOs allow compulsory treatment to be imposed in the community, with stringent conditions attached to a person’s movements, conduct and who they can associate with.
We are told this is to enable people to be released from hospital earlier, and ensure they continue to have access to treatment. But research by the Institute of Psychiatry into the use of CTOs internationally shows that they have limited success in reducing hospital admissions, length of stay in hospital, medication or – most importantly – improvements in patients’ quality of life.
There have been some positive changes in the new bill – all of them won through intensive campaigning by service user groups and organisations such as the Mental Health Alliance.
There are new safeguards for those treated using the controversial electro-convulsive therapy (ECT), and an automatic right to advocacy for those detained in hospital.
There is also for the first time an obligation on health trusts to provide age appropriate services, which in theory will lead to a reduction in the number of children detained on adult psychiatric wards.
However, there are issues – too many to cover here – that are not addressed. These include issues around the right to create directives to influence your own treatment should you become ill.
It is still unclear what the precise implications of the new legislation will be for mental health professionals.
But there is already concern about how the new elements, in particular CTOs, will impact on the relationship between workers and service users.
How will issues such as service users’ movements and medication compliance be monitored? What impact will the inevitable bureaucratic monitoring have on overstretched community services?
As every worker in frontline services knows, we work in a blame culture that covers up for lack of resources by scapegoating individuals when things go wrong.
This leads to defensive practice, and there is grave concern that the days of independent professionals taking positive risks to improve lives may be coming to an end.
Mental health is often described as the Cinderella service of the NHS, and has been consistently under-resourced for many years. It is also subject to the same punitive cuts and privatisation we have seen elsewhere in the NHS.
The government responded to criticisms of the bill by stating that it is “not about service provision” but about the legal process of bringing people under compulsion.
Civil rights and fully funded services for those experiencing mental illness are issues for us all.
Some one in four of the population will experience mental health problems at some point in their life and every year there are 250,000 admissions to psychiatric hospitals.
Inequality is still rife. Mental illness continues to disproportionately affect those from poorer social classes. Black people are still six times more likely to be detained against their will in the mental health system.
There is much left for us to fight for!
Andy Brammer is an approved mental health social worker and chair of the family services stewards’ committee in Wakefield council Unison union branch. He writes in a personal capacity