UK Mental Health Act

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Survivors Lobby of Parliament - 29.3.2000

(consultation ends March 31st 2000 - write in quick!!)

New Mental Health Act…direct from Hell

  In mid November 1999, the Mental Health Green Paper (Reform of the Mental Health Act) was released by the Government. It includes the hated Community Treatment Orders as expected. Press reactions were mixed and probably can best be described as luke-warm. The Guardian felt that “care in the community” had never been properly tried and that it should be adequately planned and resourced before compulsory treatment was introduced.
  The mental health world of mainly professionals and voluntary sector was almost universally critical. The notable exception was Michael Howletts from the Zito Trust who expressed the view that the Green Paper was a good development and he hoped “it would not get watered down” during the legislative process. But even he said “If a patient is sitting in a bedsit refusing to take medication, they really need to be returned to a clinical setting where they can receive humane treatment.”
  Publicly survivor groups have yet to comment in detail on the Green Paper but have said again and again that they do not want compulsory treatment – let alone in their own homes. Privately survivors are saying that Government proposals are much worse than they feared, and the document makes for extremely distressing and depressing reading indeed.

What the Green Paper (Reform of the Mental Health Act 1983) contains

Principles
  The first important part of the document deals with Principles. One is: Informal care should always be considered before compulsory powers. This is no change from the 1983 Act. Another is: Patients should be “involved as far as possible in the process of developing and reviewing their care plan.” This is of course an optional principle which can easily be ignored. Ominously though it could spell the end of any credibility given to collective user involvement which is not mentioned.
  Public safety being of key importance is the Government’s central principle which overrides all others. The documents then cites a further principle that “care should be the least restrictive setting consistent with safety, best interests of the patient, and safety of the public”. This may sound good but is probably a meaningless fudge, since it lets providers off the hook.
  There is no mention of what many agree is or should be the central aim of mental health services – the relief of suffering of people in distress or crisis. Sadly Human Rights of people are to be given no weight under this legislation – when mental health history is littered with major Human Rights abuses. And other principles such as patient autonomy, non discrimination, consensual care, reciprocity (a right to a service) are rejected as being covered elsewhere.

The “Sectioning” Process

Forced Treatment to operate everywhere
  We have to remember that the sectioning process leading to forced treatment is now to be extended beyond hospital – both out into the community and into prisons.

Any Professional can section us
  Although not decided yet, the Government is leaning towards allowing any mental health professional to be the applicant for a section – not simply Approved Social Workers as now. Conceivably this could be your Care Home Manager - which could leave room for massive abuse. Sections could be used as a means to evict people. The important thing here is the independence of ASW’s is now under direct threat.

One good thing
  Government recommends that all people sectioned are to be reviewed by a tribunal – not just those people who apply to the Review Tribunal as now. On balance this may be one of only two good things in the document for survivors.

Treatment before assessment or appeal
  However the timing and the number of allowable applications is something which is highly sinister. Government questions the need for a review within seven days.

Assessment abolished
  Also because the paper keeps talking about “initial assessment and treatment”, we can assume that the assessment process is effectively abolished. So we can be treated routinely against our will without appeal! And before the presence of a “mental disorder” is established. This is rather like carrying out a punishment before a trial. And how many people wrongly sectioned ever get redress?

An appeal process ditched
  The horrific part of this is that Sections two (28 days) and Three (6 months) of the 1983 Act are effectively merged. This means that one appeal procedure is abolished. Now you can only appeal once – lose that appeal (while you are still perhaps in crisis and are likely to do) and you can be treated for six months. This is no justice at all since it is weighted so massively in favour of the system!
  The shape of the tribunal itself is something the Government clearly has trouble with in deciding. It will now chaired by a lawyer. There could be a three person tribunal or a one person tribunal who have access to specialist medical and social care experts. The arrogance and injustice of this is astounding as the person making an appeal does not have access to their own experts. This would not be permitted in criminal or civil cases in the Courts. There is to be no access, as survivors argued for, to independent second medical opinion of their choice.
  The Tribunal itself, instead of being a Mental Health Review Tribunal is to be renamed a mental disorder tribunal. Of course this ugly name is more than just a piece of stigmatisation, it is presuming “guilt” from the outset and is therefore highly prejudicial.

No Justice – no establishing the facts
  Survivors know full well the weakness of information about held about them. Psychiatric notes are notorious for containing, innuendo, negativity, hunch, hearsay, chinese whispers and bald face lies. Professionals lie because they know they can get away with it. Within these proposals there is no mention of a sacred principle of justice – the rules of evidence. If we are to be forcibly treated and some of us will die as a direct result of that treatment, we are owed a trial – with a judge and a jury, at which information which is held about us is open to cross-examination. In short evidence should be tested so the facts can be established.

  People have been sectioned for reasons such as “smoking in bed” at a residential home or crossing a busy road slowly. Without the testing of evidence justice is likely to be both summary and arbitrary.

Another Appeal Process to go
  Presently there are two independent bodies which can discharge a person from compulsion – the Tribunals and the Hospital (Mental Health Act Managers). At present you can appeal to either body or both. Whereas the Hospital Managers rarely discharge nowadays they can make recommendations to professionals about any aspect of treatment they are not happy with.) The Government proposes removing this entire tier of safeguards by abolishing the Hospital Managers and putting nothing in its place. Now no independent body or person may review your treatment. (Government is concerned that the new Tribunal cannot interfere with care plans).

Capacity
  There has been a lot of debate recently around the rights of people capable of making decisions, to actually make those decisions – including those around their own health care. Astonishingly Government is of the view that this issue is entirely irrelevant in mental health. For them capacity should not enter into mental health. It should be overriden entirely by the interests of those they see do have capacity i.e. the public. Logically the default position is that all those whose mental health is called into question will be deemed to have no capacity to decide. Therefore they will not be permitted to decide anything about treatment which is not convenient for professionals. This contravenes a fundamental right – the right to self-determination. Instead people will be treated in what is their “best interests” and those best interests will be decided by who else… mental health professionals. Real scary eh?

The Compulsory Order in the Community (CTO)
  At the heart of the document is the CTO which of course is a brand new power. This will require a person to live at a specified place in order to allow easy access by professionals, “trained paramedics” and the police. The person will be under curfew at particular times to allow access for scheduled visits. The CTO will state the consequences of non-compliance which may include powers to enter by force, convey the person to a place of treatment (in the community) or to hospital. Although the order will last for specified periods, it is renewable so effectively it could be indefinite.

  Against orders less than three months there is no appeal. This is very heavy indeed for people most of whom will have committed no crime.

Users forced to pay for compulsory services?
  Additionally part of the compulsory care plan may require someone to attend a Day Centre or other social care facility. Although the Government is especially reticent about this, they do not rule out forcing people to pay charges for social care services they are ordered to use! That of course is a new tax on vulnerable people.
  But the stigma, fear and inconvenience of this interference in our lives is as nothing compared with the so-called treatments that will be forced upon people in the community. For at the heart of this procedure lies the effects of old-fashioned and often dangerous injectable neuroleptic drugs and also forced Electro-convulsive therapy (ECT). Neuroleptics help some people but in some they cause death. In others they cause restlessness, loss of looks and massive weight-gain, profound depression and perhaps saddest of all – the loss of imagination. ECT also helps some people but often causes profound brain damage and memory loss.
  Without medical support and monitoring such treatments when given to people living in the community will inevitably lead to an increase in death-rates.

The Mental Health Act and Offenders/Prisoners
  The new proposals suggest that the new Act should operate in prison – quite unlike the 1983 Act which prohibits this. For good reason too, since forcing medication on prisoners used to be thought to be so liable to abuse it could not be allowed. Why it is thought that abuse would not operate now is hard to see.

Massive powers of indefinite detention for all Courts
  The Court which sentences offenders will be given brand new powers to send any prisoner – whether convicted or on remand awaiting trial, to prison, hospital or to be treated forcibly in the community.
  Magistrates and higher courts will also have a new power to remand people to hospital for treatment – even if they are unconvicted or convicted of an offence which does not carry a custodial sentence.
  One of the most abhorrent parts of the Green Paper suggests that prisoners with a “mental disorder” i.e. a majority of all prisoners according to research cited by the Expert Group may now be treated differently from other prisoners. They may now be assessed under the new act and treated either in hospital or in prison. If treated in prison, s/he may be treated for as long as that mental disorder lasts. The net effect of this may be the end of time-limited sentences for some, and the end of parole for others. It is surely monstrous for someone say sentenced for 21 days for non payment of TV licence to end up spending a lifetime in jail because they have a psychiatric diagnosis!

  And how elegantly does the Green Paper mask this preposterous proposal: “A finding that an offender suffered from the mental disorder for which medical treatment was available should suffice to enable his subsequent safe management for as long as the disorder persisted.” And of course exactly when has anyone with a psychiatric diagnosis ever had that diagnosis lifted?

  The police are to be given new powers to remove people from private property.

No New Safeguards
  The Government has already assured Parliament that safeguards would be adequate and put in place. Yet we have already seen the careful dismantling of so many safeguards which although inadequate – do exist currently under the 1983 Act. So are there any new ones?
  Psychosurgery is to be subject to special safeguards just as it is in the 1983 Act.
  Government is clearly of the opinion that ECT should not be controlled with special safeguards and may be forcibly given as of now.
  Polypharmacy is defined as three or more drugs of the same class, whereas in reality it should of course be two or more. And this warrants some mention but only in the Code of Practice – which is of course optional only. Polypharmacy of neuroleptics is known to be especially dangerous.
  Special Safeguards against depot medication or long-term injectable nuroleptics was suggested to the Expert group as being crucial to the welfare of patients – especially in the community where medical monitoring is at a minimum. Long-term use causes neurological damage and brain shrinkage. “We do not accept that depot medication should be subject to special safeguards” says the Government with casual indifference.
  So how many new meaningful safeguards are to be contained in the Act when so much more is known about the dangers of treatment since the last Act was written in the early Eighties? Precisely zero!

Another good thing
  The fact that a patient can choose their “next of kin” who will have powers to apply for discharge – is something that survivors have argued for so this has to be welcomed. However the Tribunal can replace the nominated person.

But Carers have massive powers
  On the other hand – a carer is given the huge right to have a person assessed for a mental disorder. This traditional right of the next of kin is now extended to presumably anyone who says they are your carer – including of course the Care Home Manager. Now the Manager asks for an assessment and has the dual function of applicant under the Act!

Right to Advocacy – not recognised
  It was great hope that a right to an independent advocate would be contained in the new Act, but Government has witheld this right although they will keep the situation “under review”. Of course this means that a new Act will come out before the right to Advocacy is established. This is very poor.

No Advance Directives
  Perhaps the greatest hope of all was the people under a New Act would be able to make Advance Directives. The Government has different ideas and waters down the concept to advance agreements and then goes further by saying “Advance agreements will not be given special status in the Act.”

Conclusion
  If you are unfortunate enough to become part of this brave new mental health world, this is no less than the arrival of the totalitarian state. This Green Paper displays massive incompetence on two fronts. It is ignorant about mental health, it is ignorant also about justice. As a piece of law, it may be the most oppressive one introduced to the UK this century – internment included. In fact as far as the rights of people are concerned it echoes the sort of laws which the Lord Chancellor of the 1690’s – Judge Jeffreys operated – when he condemned political opponents to death without trial.

What Needs to be done
  Firstly study the Green Paper and the flawed but relatively/considered report by the Expert Committee chaired by Professor Genevra Richardson which was published at the same time. You can download both documents from www.doh.gov.uk on the Web. Order copies of the Green Paper from: The Stationery Office London 123 Kingsway, London WC2B 6PQ Tel: 0171-242 6393 Fax: 0171-242 6394

  Responses should be sent by 31st March 2000, to:
  Will Niblett Department of Health Wellington House
  135-155 Waterloo Road London SE1 8UG

  The Expert Group Report (Review of the Mental Health Act) is available from the Department of Health: Richmond House
  79 Whitehall
  London SW1A 2NL
  Tel: 020-7210-4850 (10.00 - 17.00 Monday - Friday)
  Tip – Copies of both documents may be available from your local Community Health Council free of charge.
  Make sure your group does a response to this Green Paper. Also arrange meetings locally to discuss it. Please make sure you local Association of Disabled People are aware of these proposals.

  One of the dilemmas survivor groups may face is whether to reject the entire Green Paper – or try to work with it as it stands. The Expert Committee Report – had it formed the basis of the Green Paper – was something that perhaps survivors could negotiate from. But whether the Green Paper forms any basis for negotiation whatsoever is quite another matter. And make sure your MP knows your individual views as soon as possible.
  This is a horrible evil and fascist set of proposals. It is brim-full of hatred and revenge. It simply cannot stand. Watch out for campaigns and get involved! This affects all of us.

Events
June 23-25, 2000 (!!!) The Russell Tribunal – on Human Rights in Psychiatry. Scarborough. At which the World Psychiatric Assocaition will be accused of persistent systematic violation of human rights through coercion. Speakers include Kate Millet – author of the Loony Bin Trip. (co-hosted by Scarborough Survivors) Mental Health Resource Centre, 9 Almo Square, Scarborough, North Yorkshire

This article was taken from the December 1999 Edition of the Common Agenda Newsletter published by Greater London Action on Disability (GLAD) - in London 0171 - 346 5805