Thursday, January 11, 2007

Locking people up on the say-so

Locking people up on the say-so of the authorities because they are said to be mentally ill is not only authoritarian but is also an attitude to health issues that stretches back to the darkest days of early Victorian England. Mental health campaigners are in the middle of an eight-year campaign to stop this particular New Labour attack on human rights. The Bill that resumed its passage in Parliament this week is the third attempt by the government to introduce draconian changes to the law. The 78 members of the Mental Health Alliance have promptly denounced the Bill as "unfit for the 21st century”. The MHA is a unique alliance of service users, psychiatrists, social workers, nurses, psychologists, lawyers, voluntary associations, charities, religious organisations, research bodies and carers' groups. For once, New Labour is honest about its intentions. In its response to a 2005 consultation, the government admitted that in its view the purpose of mental health law is "not about service provision, it is about bringing people under compulsion". The MHA takes the completely opposite view, saying: “We fundamentally disagree with this approach. Undoubtedly mental health law must include provisions which authorise detention and compulsory treatment, and safeguards to prevent their arbitrary use - but it must also ensure that every person with mental health problem receives the range of mental health services they need, so that crises and detention are anticipated and prevented where possible.”

One of the major concerns is that if the legislation goes through some people with mental illness will be fearful of presenting themselves for treatment in the first place if they think they may be locked up. Psychiatrists have also voiced fears that they will be made to act like police officers when making decisions about who to lock up in a secure hospital. Other campaigners have pointed out that that inpatients from black and minority groups are far more likely to be detained under the Mental Health Act than their white counterparts. The new provisions for compulsory treatment in the community will also disproportionately affect such people. Under the proposed Community Treatment Order (CTO), a patient would be compelled to take their treatment after discharge on threat of being readmitted to hospital. CTOs are used in New Zealand, Australia and 38 states in the US, where they have provoked controversy. A US study published in 2005 concluded it would take 85 CTOs to prevent one readmission and 238 to prevent one arrest. New Labour’s reactionary legislation serves a number of purposes. It satisfies tabloid prejudice, which is fuelled by high-profile inquiries that have looked into cases where patients have killed other people in the community. What the Bill equally does by emphasising detention is to make treatment and care secondary considerations. This is, of course, much the cheapest option. Yet all the evidence points to the fact that it is lack of support that lies behind tragedies like the killing of Denis Finegan, stabbed on his morning bike ride through Richmond Park in 2004 in an unprovoked attack by mental patient John Barrett. The report into the death came out the day before the Mental Health Bill was published last November. It said Barrett was "inadequately treated", but added that the remedy for what went wrong "lies not in new laws or policy changes" but in "sound clinical practice and organisational management". Paul Corry, of the mental health charity Rethink, said: "Everybody knows the mental health services in this country are not what they should be. If you add human error to that you will get tragedies occurring. The answer is not new legislation which diverts time, effort and resources - it is to use the resources to improve the services that we have." That is so obvious that is barely needs saying – unless, of course, you are a New Labour minister who thinks that the first priority is to detain people first and ask questions later.

Paul Feldman, communications editor

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