Flawed mental health bill could put the public at risk

The new mental health legislation is "fundamentally flawed" and could actually increase the risk to the public, according to an editorial in today's BMJ.

The Mental Health Bill, which is currently progressing through Parliament, makes a number of amendments to the Mental Health Act 1983.

Writing in the BMJ, Dr John Crichton and Dr Darjee note certain aspects of the proposed legislation which cause them concern. The Bill simplifies the criteria for mental disorder and they highlight in particular the identification of sexual deviance as a category where treatment should be compulsory. There is provision for supervised community treatment but they say it lacks the appropriate safeguards.

The group of people with the responsibility for the detention of patients is widened, despite what they say is a lack of clear guidance detailing how this would work in practice. And the test which determines whether a patient should be detained is being replaced with a broader one as the old test was seen to limit the ability to detain patients.

They argue the government is focussing too much on public safety and that paradoxically that will increase the risk to the public. Dr Crichton and Dr Darjee say the proposed legislation is so broad it would label most violent offenders as having a mental disorder. It would therefore place them within the boundary of needing compulsory psychiatric treatment.

They ask: "What prisoner will engage in an anger management course or a sex offender programme with the prospect of compulsory indefinite detention and transfer to a secure psychiatric hospital? What potential patient with a violent thought will dare seek help from a doctor?"

They go on to argue that the rate of violence in those with mental disorders actually mirrors the rate of violence of those in the same social group. Treating violent and sexual offenders medically is, they say, unlikely to make them change their ways unless the aim is a very long preventative detention.

They also say there is too much focus on individual high profile tragedies, for example, the failings in the mental health care of John Barrett, a paranoid schizophrenic who in 2004 stabbed Denis Finnegan to death as he cycled in Richmond Park.

"Results from the National Confidential Inquiry identified only 12 cases, 6% of a sample, where respondents involved in the care of a mentally ill perpetrator believed different legal powers may have made a homicide less likely."

The writers agree the best way for mental health to protect the public is the provision of comprehensive services, but say the government needs to be realistic about what can be offered. They point to Scotland where the Executive has successfully implemented mental health legislation after keeping the focus on care and treatment. Yet in England and Wales new mental health legislation has faltered because of a confusion of purpose. They say mental health services should be seen as a support for criminal justice agencies and the law when appropriate and conclude:

"Efforts for reform will fail if mental health legislation is wrongly identified as a principal mechanism for enhancing public safety."