Jacqui Smith

The government has unveiled plans to protect the public from dangerous mental health patients.

Publishing draft mental health legislation, health minister Jacqui Smith conceded that there were a "small number of patients" who need to be detained for their own safety and the public's protection.

The new legislation means that people with dangerous personality disorders could be detained indefinitely in secure mental hospitals - even if they have committed no crimes.

Forum Response: Royal College of Psychiatrists

Dr Mike Shooter, president elect of the Royal College of Psychiatrists, told ePolitix.com: "The Royal College of Psychiatrists has been calling for reform in mental health legislation for nearly a decade. Along with fellow professionals and the patients and carers organisations, we recognise the need for a new Mental Health Act that reflects modern practice. But it must be done right.

"The government's current proposals, if substantially unchanged from the white paper, are fundamentally flawed in principle and practical reality. The college will be campaigning very strongly for a total re-think on these proposals, in close association with all other organisations involved in the treatment of the most vulnerable members of our society.

"We call upon the government to halt any further attempt at legislation based on the white paper 'Reforming the Mental Health Act' and to begin meaningful consultation on a statutory scheme that takes account of mental incapacity on the successful Scottish model.

"As the professional body psychiatrists, we consider that a new act based on these proposals would collapse under the weight of its own regulatory framework. The proposals would be costly and complex to implement. Government funds would be better spent in the provision of more effective clinical services for patients.

"The new mental health review tribunals alone would require the time of 600 (extra) psychiatrists. It would be impossible to recruit such numbers. Those in post would be diverted from direct patient care.

"We believe that the proposals are driven by the perceived risk presented by a small number of people with Dangerous and Severe Personality Disorder, rather than the proper treatment of those who need it.

"In order to accommodate such a risk, the criteria for compulsion have been so widened that large numbers of patients would find themselves inappropriately placed under sections of the Mental Health Act.

"The increased numbers would overwhelm already over-stretched acute ward and community teams. Patient care would suffer and the level of risk would be increased rather than reduced.

"Such an emphasis on dangerousness further stigmatises people with a mental illness, the vast majority of whom are more likely to be the victims than the perpetrators of violence. As a result, they are likely to be deterred from seeking treatment.

"It is right that new legislation should reflect the move from hospital to community care. But the proposals as they stand would introduce powers that are ethically dubious and practically unworkable. They take no account of alternatives such as the use of leave and discharge with treatment conditions.

"The proposals do not offer a satisfactory framework for the protection of the very many people estimated to fall within the 'Bournewood gap' - patients not objecting to treatment but without the capacity to consent.

"In the interests of transparency and open government, the Department of Health and the Home Office should carry out a comparative analysis of the cost in money, workforce and training, between the current act and the new proposals.

"The new proposals may well be incompatible with the terms of the European Convention on Human Rights as implemented in the Human Rights Act 1998. The government should review both the proposals and the current act in the light of possible challenge.

"While new consultations take place, urgent amendments may be needed to the current act to address such issues as the patient's right to nominate a 'nearest relative' and to trained advocacy.

"Why is the government proposing to spend millions of pounds on legislation that we all oppose when it should be putting it into services for patients?"

Forum Response: SANE

Marjorie Wallace, chief executive of SANE, told ePolitix.com: "SANE has campaigned for many years to update the mental health act which was written at a time when the majority of psychiatric patients were in hospital.

"Now the majority live in the community it is essential that this new bill should provide new protection both for the individual who may be suffering from mental health and disorder and the public.

"We have concerns that the proposals have created a climate of alarm, however unfounded, which may further increase the distrust of the psychiatric services.

"We feel strongly that there would be no need to introduce more compulsions had we not eroded so much of our mental health services. The compulsion should be in the NHS to enforce duty of care towards people who may have serious illness."

Forum Response: Royal College of Nursing

Dr Beverly Malone, general secretary of the Royal College of Nursing, told ePolitix.com: "We have serious concerns about some of the proposals in this bill. Patient trust in nurses is central to their care.

"The extension of care and treatment orders and proposals relating to people with personality disorders could seriously damage that relationship and could result in patients failing to seek future care."

Forum Response: The Depression Alliance

A spokeswoman for the Depression Alliance told ePolitix.com: "The governments detention plan for 'dangerous' mental patients is not only immoral, repressive and impractical, but also represents the tip of the iceberg for the 1 in 4 of us who already experience the pain and stigma attached to mental illness.

"Jacqui Smith may believe that she has closed a loophole in mental health legislation, she has in fact widened another, more dangerous and far-reaching one. This Bill could lead to abuse and neglect in the provision of mental health services and further fuel the fire of those who stigmatise mental illness. As has already been proven in the recent human rights victory for psychiatric patients, the reports of mental health care crisis, and the hijacked funds for mental health, the government is intent on continuing its appalling record on mental health issues.

"It was widely reported that this new legislation would be without spin. We are seriously worried that this populist, knee-jerk Bill will set the treatment and public view of mental health back 100 years, allowing the present government to continue getting away with under-resourcing vital services and research."