Mind: Government proposals will damage future of mental health care

Embargoed until 0001 Monday 16 April

• Mental Health Bill will divert resources from health care to red tape
• Big Brother plans will frighten people from seeking help
• Government ploughs ahead in spite of overwhelming expert evidence

MPs vote this afternoon on the second Commons reading of the Government's Mental Health Bill. Widely criticised by mental health experts, the Bill met fierce opposition and was significantly amended in the House of Lords, where it started.

Mental health charity Mind today painted a bleak picture of the future of mental health under the Government's Mental Health Bill, which introduces alarming measures to extend forced treatment beyond hospital, and in to the community, under new Community Treatment Orders (CTOs).

These far-reaching powers would specify a treatment regime which patients would be obliged to comply with in their own home, and determine limits on their lifestyles, for example, forcing them to take certain medicine, or saying what time they have to be in at night. Mind believes that if someone is so ill they have to be given forced treatment, they are so ill they should be in hospital.

Sophie Corlett, Mind's policy director, said:

"Ministers would like us to believe that Community Treatment Orders mean people with mental health problems will be getting extra attention and support. (2) But they won't. This legislation will not make up for inadequate mental health services. And every pound spent on red tape and forced treatment is a pound we could and should be spending on helping people when they ask for help. It will subject vulnerable people to Big Brother restrictions that will hinder instead of help their recovery."

Community Treatment Orders will frighten patients away from seeking help when they need it. If people aren't seeking help, then their health problems will only come to attention when something goes wrong. CTOs are even opposed by the clinicians who would be expected to implement them. The Government's own study of CTOs found that there was no clear evidence for their use. (1)

Mind wants people to seek help when they first need it. This Bill will divert resources from healthcare to the bureaucracy of compulsory treatment. Doctors will be turning people away when they are desperately seeking help, even more so than now, only to have to forcibly treat them later when their condition deteriorates.

Sophie Corlett, Mind's policy director, continued:

"This legislation is dangerous. The result of it will be that people with mental health problems won't get the help they need. The Government are ploughing ahead in spite of all the evidence. Psychiatrists oppose the Government proposals, nurses oppose them, mental health organisations oppose them, and, crucially, patients oppose them. We're asking MPs to consider the advice of the experts and oppose them too."

What might the future of mental health care look like under this law?

It's 2017, ten years since the Mental Health Bill was passed... At the time, Ministers said that only around 1,000 people would be subject to Community Treatment Orders, a figure that was widely believed by experts to be a gross underestimate (4). Since then, as with the use of sectioning now (5), the number of people subject to CTOs has gone up and up, rising far beyond Government estimates. The Bill made no attempt to tackle ethnic inequalities at the time, and, unsurprisingly, it's people from ethnic minorities who are most likely to be subject to the ‘psychiatric Asbos'.

Meanwhile, many thousands of people who are experiencing mental health problems, including psychosis, are scared to seek help. They fear that they will be subjected to draconian CTOs. Psychiatrists were deeply reluctant to use CTOs at first, but they soon started acting defensively and issuing them 'just in case' to avoid being viewed as negligent, adding more and more restrictions to patients' lifestyles. Staff vacancies were a problem in 2007, but have reached endemic, debilitating levels. Mental health professionals, demoralised by the focus on compulsion instead of compassion, have been leaving the sector at an ever-increasing rate.

Community services have refocused around compulsion, effectively operating a 2-tier system: those with CTOs get priority for what little help is available, while there isn't the resource to help others through outreach services that would have intervened to help people when their mental health started to deteriorate.

Whereas in 2007, people would typically spend a few weeks recovering on a mental health ward, now they often spend just a few days before being discharged with a CTO. If people were unwell enough to be subject to compulsion, they were unwell enough to be in hospital. Now, without the 24/7 support of people around them, recovery is much harder, and their experience of mental health services more alienating. With inpatient care being constantly cut, people are left without somewhere to go when their mental health deteriorates.

For more information, read Mind's briefing on the Mental Health Bill second reading:

Mind press office: 020 8522 1743 / 07850 788 514

Notes

Mind is a core member of the Mental Health Alliance. www.mentalhealthalliance.org.uk

Please note that Mind is not an acronym and should be set in title case.

1) Government's own research shows CTOs will be of no benefit

www.mind.org.uk/News+policy+and+campaigns/Press/2007-03-07+IoP+research.htm

Researchers said:

"This review has found very little evidence of positive effects of CTOs in the areas where they might have been anticipated. None of the nine experimental studies found evidence suggesting that CTOs reduce either hospital readmission or length of stay, or that they improve compliance."

"There are genuine concerns that CTOs might be used as an alternative to providing a comprehensive package of effective community mental health services."

"Given the coercive nature of CTOs, there is a need to consider whether any potential therapeutic gains might be better delivered by enhancing the quality and assertiveness of community treatment for high risk patients through, for example, Assertive Community Treatment (ACT)."

2) Government's Mental Health Bill will not help reduce suicides

www.mind.org.uk/News+policy+and+campaigns/Press/AW2007-04-11+SCTs+and+suicide.htm

3) Mind is a member of the Mental Health Alliance, campaigning for better mental health legislation. Other members include the Royal College of Psychiatrists, British Medical Association, Royal College of Nursing, British Association of Social Workers, and the Law Society. www.mentalhealthalliance.org.uk

4) Mind comments on Cochrane and King's Fund reports: Government figures totally inaccurate

www.mind.org.uk/News+policy+and+campaigns/Press+archive/cochrane-kingsfund0905.htm

5) 29 March 2007, New statistics show more people sectioned than ever before

www.mind.org.uk/News+policy+and+campaigns/Press/mhastats.htm

Admissions under the Mental Health Act hit a record high last year, prompting fears that the Government's planned 'psychiatric Asbos' will be overused…