Detaining dangerous people with mental disorders

Editor—Birmingham summarises the latest version of the proposed new Mental Health Act.¹ I was surprised, however, that the proposals have attracted as much libertarian opposition as the several earlier announcements. The consultation document promises that now, a primary aim is to bring the law more closely into line with modern law on human rights. The government had already adopted the phrase “medical treatment” in preference to the current “treatment in hospital” to achieve one of its key aims—compulsory care in the community. It has now embraced even further the wording of the leading European human rights case,² and as Birmingham notes, dropped completely the “detention to manage behaviour” approach.

In the new draft bill, compulsory treatment requires that a patient must have a mental disorder of such a nature or degree as to warrant the provision of medical treatment. In my view this is a much better treatability clause than the one in the current Mental Health Act. For surely a mental disorder can warrant the provision of treatment only if the patient is likely to benefit from it. If it be argued, as under the current Mental Health Act's treatability clause, that treatment in a secure hospital will “prevent a deterioration” into serious offending, then the definition of medical treatment, which has become so central to the new bill, is most helpful. Medical treatment covers care, nursing, and (re)habilitation—the latter including education, and training in work, social, and independent living skills. As absurdly wide a definition of medicine as this is, it explicitly does not include preventive detention.

Birmingham alludes to the exclusion clause in the current law for substance dependence and sexual deviancy, which is missing in the new bill. Instead we find a condition that appropriate medical treatment is available in the patient's case. This “availability test” will, I anticipate, protect most psychiatric services from having to impose such specialist treatments. The media announcement of the bill of course made no mention of a U turn, but we must allow the government a graceful retreat. A few wisely chosen words in Strasbourg almost a quarter of a century ago have saved British psychiatry from the most serious threat in living memory.