Reform of the Mental Health Act 1983: Squandering an Opportunity?

International Journal of Mental Health and Capacity Law ◽

10.19164/ijmhcl.v0i3.298 ◽

2014 ◽

pp. 5

Author(s):

Jill Peay

Keyword(s):

Mental Health ◽

Time Scale ◽

Expert Advice ◽

Green Paper ◽

Final Report ◽

Expert Committee ◽

Mental Health Act ◽

Department Of Health ◽

Secretary Of State

This article compares and contrasts two recently published documents: the Report of the Expert Committee (chaired by Professor Genevra Richardson) entitled ‘Review of the Mental Health Act 1983’, and ‘Reform of the Mental Health Act 1983 - Proposals for Consultation’.Whilst both documents were published in November 1999 under the remit of the Department of Health, the Richardson Report preceded the Green Paper. It was delivered in July 1999 to the Parliamentary Under Secretary of State for Health, John Hutton. The Richardson Committee had been established in September 1998 by the DoH in order to provide them with expert advice. The Committee was serviced by the DoH. Accordingly, the contents of the final report would have come as no surprise to them, since they had themselves been fully exposed to the developing reasoning of Richardson. In publishing their own Green Paper some four months later, the DoH had had an opportunity to reflect upon the final Richardson Report. Nonetheless, some might argue that, given the time-scale involved in the production of other similar documents in the field, this rush to a Green Paper was unseemly and unwise. Moreover, since it departs markedly from the recommendations of Richardson, one might argue that the pressure to produce has been, and will prove, counter-productive.

Download Full-text

The new Mental Disorder Tribunal

International Journal of Mental Health and Capacity Law ◽

10.19164/ijmhcl.v0i3.300 ◽

2014 ◽

pp. 29

Author(s):

Mark Mullins

Keyword(s):

Mental Health ◽

Mental Disorder ◽

Fundamental Principle ◽

Green Paper ◽

Final Report ◽

Expert Committee ◽

Committee Report ◽

The Public ◽

Mental Health Act ◽

The Government

In its final report the Expert Committee on reform of the Mental Health Act 1983 chaired by Professor Genevra Richardson proposed a new Mental Disorder Tribunal. This tribunal would have fundamentally different functions, composition, procedure and powers to the present Mental Health Review Tribunals (MHRTs). The Committee’s objective was not merely to repair the failings of the present MHRT system but to replace it with a new structure promoting the principles of patient autonomy and non-discrimination. Reading the Committee report and the Government’s Green Paper proposals in response together it soon becomes clear that the Government has rejected the recommendation that the new mental health law should be based on principles of autonomy and nondiscrimination. In their place the Green Paper puts “safety” and “risk”. While it will incorporate safeguards to ensure compliance with the Human Rights Act 1998, the “dual aims” of the new Mental Health Act are to be to ensure the health and safety of patients and safety of the public. Whereas the Committee saw the new tribunal as an active guarantor and promoter of individual rights the Green Paper recasts it as a body preoccupied with risk and safety, stating as a fundamental “principle” that: “Issues relating to the safety of the individual patient and of the public are of key importance in determining the question of whether compulsory powers should be imposed”

Download Full-text

‘Juridogenic’ harm: statutory principles for the new mental health tribunals

Psychiatric Bulletin ◽

10.1192/pb.25.9.331 ◽

2001 ◽

Vol 25 (9) ◽

pp. 331-333 ◽

Cited By ~ 7

Author(s):

W. Obomanu ◽

H. G. Kennedy

Keyword(s):

Mental Health ◽

Green Paper ◽

Expert Committee ◽

Proper Place ◽

Code Of Practice ◽

Mental Health Act ◽

Department Of Health ◽

Explicit Statement ◽

First Time ◽

Health Review

The new Mental Health Act for England and Wales is likely to extend the powers of mental health review tribunals (MHRTs) by giving tribunals the power to approve all compulsory treatment (Department of Health, 1999a, b). The medical member may be dropped entirely from the tribunal's proceedings (Richardson & Machin, 2000). In Ireland, a proposed new Mental Health Act will introduce MHRTs for the first time (Calvert, 2000). The 1983 Mental Health Act contains no explicit statement of underlying principles, although some were introduced in the revised Code of Practice. The Expert Committee (Department of Health, 1999b) suggested that the new Act should specify broad principles where these would help in statutory interpretation, particularly because a range of practitioners working in different settings will be required to understand and implement its provisions. The Green Paper initially suggested that the proper place for setting out principles should be a Code of Practice, but ended by inviting comments on the principles proposed by the Expert Committee, and on whether inclusion of principles would aid interpretation of the new Act.

Download Full-text

Reform of the Mental Health Act 1983: the Green Paper

Psychiatric Bulletin ◽

10.1192/pb.25.4.126 ◽

2001 ◽

Vol 25 (4) ◽

pp. 126-128 ◽

Cited By ~ 7

Author(s):

A. S. Zigmond

Keyword(s):

Mental Health ◽

White Paper ◽

Green Paper ◽

Closing Date ◽

Mental Health Act ◽

Department Of Health

The profession awaits the Government's White Paper on a new Mental Health Act (MHA) with trepidation. At the time of writing, the closing date for consultation on the Green Paper (Department of Health, 1999a) has passed. None the less, discussion and lobbying must continue.

Download Full-text

‘Offenders, Deviants or Patients’ - Comments on Part Two of the White Paper

International Journal of Mental Health and Capacity Law ◽

10.19164/ijmhcl.v1i5.355 ◽

2014 ◽

Vol 1 (5) ◽

pp. 21

Author(s):

Herschel Prins

Keyword(s):

Mental Health ◽

Mental Health Professionals ◽

Good Deal ◽

Legal Framework ◽

White Paper ◽

Green Paper ◽

Expert Committee ◽

The Past ◽

Mental Health Act ◽

The Government

The Government White Paper Reforming the Mental Health Act follows closely on the heels of the Green Paper - Reform of the Mental Health Act, 1983 which derives from (but also departs from in many respects) the Report of the Expert Committee chaired by Professor Genevra Richardson. One could say, with some justification, that mental health professionals have been ‘deluged’ with paper in this area in the past year or two, so that trying to discern trends has become very difficult. In particular, the material in the White Paper is somewhat closely written and needs to be read with a good deal of care (or, so it seemed to me). To complicate matters further, offender-patients are also discussed in Part I of the White Paper (The Legal Framework) whereas it would have been more logical to have dealt with the proposed provisions for them in Part II. For clarity, I propose to deal with all these matters under one heading.

Download Full-text

Foreword

International Journal of Mental Health and Capacity Law ◽

10.19164/ijmhcl.v0i3.297 ◽

2014 ◽

pp. 4

Author(s):

Charlotte Emmett

Keyword(s):

Mental Health ◽

Health Care ◽

Legal Framework ◽

Green Paper ◽

Health Law ◽

Special Issue ◽

Mental Health Act ◽

Department Of Health ◽

Review Team ◽

Key Issues

This special issue of the Journal of Mental Health Law has been prompted by the recent publication of the Government’s Green Paper Review of the Mental Health Act 1983: Proposals for Reform. The Green Paper aims to "modernise the legal framework within which mental health care is delivered" by proposing a number of reforms to the current regime established under the Mental Health Act 1983.We have aimed in this edition to highlight some of the key issues arising from both the Green Paper and the Report submitted to the Department of Health by the Scoping Study Review Team, in July 1999.

Download Full-text

Department of Health Review of Research on the Mental Health Act 1983

International Journal of Mental Health and Capacity Law ◽

10.19164/ijmhcl.v0i3.316 ◽

2014 ◽

pp. 58

Author(s):

Martin Humphreys ◽

Helen Smith

Keyword(s):

Mental Health ◽

Current Data ◽

Expert Committee ◽

Mental Health Act ◽

Department Of Health ◽

School Of Medicine ◽

King's College ◽

Invaluable Tool ◽

The Government ◽

The Uk

At the same time that the Government published the Report of the Expert Committee on the Review of the Mental Health Act 1983 and the accompanying consultation document, the Department of Health produced a systematic review of research relating to the Mental Health Act 1983. This was written jointly by a team made up of researchers and senior academics from King’s College School of Medicine and Dentistry, St George’s Hospital Medical School and the Institute of Psychiatry in London. It represents a major undertaking and will be an invaluable tool, particularly for those involved in research into mental health law and allied legislation, both in the UK and further afield, but also anyone involved in the care of detained patients. It is strengthened greatly by the fact that it was undertaken in a structured, rigorous and scientific manner and involved those with not only a formidable academic background, but also clinical experience in the use of the Act itself.The review is comprehensive, both in form and content. The authors' stated aims to summarise the available current data and from that, determine how the Act has been used, and describe which parts are effective or otherwise, has generally been achieved.

Download Full-text

Unethical Mental Health Law; History Repeats Itself

International Journal of Mental Health and Capacity Law ◽

10.19164/ijmhcl.v0i3.315 ◽

2014 ◽

pp. 50 ◽

Cited By ~ 1

Author(s):

A. Zigmond ◽

A. J. Holland

Keyword(s):

Mental Health ◽

Decision Making ◽

The Other ◽

European Convention ◽

Green Paper ◽

Expert Committee ◽

Mental Health Act ◽

Decision Making Capacity ◽

Mental Health Legislation ◽

Health Legislation

The powers enshrined in mental health legislation go directly to fundamental principles central to any caring and democratic society. The tension and dilemma that exists is, on the one hand, the importance of respect for an individual’s right to make decision’s affecting his/her own life to, on the other, the recognition that there are people with mental disabilities that may be vulnerable to abuse and/or neglect and who throughout their lives or at particular times need care and/or treatment, which they may not seek or be able to consent to themselves. In any society it is through case law and statute that an attempt is made to resolve this tension and to ensure that individual rights are not infringed and that those who need care and treatment receive what is in their best interest. Thus a change in such legislation requires the most rigorous of examination and must be judged on the grounds that it a) does not infringe accepted principles such as those of the United Nations Declaration of Human Rights and the European Convention, b) is based on sound ethical principles and does not conflict with the established law of the country, and c) it is practicable and achieves the right balance with respect to the potential tension described above. As practising clinicians (one working in an acute psychiatric service the other in a district learning disability service) we are not in a position expertly to judge the first of these but we believe we can contribute to the second and the third. In this paper we consider specifically the reasons for, and the consequences that follow, the failure on the Government’s part to accept the central importance of decision-making capacity assessment in any new mental health legislation.The Green Paper proposals for a new Mental Health Act for England and Wales have now been published. A broad definition of ‘mental disorder’ has been retained, a new system of tribunals is to be established and compulsory treatment in the community would become lawful. However, it rejects the recommendation of the expert committee chaired by Professor Richardson that the assessment of an individual’s decision-making capacity should be a determining factor in the use of compulsory detention. Given this, it does not address the relationship between this legislation and the proposed Mental Incapacity Act. The failure to recognise the central place of decision-making capacity in a modern Mental Health Act is, we believe, a serious omission as it is a reflection of a failure to acknowledge that the basic principle of autonomy is central to such legislation.

Download Full-text

Code of Practice 1999: navigating before reform of the Mental Health Act 1983

Advances in Psychiatric Treatment ◽

10.1192/apt.6.1.3 ◽

2000 ◽

Vol 6 (1) ◽

pp. 3-4

Author(s):

Julian C. Hughes ◽

Tony Lawson

Keyword(s):

Mental Health ◽

Public Safety ◽

Green Paper ◽

Code Of Practice ◽

Mental Health Act ◽

Department Of Health ◽

Mental Health Legislation ◽

Health Legislation

Mental health legislation must steer a course between Scylla and Charybdis. Scylla represents the notion of individual liberties; Charybdis represents the notion of safety and, in particular, public safety. At the time of writing a Green Paper is expected in 1999, so reform of the Mental Health Act 1983 is on its way. Meanwhile, does the new Code of Practice (Department of Health & Welsh Office, 1999), in force since 1 April 1999, give us any indication as to the course we might be steering?

Download Full-text

The future (or not) of the medical member

Psychiatric Bulletin ◽

10.1192/pb.25.1.8 ◽

2001 ◽

Vol 25 (1) ◽

pp. 8-9 ◽

Cited By ~ 2

Author(s):

Graham Rooth

Keyword(s):

Mental Health ◽

Common Sense ◽

Green Paper ◽

Judicial Process ◽

Medical Expertise ◽

Mental Health Act ◽

Department Of Health ◽

Uncertain Significance ◽

Present Role

The present role of the medical member combines considerable common sense strengths with a particular legal weakness. It reflects a compromise between the need to inform the judicial process with an appropriate level of medical expertise, and the risk that information could be presented to the tribunal without being open to challenge by the patient.Concern over this perceived, but unresearched risk, is reflected in the Green Paper on the Reform of the Mental Health Act 1983 (Department of Health, 1999). Here the bold solution to a problem of uncertain significance is to remove the offending medical member.

Download Full-text

A Successor Body to the Mental Health Act Commission

International Journal of Mental Health and Capacity Law ◽

10.19164/ijmhcl.v0i4.301 ◽

2014 ◽

pp. 157

Author(s):

Margaret Clayton

Keyword(s):

Mental Health ◽

Clinical Excellence ◽

Second Opinion ◽

Green Paper ◽

Health Improvement ◽

Code Of Practice ◽

Patient Advocate ◽

Mental Health Act ◽

Secretary Of State ◽

Local Quality

“The Mental Health Act Commission (MHAC) has a major role in protecting the interests of patients who are subject to the provisions of the 1983 Act. Its principal functions are to: • appoint Second Opinion Appointed Doctors • review treatments given under sections 57(2) or 58(3)(b) of the Act, ie treatment that requires a second opinion • visit detained patients and investigate complaints • keep under review the exercise of statutory powers relating to detained patients • submit proposals for a code of practice • look into matters relating to informal patients, when directed to do so by the Secretary of State, and • report to the Secretary of State every two years on the operation of the Act.”This is the summary of the functions of the MHAC contained in the Green Paper on Reform of the Mental Health Act 1983. In this brave new world of the Modern NHS, with much enhanced arrangements for local quality assurance and clinical governance, the Commission for Health Improvement, the Commission for Care Standards, the National Institute for Clinical Excellence, the establishment of Patient Advocate and Liaison Services, and the numerous other ways of increasing patient participation which are outlined in the National Plan for England, is a successor body to the Mental Health Act Commission really necessary ?

Download Full-text