The Public and the Mental Health Bill By
KENNETH
ROBINSON,
M.P.
So far as the problem of mental disorder is concerned, most sensible people would agree that the last five years has seen a steady growth in understanding, sympathy and enlightenment on the part of the public at large. The old fears and prejudices linger on in places, but free and frank discussion of the problem, in the press, on radio and TV and above all, in peoples' homes has done much to remove them. How far will the Government's new Mental Health Bill help this process of enlightenment? Will some think we are going too far in eroding safeguards which have protected society in the past? To what extent will this new legislation enable us to get better mental health services? What opportunities will it offer the nonprofessional who wishes to play his or her part in helping to solve this problem? These are some of the questions that are being asked and they deserve serious consideration. The law relating to mental disorder must always be the resultant of conflicting interests. On the one hand there is the public safety to be considered. The more potentially dangerous persons are isolated from the community, the greater, obviously, is the protection of the public. On the other hand, there is something offensive in a democratic society in detaining against their will?often for long periods, sometimes for life?persons who have committed no offence against that society. That is the dilemma stated in crude terms. The balance, once heavily weighted in favour of the public safety, has steadily shifted in the direction of individual freedom over the past hundred years and more. The new Mental Health Bill carries the process further. Compulsory powers remain, but in future they will be exercised only on the recommendation of two doctors, one of whom should be a psychiatrist. The Justice of the Peace, so long regarded as the guardian of civil liberties under the old certification procedure, has disappeared from the scene. The Royal Commission took the view that the magistrate's signature on the certificate was, in fact, no protection since few magistrates had the knowledge and understanding of mental disorder which would enable them to controvert the medical judgment on the person brought before them for certification. The signature had become, in the view of the Commission, little more than a rubber stamp and the safeguard illusory. At the same time, the intervention of the J.P. brought a flavour of the Courts to the process of certification which itself contributed to the stigma in the mind of the public. For these reasons it is proposed that the decision as to whether treatment shall be compulsory should be, in law, as it has been in fact, a medical decision. The Magistrates' Association
in this view, though there doctors about the powers over civil confers upon them. concurs
are
some
liberty
misgivings
which the
among Bill
new
Though the procedures for compulsory admission are simplified, two things should be kept in mind. First, that the vast majority of patients will be admitted without any formality whatever. Secondly, discharge of compulsory patients will also be made much easier. Powers of discharge rest with the nearest relative, the responsible medical officer and the hospital management committee. Mental Health Review Tribunals are to be established to which the patient or nearest relative can appeal. The Tribunals will comprise lawyers, medical members and laymen with the appropriate kind of experience.
should afford ample reduce the number of mentally disordered patients compulsorily detained. The definition of mental disorder has been redrawn in such a way as to exclude from compulsion the greater part of that category hitherto known as the feeble-minded defectives (now termed "subnormal"). A new category of persons, those suffering from psychopathic disorder, hitherto not subject as such to compulsion, may be detained up to the age of 25 for treatment. For some years this power is expected to be exercised sparingly, since few facilities for treating this exceptionally difficult type of case exist. It is praiseworthy, however, that an effort is to be made to do something for these anti-social beings before, as well as after, their almost inevitable collision with the law. Thus the
new
machinery,
much
simplified,
protection for society while serving
to
Public fears about the mentally disordered are of course concentrated upon the violent, potentially homicidal type and those whom the popular press is prone to label as "sex maniacs". Fears have been expressed that such people will be at large in greater numbers owing to the more liberal provisions of this Bill. Public safety in this connection will rest basically, in future as in the past, upon the medical judgment of psychiatrists. If the doctor in charge of a patient considers that his discharge would involve serious danger to the public, no Tribunal will lightly override such an opinion. What the new procedures do largely ensure is that no patient is likely to remain in detention because of administrative failure, or because his case is not regularly reviewed. The Bill goes far, if
not far enough, in sketching the outline health service. It divides responmental fully comprehensive sibility clearly between hospital authorities and local health authorities, but having done so, fails to place a mandatory duty on local authorities to establish the community care services for which they are to be responsible. The powers remain permissive, as they have been in the past, and no special financial aid is to be
of
a
provided to encourage the development of new services. Until this done, there will still be large areas of Britain where virtually no community services exist. Finally, there is the question of how members of the public can participate in this work. There will be opportunities for voluntary service in the community for those who wish to help. Already, in a pioneering experiment on the outskirts of South London, some hundred voluntary workers are joining ex-patients in the running of a Social Club which has had a remarkable success. Perhaps the greatest contribution the layman can make is to extend a sympathetic helping hand wherever he or she comes into contact with mental disorder. This will be valuable not only in the more organised forms, such as home visiting and service on committees, but above all in ordinary day-to-day social contacts. For, in the final analysis, it is the attitude of the public that decides the pace and the direction of advance on this, as on so many fronts.
is
KENNETH
ROBINSON,
M.P.
So far as the problem of mental disorder is concerned, most sensible people would agree that the last five years has seen a steady growth in understanding, sympathy and enlightenment on the part of the public at large. The old fears and prejudices linger on in places, but free and frank discussion of the problem, in the press, on radio and TV and above all, in peoples' homes has done much to remove them. How far will the Government's new Mental Health Bill help this process of enlightenment? Will some think we are going too far in eroding safeguards which have protected society in the past? To what extent will this new legislation enable us to get better mental health services? What opportunities will it offer the nonprofessional who wishes to play his or her part in helping to solve this problem? These are some of the questions that are being asked and they deserve serious consideration. The law relating to mental disorder must always be the resultant of conflicting interests. On the one hand there is the public safety to be considered. The more potentially dangerous persons are isolated from the community, the greater, obviously, is the protection of the public. On the other hand, there is something offensive in a democratic society in detaining against their will?often for long periods, sometimes for life?persons who have committed no offence against that society. That is the dilemma stated in crude terms. The balance, once heavily weighted in favour of the public safety, has steadily shifted in the direction of individual freedom over the past hundred years and more. The new Mental Health Bill carries the process further. Compulsory powers remain, but in future they will be exercised only on the recommendation of two doctors, one of whom should be a psychiatrist. The Justice of the Peace, so long regarded as the guardian of civil liberties under the old certification procedure, has disappeared from the scene. The Royal Commission took the view that the magistrate's signature on the certificate was, in fact, no protection since few magistrates had the knowledge and understanding of mental disorder which would enable them to controvert the medical judgment on the person brought before them for certification. The signature had become, in the view of the Commission, little more than a rubber stamp and the safeguard illusory. At the same time, the intervention of the J.P. brought a flavour of the Courts to the process of certification which itself contributed to the stigma in the mind of the public. For these reasons it is proposed that the decision as to whether treatment shall be compulsory should be, in law, as it has been in fact, a medical decision. The Magistrates' Association
in this view, though there doctors about the powers over civil confers upon them. concurs
are
some
liberty
misgivings
which the
among Bill
new
Though the procedures for compulsory admission are simplified, two things should be kept in mind. First, that the vast majority of patients will be admitted without any formality whatever. Secondly, discharge of compulsory patients will also be made much easier. Powers of discharge rest with the nearest relative, the responsible medical officer and the hospital management committee. Mental Health Review Tribunals are to be established to which the patient or nearest relative can appeal. The Tribunals will comprise lawyers, medical members and laymen with the appropriate kind of experience.
should afford ample reduce the number of mentally disordered patients compulsorily detained. The definition of mental disorder has been redrawn in such a way as to exclude from compulsion the greater part of that category hitherto known as the feeble-minded defectives (now termed "subnormal"). A new category of persons, those suffering from psychopathic disorder, hitherto not subject as such to compulsion, may be detained up to the age of 25 for treatment. For some years this power is expected to be exercised sparingly, since few facilities for treating this exceptionally difficult type of case exist. It is praiseworthy, however, that an effort is to be made to do something for these anti-social beings before, as well as after, their almost inevitable collision with the law. Thus the
new
machinery,
much
simplified,
protection for society while serving
to
Public fears about the mentally disordered are of course concentrated upon the violent, potentially homicidal type and those whom the popular press is prone to label as "sex maniacs". Fears have been expressed that such people will be at large in greater numbers owing to the more liberal provisions of this Bill. Public safety in this connection will rest basically, in future as in the past, upon the medical judgment of psychiatrists. If the doctor in charge of a patient considers that his discharge would involve serious danger to the public, no Tribunal will lightly override such an opinion. What the new procedures do largely ensure is that no patient is likely to remain in detention because of administrative failure, or because his case is not regularly reviewed. The Bill goes far, if
not far enough, in sketching the outline health service. It divides responmental fully comprehensive sibility clearly between hospital authorities and local health authorities, but having done so, fails to place a mandatory duty on local authorities to establish the community care services for which they are to be responsible. The powers remain permissive, as they have been in the past, and no special financial aid is to be
of
a
provided to encourage the development of new services. Until this done, there will still be large areas of Britain where virtually no community services exist. Finally, there is the question of how members of the public can participate in this work. There will be opportunities for voluntary service in the community for those who wish to help. Already, in a pioneering experiment on the outskirts of South London, some hundred voluntary workers are joining ex-patients in the running of a Social Club which has had a remarkable success. Perhaps the greatest contribution the layman can make is to extend a sympathetic helping hand wherever he or she comes into contact with mental disorder. This will be valuable not only in the more organised forms, such as home visiting and service on committees, but above all in ordinary day-to-day social contacts. For, in the final analysis, it is the attitude of the public that decides the pace and the direction of advance on this, as on so many fronts.
is
