News > Key article published in The Independent on Sunday

Created: 2002-11-17 12:59:53

The Independent on Sunday has printed a key article outlining 'The SANE view' on rights for mental health service users, written by former journalist and SANE's Chief Executive, Marjorie Wallace.

SANE  shares the collective dismay at the clumsy handling of the Mental Health Bill, left out of the Queen's Speech but seemingly revived the next day by the Secretary of State. As originally drafted the legislation was riddled with flaws, open to misinterpretation, and had created a climate of fear, alienating not only those whom the proposals were intended to benefit but also the psychiatrists and other professionals responsible for providing that help - turning them, they say, from therapists into jailers.

Widening the scope of mental health laws to include people with "untreatable" severe personality disorders and abusers of drink or drugs also revived old terrors of the state taking away liberty, on the grounds of odd behaviour or from more sinister motives.
Now, however, as an individual who has long campaigned for "root and branch" reform of an outdated legal system, I am concerned that the Government's crumbling nerve in the face of criticism could risk an even more jittery compromise between those old warring agendas: civil liberties and public safety.

There is sometimes an inherent conflict between the rights of a person with mental illness or disorder and the families or carers who feel their rights have been ignored. This conflict has been inflamed over the past years, as the public has been disproportionately traumatised by the relatively few but shocking tragedies headlined in the media.

The reality which any new bill should better reflect is that the majority of people with mental illness need not more legislation restricting their freedoms but rights to the care and treatment they are all too frequently denied.

Recent surveys show that one in three people are turned away when first seeking help for illness or relapse, and patients are made to wait for up to a year or more before seeing a consultant. We listen to an average 1,000 callers a week on our telephone help service SANEline, two thirds of whom are service users. Many tell us that if they had been given help when they first sought it, before they became so ill they denied their illness and refused voluntary treatment, there would have been less need for compulsion and all the misery it can bring.

Despite the fashionable rhetoric of choice and diversity there is still no option to have humane inpatient care, time for rehabilitation, or a place of asylum when stresses are intolerable, let alone consistent and reliable care in the community. Mental health law should be designed to prevent a person deteriorating to the point they have to be detained against their will, and to protect them from neglect and suicide. Any increased compulsion should be on the services to fulfil their duty of care, rather than on the individual.

The concept of compulsory treatment orders for people living in the community has been one of the Bill's red rags. There was genuine alarm that people who did not need or want medication would endure kitchen table jabs and be left to get on with the often devastating side effects of powerful medication. SANE is firmly opposed to anyone being forced to take medication outside a hospital or other clinical setting.

There were, however, good things in the Bill albeit still in need of revision.   It could be argued that the most controversial proposals, if examined dispassionately, may have made a difference to the outcome of some of the headline cases which propelled the reforms in the first place. Michael Stone was deemed untreatable and therefore not eligible to be detained in hospital. The Bill would have changed the main criterion for sectioning from treatability to the risk a person posed, to themselves and others. Had he been sectioned when seeking help he may not have murdered Megan Russell and her mother. After seeing 43 psychiatrists in four years Christopher Clunis was discharged into the community, where the follow-up was pathetic. Unlike Michael Stone, he had paranoid schizophrenia, an illness which responded well to medication.  No-one even seemed to know he had stopped taking that medication.  Social services had left a card on his doormat while he was already on the way to Finsbury Park, where he stabbed Jonathan Zito. The Bill would have given Clunis the right to a care plan, and put the onus on the health and social services to ensure that he took his medication or was returned to hospital. Had this happened he may not have deteriorated over the crucial weeks before he killed.

There are important proposals I would like to see included. Families and carers should have legal rights to reflect their status. They should no longer be fobbed off by issues of confidentiality when lack of information jeopardises their own and the health of the person they look after. If a person with mental illness is to be given the right to an advocate representing their interest then so, in some circumstances, should their carer. We also believe victims and their families should have the right to information when a person who has perpetrated a crime against them is, for example, being discharged.

The third important element is to ensure that people are given the right to advance directives, so that if they reach a state in which they are considered unable to make a rational decision they have chosen in advance the kind of treatment they would accept.

The chance to revise the bill gives us a rich opportunity to resolve the many different agendas and produce a more workable set of guidelines. But the bleak truth is that no new laws can make up for the horrendous undernourishment of medical and social services in this stigmatised field. Neither can legislation change how people carry out their jobs, as in the recent case where two social workers were apparently so reluctant to invade the privacy of a patient that they didn't realise she was already dead. It can, however, provide an enlightened framework that enables people with serious mental illness to receive better quality care and treatment; and for those around them to be able to intervene more effectively, before an unnecessary tragedy occurs.

A slightly shorter version of this article was published as part of the Independent on Sunday's Mental Health Campaign, 17 November 2002.