Common Agenda
Newsletter
Mental Health User/Survivors and Disabled People campaigning together
New Mental Health Act…direct from
Special Mental Health Green Paper Edition
Hell
In mid November, the Mental
Health Green Paper (Reform of
the Mental Health Act) was
released by the Government. It
includes the hated Community
Treatment Orders as expected. Press
reactions were mixed and probably
can best be described as luke-warm.
The Guardian felt that “care in the
community” had never been properly
tried and that it should be adequately
planned and resourced before
compulsory treatment was introduced.
The mental health world of mainly
professionals and voluntary sector was
almost universally critical. The
notable exception was Michael
Howletts from the Zito Trust who
expressed the view that the Green
Paper was a good development and he
hoped “it would not get watered
down” during the legislative process.
But even he said “If a patient is sitting
in a bedsit refusing to take medication,
December
1999
they really need to be returned to a
clinical setting where they can receive
humane treatment.”
Publicly survivor groups have yet to
comment in detail on the Green Paper
but have said again and again that they
do not want compulsory treatment –
let alone in their own homes.
Privately survivors are saying that
Government proposals are much
worse than they feared, and the
document makes for extremely
distressing and depressing reading
indeed.
This Edition of the Common Agenda
Newsletter is devoted to an
exploration of the Governments
proposals. As we shall see they are
very far-reaching. The Green Paper is
believed to have been written in 3
months, and counteracts the Report by
the Expert Committee – which clearly
the Government found very
disappointing
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What the Green Paper (Reform of the Mental Health Act 1983) contains
Principles
The first important part of the document
deals with Principles. One is: Informal
care should always be considered before
compulsory powers. This is no change
from the 1983 Act. Another is: Patients
should be “involved as far as possible in
the process of developing and reviewing
care plan.” This is of course an optional
principle which can easily be ignored.
Ominously though it could spell the end
of any credibility given to collective user
involvement which is not mentioned.
Public safety being of key importance is
the Government’s central principle which
overrides all others. The documents
then cites a further principle that “care
should be the least restrictive setting
consistent with safety, best interests of the
The “Sectioning” Process
Forced Treatment to operate
everywhere
We have to remember that the sectioning
process leading to forced treatment is now
to be extended beyond hospital – both out
into the community and into prisons.
Any Professional can section us
Although not decided yet, the Government is
leaning towards allowing any mental health
professional to be the applicant for a section
– not simply Approved Social Workers as
now. Conceivably this could be your Care
Home Manager - which could leave room for
massive abuse. Sections could be used as
a means to evict people. The important
thing here is the independence of ASW’s is
now under direct threat.
patient, and safety of the public”. This
may sound good but is probably a
meaningless fudge, since it lets providers
off the hook.
There is no mention of what many agree
is or should be the central aim of mental
health services – the relief of suffering of
people in distress or crisis. Sadly
Human Rights of people are to be given
no weight under this legislation – when
mental health history is littered with
major Human Rights abuses. And other
principles such as patient autonomy, non
discrimination, consensual care,
reciprocity (a right to a service) are
rejected as being covered elsewhere.
One good thing
Government recommends that all people
sectioned are to be reviewed by a tribunal –
not just those people who apply to the
Review Tribunal as now. On balance this
may be one of only two good things in the
document for survivors.
Treatment before assessment or appeal
However the timing and the number of
allowable applications is something which is
highly sinister. Government questions the
need for a review within seven days.
Assessment abolished
Also because the paper keeps talking about
“initial assessment and treatment”, we can
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assume that the assessment process is
effectively abolished. So we can be treated
routinely against our will without appeal!
And before the presence of a “mental
disorder” is established. This is rather like
carrying out a punishment before a trial.
And how many people wrongly sectioned
ever get redress?
An appeal process ditched
The horrific part of this is that Sections two
(28 days) and Three (6 months) of the 1983
Act are effectively merged. This means
that one appeal procedure is abolished.
Now you can only appeal once – lose that
appeal (while you are still perhaps in crisis
and are likely to do) and you can be treated
for six months. This is no justice at all since
it is weighted so massively in favour of the
system!
The shape of the tribunal itself is something
the Government clearly has trouble with in
deciding. It will now chaired by a lawyer.
There could be a three person tribunal or a
one person tribunal who have access to
specialist medical and social care experts.
The arrogance and injustice of this is
astounding as the person making an appeal
does not have access to their own experts.
This would not be permitted in criminal or
civil cases in the Courts. There is to be no
access, as survivors argued for, to
independent second medical opinion of their
choice.
The Tribunal itself, instead of being a Mental
Health Review Tribunal is to be renamed a
mental disorder tribunal. Of course this
ugly name is more than just a piece of
stigmatisation, it is presuming “guilt” from
the outset and is therefore highly prejudicial.
No Justice – no establishing the facts
Survivors know full well the weakness of
information about held about them.
Psychiatric notes are notorious for
containing, innuendo, negativity, hunch,
hearsay, chinese whispers and bald face
lies. Professionals lie because they know
they can get away with it. Within these
proposals there is no mention of a sacred
principle of justice – the rules of evidence.
If we are to be forcibly treated and some of
us will die as a direct result of that treatment,
we are owed a trial – with a judge and a jury,
at which information which is held about us
is open to cross-examination. In short
evidence should be tested so the facts can
be established.
People have been sectioned for reasons
such as “smoking in bed” at a residential
home or crossing a busy road slowly.
Without the testing of evidence justice is
likely to be both summary and arbitrary.
Another Appeal Process to go
Presently there are two independent bodies
which can discharge a person from
compulsion – the Tribunals and the Hospital
(Mental Health Act Managers). At present
you can appeal to either body or both.
Whereas the Hospital Managers rarely
discharge nowadays they can make
recommendations to professionals about
any aspect of treatment they are not happy
with.) The Government proposes removing
this entire tier of safeguards by abolishing
the Hospital Managers and putting nothing
in its place. Now no independent body or
person may review your treatment.
(Government is concerned that the new
Tribunal cannot interfere with care plans).
Capacity There has been a lot of debate
recently around the rights of people capable
of making decisions, to actually make those
decisions – including those around their own
health care. Astonishingly Government is
of the view that this issue is entirely
irrelevant in mental health. For them
capacity should not enter into mental health.
It should be overriden entirely by the
interests of those they see do have capacity
i.e. the public. Logically the default
position is that all those whose mental
health is called into question will be deemed
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to have no capacity to decide. Therefore
they will not be permitted to decide anything
about treatment which is not convenient for
professionals. This contravenes a
fundamental right – the right to self-
determination.
Instead people will be treated in what is their
“best interests” and those best interests will
be decided by who else… mental health
professionals. Real scary eh?
The Compulsory Order in the
Community (CTO)
At the heart of the document is the CTO
which of course is a brand new power. This
will require a person to live at a specified
place in order to allow easy access by
professionals, “trained paramedics” and the
police. The person will be under curfew at
particular times to allow access for
scheduled visits. The CTO will state the
consequences of non-compliance which
may include powers to enter by force,
convey the person to a place of treatment (in
the community) or to hospital. Although
the order will last for specified periods, it is
renewable so effectively it could be without
indefinite.
Against orders less than three months there
is no appeal. This is very heavy indeed for
people most of whom will have committed
no crime.
The Mental Health Act and Offenders/Prisoners
The new proposals suggest that the new Act should operate in prison – quite unlike the
1983 Act which prohibits this. For good reason too, since forcing medication on prisoners
used to be thought to be so liable to abuse it could not be allowed. Why it is thought that
abuse would not operate now is hard to see.
Massive powers of indefinite
detention for all Courts
The Court which sentences offenders will
be given brand new powers to send any
Users forced to pay for compulsory
services?
Additionally part of the compulsory care plan
may require someone to attend a Day
Centre or other social care facility.
Although the Government is especially
reticent about this, they do not rule out
forcing people to pay charges for social care
services they are ordered to use! That of
course is a new tax on vulnerable people.
But the stigma, fear and inconvenience of
this interference in our lives is as nothing
compared with the so-called treatments that
will be forced upon people in the community.
For at the heart of this procedure lies the
effects of old-fashioned and often dangerous
injectable neuroleptic drugs and also forced
Electro-convulsive therapy (ECT).
Neuroleptics help some people but in some
they cause death. In others they cause
restlessness, loss of looks and massive
weight-gain, profound depression and
perhaps saddest of all – the loss of
imagination. ECT also helps some people
but often causes profound brain damage
and memory loss.
Without medical support and monitoring
such treatments when given to people living
in the community will inevitably lead to an
increase in death-rates.
prisoner – whether convicted or on
remand awaiting trial, to prison, hospital
or to be treated forcibly in the
community.
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Magistrates and higher courts will also
have a new power to remand people to
hospital for treatment – even if they are
unconvicted or convicted of an offence
which does not carry a custodial sentence.
One of the most abhorrent parts of the
Green Paper suggests that prisoners with
a “mental disorder” i.e. a majority of all
prisoners according to research cited by
the Expert Group may now be treated
differently from other prisoners. They
may now be assessed under the new act
and treated either in hospital or in prison.
If treated in prison, s/he may be treated
for as long as that mental disorder lasts.
The net effect of this may be the end of
time-limited sentences for some, and the
end of parole for others. It is surely
monstrous for someone say sentenced for
21 days for non payment of TV licence to
end up spending a lifetime in jail because
they have a psychiatric diagnosis!
And how elegantly does the Green Paper
mask this preposterous proposal: “A
finding that an offender suffered from the
mental disorder for which medical
treatment was available should suffice to
enable his subsequent safe management
for as long as the disorder persisted.”
And of course exactly when has anyone
with a psychiatric diagnosis ever had that
diagnosis lifted?
The police are to be given new powers to
remove people from private property.
No New Safeguards
The Government has already assured
Parliament that safeguards would be
adequate and put in place. Yet we have
already seen the careful dismantling of so
many safeguards which although
inadequate – do exist currently under the
1983 Act. So are there any new ones?
Psychosurgery is to be subject to special
safeguards just as it is in the 1983 Act.
Government is clearly of the opinion that
ECT should not be controlled with special
safeguards and may be forcibly given as
of now.
Polypharmacy is defined as three or
more drugs of the same class, whereas in
reality it should of course be two or more.
And this warrants some mention but only
in the Code of Practice – which is of
course optional only. Polypharmacy of
neuroleptics is known to be especially
dangerous.
Special Safeguards against depot
medication or long-term injectable
nuroleptics was suggested to the Expert
group as being crucial to the welfare of
patients – especially in the community
where medical monitoring is at a
minimum. Long-term use causes
neurological damage and brain shrinkage.
“We do not accept that depot medication
should be subject to special safeguards”
says the Government with casual
indifference.
So how many new meaningful safeguards
are to be contained in the Act when so
much more is known about the dangers of
treatment since the last Act was written in
the early Eighties? Precisely zero!
Another good thing
The fact that a patient can choose their
“next of kin” who will have powers to
apply for discharge – is something that
survivors have argued for so this has to be
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welcomed. However the Tribunal can
replace the nominated person.
On the other hand – a carer is given the
huge right to have a person assessed for a
mental disorder. This traditional right of
the next of kin is now extended to
presumably anyone who says they are
your carer – including of course the Care
Home Manager. Now the Manager asks
for an assessment and has the dual
function of applicant under the Act!
Right to Advocacy – not
recognised
It was great hope that a right to an
independent advocate would be contained
in the new Act, but Government has
witheld this right although they will keep
the situation “under review”. Of course
this means that a new Act will come out
before the right to Advocacy is
established. This is very poor.
Perhaps the greatest hope of all was the
people under a New Act would be able to
make Advance Directives. The
Government has different ideas and
waters down the concept to advance
agreements and then goes further by
saying “Advance agreements will not be
given special status in the Act.”

Conclusion
If you are unfortunate enough to become part of this brave new mental health
world, this is no less than the arrival of the totalitarian state. This Green Paper
displays massive incompetence on two fronts. It is ignorant about mental
health, it is ignorant also about justice. As a piece of law, it may be the most
oppressive one introduced to the UK this century – internment included. In
fact as far as the rights of people are concerned it echoes the sort of laws which
the Lord Chancellor of the 1690’s – Judge Jeffreys operated – when he
condemned political opponents to death without trial.

What Needs to be done

Firstly study the Green Paper and the flawed but relatively/considered report by the
Expert Committee chaired by Professor Genevra Richardson which was published at the
same time. You can download both documents from www.doh.gov.uk on the Web. Order
copies of the Green Paper from: The Stationery Office London 123 Kingsway, London
WC2B 6PQ Tel: 0171-242 6393 Fax: 0171-242 6394

Responses should be sent by 31st March 2000, to:

Will Niblett Department of Health Wellington House 135-155 Waterloo Road London
SE1 8UG
The Expert Group Report (Review of the Mental Health Act) is available from the
6
Department of Health: Richmond House
79 Whitehall
London SW1A 2NL
Tel: 020-7210-4850 (10.00 - 17.00 Monday - Friday)
Tip – Copies of both documents may be available from your local Community Health
Council free of charge.
Make sure your group does a response to this Green Paper. Also arrange meetings locally
to discuss it. Common Agenda is going to promote London-wide or sub-regional
meetings before March. Please make sure you local Association of Disabled People are
aware of these proposals.
One of the dilemmas survivor groups may face is whether to reject the entire Green Paper
– or try to work with it as it stands. The Expert Committee Report – had it formed the
basis of the Green Paper – was something that perhaps survivors could negotiate from.
But whether the Green Paper forms any basis for negotiation whatsoever is quite
another matter. And make sure your MP knows your individual views as soon as
possible.
This is a horrible evil and fascist set of proposals. It is brim-full of hatred and revenge. It
simply cannot stand. Watch out for campaigns and get involved! This affects all of us.
Events
June 23-25, 2000 (!!!) The Russell Tribunal – on Human Rights in Psychiatry. Scarborough. At
which the World Psychiatric Assocaition will be accused of persistent systematic violation of human
rights through coercion. Speakers include Kate Millet – author of the Loony Bin Trip. (co-hosted by
Scarborough Survivors) Mental Health Resource Centre, 9 Almo Square, Scarborough, North Yorkshire