20 December 2000

Press release embargoed until publication of White Paper

SANE RESPONDS TO WHITE PAPER ON REFORM OF MENTAL HEALTH ACT

SANE, the mental health charity, today welcomed the White Paper on reform of the Mental Health Act. SANE has campaigned for reform to reflect the fact that the majority of people with mental illness are now cared for in the community. Under its Balance of Rights campaign SANE has called for:

• a positive right to assessment, care and treatment for people suffering from mental illness or disorder;
  
• families and carers to be given information and involved where appropriate in key decisions;
  
• the treatability test in the Mental Health Act 1983 for those diagnosed as suffering from personality disorder to be removed.
  

Marjorie Wallace, SANE's Chief Executive said:

"We are pleased that the proposals will end the out-dated polarisation between hospital and community, and are likely to remove the treatability test for people with personality disorders. We are disappointed that it does not seem likely that they will provide positive rights to treatment and involvement of families and carers.

"SANE does not wish to see any further compulsion. The greatly increased use of compulsion we have seen in recent years is due to the lack of early intervention and to impoverished community and in-patient care. The way forward is not more safeguards but a revolution in attitude and more resources.

"We need to replace the lost concept of asylum and ensure the beds, the supported places and far more skilled staff to provide the rigorous risk assessment and care needed. The Government must look beyond the law and guarantee the funding to provide the ‘safe, sound and supportive' system it promised."

ends

Notes to Editors

• On the issue of compulsory treatment, SANE continues to believe that it should only be used as a last resort, with full safeguards for the individual, in a fully clinical setting, and wherever possible as part of a contract between the patient and services
  
  
• SANE is a member of the Mental Health Alliance, a grouping of voluntary organisations, service user groups, service providers, professional organisations and trade unions sharing the following views on reform of the Mental Health Act:
  
  

1. The aim of the new legislation should be to reduce the need for using compulsory powers.

2. The new legislation should offer people an individual enforceable right to a comprehensive assessment of their needs; and to have their identified needs met with good quality and effective services.

3. A free independent advocate should be available to everyone at all times, from the point of assessment; and the Government should provide adequate resources for this on a national basis.

4. The current law takes insufficient account of people's capacity to make their own treatment decisions and leaves those deemed to lack capacity without proper protection. New legislation must address both these issues in conjunction with wider incapacity legislation. Incapacity must not be equated with disagreeing with your doctor and must be sensitive to cultural differences.

5. Capacity to take treatment decisions should be part of any formal mental health assessment. In relation to longer-term criteria, compulsion on grounds of benefit to health should be more readily available for those who lack capacity in the absence of incapacity legislation. The forum for resolving any disputes over capacity should be the Tribunal.

6. People with mental health problems should have the right to draw up advance statements on their care and those they want involved in such are. Such statements should be legally enforceable such that a person who has lost capacity (whether detained or not) has the same rights as someone who has retained capacity.

7. There should be a duty for full information to be provided on any proposed treatment and for informed consent to be sought in every case. Special safeguards should continue to apply to psychosurgery, ECT and long-term drug treatment and should be extended to polypharmacy1, prescribing above BNF levels1 and force feeding. Where treatment is without consent it should be subject to independent review including a second medical opinion and involving consultation with patients and their representatives.

8. We support the formation of new independent tribunals as long as they reflect the community they serve, comprise a breadth of experience (including that of service users) and receive appropriate training. There should be an independent appeals procedure against the Tribunal's initial decision.

1The British National Formulary (BNF) is a guide for general practitioners setting out recommended dose levels for medication. We accept the Richardson Committee's definition of polypharmacy as the concurrent administration of more than two drugs for mental disorder from the same BNF class.