Mental Health Services Need Money, Not Bills

There is a cycle familiar to anyone who cares for someone suffering from an acute mental illness. Patients experience terrifying symptoms: hallucinations, paranoia, delusions. They become unable to look after themselves and are ‘sectioned’, meaning compulsory detention and treatment. Once given anti-psychotic drugs, their condition improves.

They are released for care ‘in the community’, which means they are visited at home – if they even have a home to go to – by health workers who are supposed to make sure they keep taking their medication. As they get better, they are monitored less urgently. They stop taking their drugs. The symptoms return and the patient deteriorates until another section is required.

This is the ‘revolving door’ scenario that Health Minister Rosie Winterton wants to address in the Mental Health Bill announced in the Queen’s Speech last week. Chief among its provisions is the ‘supervised community treatment order’, which would empower health services to force patients to take medication and to section people who suffer from conditions, such as severe personality disorders, that are currently deemed untreatable. Such was the condition diagnosed in Michael Stone, who bludgeoned Lin and Megan Russell to death on a Kent country lane in 1996.

There are good reasons to compel some people to take medical treatment. But this bill has a harder political edge. It is meant to reassure people that such patients will not be roaming the streets. It is launched a week after the publication of a report into the case of John Barrett, a man suffering from paranoid schizophrenia who stabbed a random member of the public in Richmond Park, south west London.

But neither Stone nor Barrett would have been prevented from committing their crimes had the government’s proposed legal changes been in place. Stone was not being monitored at all and Barrett had absconded from care. Alarming though such cases are, they are rare. They are not the best guide to understanding mental illness and certainly not for making policy.

A truer account of what mental illness means is provided by Tim Salmon, an author who writes in today’s Observer about his harrowing experience caring for a son suffering from schizophrenia. He navigates a bewildering and inhumane bureaucracy that excludes people closest to the patient – their families and friends – from decisions about their future. He describes a system in denial about the scale and complexity of the mental illness epidemic in Britain.

The proposed Mental Health Bill cynically dodges the real issue: the inadequacy of long-term care for the mentally ill. There is a desperate shortage of beds and mental health services are on the front line of cuts because they are labour-intensive and do not deliver the sort of results that are easily enumerated by managers. There is not much point strengthening doctors’ powers to section patients when there are no hospital places for them.

Meanwhile, people with serious mental illness can live successfully in the community, but only if they have a strong network of support around them. The government should listen to those people who pick up the pieces when their relatives and friends leave hospital, finding themselves without housing or social care. Instead, they seem determined to try in vain to legislate mental illness away.