Tough Mental Laws ‘Could Put Public At Risk’

The Government’s plans to toughen up mental health laws are “fundamentally flawed” and could put the public more at risk from dangerous criminals, mental health experts warn today.

Forensic psychiatrists Dr John Crichton and Dr Rajan Darjee say the proposed Mental Health Bill which is progressing through Parliament is so broad it would label most violent offenders as having a mental disorder.

The new government bill would allow the enforced detention of people who are mentally ill, even if they have not committed any crime. Writing in the British Medical Journal, the doctors say it would therefore place them within the boundary of needing compulsory psychiatric treatment.

They said: “What prisoner will engage in an anger management course or a sex offender programme with the prospect of compulsory indefinite detention and transfer to a secure psychiatric hospital? What potential patient with a violent thought will dare seek help from a doctor?”

The bill also suggests strengthening powers established in 1983 to ensure patients have therapy once they are released back into the community. The desire to change the law was largely driven by Michael Stone’s 1998 conviction for the murders of Lin and Megan Russell.

But the bill simplifies the criteria for mental disorder. Dr Crichton, of Royal Edinburgh Hospital, and Dr Darjee, of the University of Edinburgh, highlight in particular the identification of sexual deviance as a category where treatment should be compulsory.

There is provision for supervised community treatment but they say it lacks the appropriate safeguards. They said: “The group of people with the responsibility for the detention of patients is widened, despite what they say is a lack of clear guidance detailing how this would work in practice. And the test which determines whether a patient should be detained is being replaced with a broader one as the old test was seen to limit the ability to detain patients.”

They argue the government is focusing too much on public safety and that paradoxically that will increase the risk to the public. They say the rate of violence in those with mental disorders actually mirrors the rate of violence of those in the same social group. Treating violent and sexual offenders medically is, they say, unlikely to make them change their ways unless the aim is a very long preventative detention.

They also say there is too much focus on individual high profile tragedies, for example, the failings in the mental health care of John Barrett, a paranoid schizophrenic who in 2004 stabbed Denis Finnegan to death as he cycled in Richmond Park. They said: “Results from the National Confidential Inquiry identified only 12 cases, 6% of a sample, where respondents involved in the care of a mentally ill perpetrator believed different legal powers may have made a homicide less likely.”

The authors agree the best way for mental health to protect the public is the provision of comprehensive services, but say the government needs to be realistic about what can be offered. They said: “The fundamental flaw in the proposed legislation, as it was in the two preceding unsuccessful bills, is the government’s belief that mental health law is a worthy vehicle to enhance public protection – a belief that has been extensively criticised.”

They point to Scotland where the Executive has successfully implemented mental health legislation after keeping the focus on care and treatment. Yet in England and Wales new mental health legislation has faltered because of a confusion of purpose. They say mental health services should be seen as a support for criminal justice agencies and the law when appropriate.

Added Dr Crichton and Dr Darjee: “Efforts for reform will fail if mental health legislation is wrongly identified as a principal mechanism for enhancing public safety.”

Current laws do not allow people with severe personality disorders who have committed no offence to be detained. The government wants to give the right to force patients who have been released into the community to take their medication, even if they do not want to. It also wants to allow the detention of people with personality orders who are described as untreatable, even if they have not committed a crime.

The bill was promised in the Queen’s Speech and comes after previous attempts to change the act were thwarted by opposition from campaigners and doctors. The government published a draft Mental Health Bill in 2002, but dropped it last March.

Instead of replacing the old laws, the latest bill proposes amending the existing Mental Health Act from 1983. About 50 Labour MPs have already signalled their intention to oppose the bill, which would apply to England and Wales. The changes would affect about 14,000 of the 600,000 people who use mental health services each year.