BBC On The Record - Broadcast: 13.10.02

Film: David Grossman asks whether the Government is thinking again about the controversial aspects of its review of the Mental Health Act.

DAVID GROSSMAN: It's easy to see mental illness as another world, dangerous, frightening and confusing. The Government knows that one of the biggest public concerns about the mentally ill is the small number who hurt other people. Shocking stories of psycho killers are a tabloid staple. The Government's response is a proposal to change the law but their ideas are so controversial the Government may now be having to think again. The proposals would change Mental Health Law in two important ways; firstly it would allow doctors to compel those being treated for mental illness within the community to accept their treatment. At the moment that can only be done inside hospitals. And secondly, it would allow those few disturbed individuals with what is known as Dangerous Severe Personality Disorder to be incarcerated, even if their condition is untreatable and even if they've never broken the law. Now both these changes say critics and there are many of them, raise fundamental questions, not only about how we treat the mentally ill within our society but also about civil liberties in general. DR LIAM FOX MP: The Bill is regressive, it sets back attitudes to mental illness a hundred years in my view. It is stigmatizing at a time when we have to reduce stigma in mental illness and potentially is a threat to our civil liberties. It is a very bad Bill, drafted for the wrong reasons and it needs to be stopped in its tracks right away. GROSSMAN: Care of the mentally ill has come far. In the nineties many Victorian asylums closed, their patients released for Care in the Community. But the Government thinks that Mental Health Law hasn't reflected this change, compulsory treatment can only be given in hospital. As the law now stands, there is no way for doctors or other mental health professionals to force a Care in the Community patient to accept their medication. Jonathan Zito was killed by a schizophrenic who wasn't taking his treatmen, Christopher Clunis stabbed him to death in a random attack. Jonathan's widow, Jayne Zito, has long campaigned for a change in the law. JAYNE ZITO We feel that this Compulsory Treatment Order, would mean that individuals who suffer from severe mental illness like Christopher Clunis would, when they start to deteriorate, when they begin to show warning signals that things are not right, that they're not taking their medication, that they're becoming ill in the community, that prevention can take place, so we don't see people deteriorating rapidly till horrendous things happen for them and for the people around them that they love. GROSSMAN: But Jayne Zito has few supporters here at the World Mental Health Day Fair in Wakefield. Practically every organisation that has anything to do with this area of care is against the government's proposals. More than fifty organisations, including the Royal College of Psychiatrists and the Law Society as well as charities like Mind have joined in the Mental Health Alliance to fight this change to the law. PAUL FARMER: As an alliance we've got three major problems with it. We think it's unworkable, unethical and it's flawed. We think it's unworkable because of the large amount of resources required to put into the system to try and make it work. We think it's unethical because of the relationship the professionals will have with people with mental health problems which will turn them from doctors into jailers. And we think it's flawed because underneath the headlines are some very real problems with a lot of the detail which means it's going to lead to a significant increase in the use of compulsory powers. GROSSMAN: Emma Harding was diagnosed schizophrenic while at University. She's now well but is still having treatment, she now works helping people with mental illness to find jobs. She says that having the threat of compulsion hanging over her would have made it much less likely that she would have sought help in the first place. EMMA HARDING: I would have been a lot less willing to actually access mental health services, had I thought that there was a likelihood that I'd be treated compulsorily. I think there's a lot of stigma attached to that particular situation. I think it's quite likely that people will want to be a little bit more guarded about the information they give to mental health professionals, if there's an increased chance that compulsion is going to be used in their treatment and it will put a lot of people off actually being open and honest about some of the feelings they have and that will make people more vulnerable to suicide for example. GROSSMAN: But Compulsory Treatment Orders aren't the only controversial proposal. At the moment there are some individuals doctors can't help. The condition is called Dangerous Severe Personality Disorder, those who have it are more commonly called psychopaths. It's a controversial diagnosis as there's no accepted way to recognise it and some dispute whether it exists at all. The current Mental Health Law can only be used to detain those whose condition is treatable and Dangerous Severe Personality Disorder can't be treated. That means these individuals can only be dealt with by the Criminal Justice System, commonly resulting in a cycle of violence, imprisonment, release and more violence. The government wants to move to close down that cycle and allow individuals with Dangerous Severe Personality Disorder to be detained indefinitely before they can harm anyone else. Sounds very neat, but hang on say critics, that change would fundamentally destroy cherished principles of civil liberty. Dr LIAM FOX If you are regarded as having a Personality Disorder and remember there's no objective test for that and someone thinks that you might commit a crime in future, you can be detained against your will. It's the only example I can think of in this country where you could actually have your liberty denied without breaking any law and I find that really quite sinister. DAVID HINCHLIFFE I think there is a worry that where you've got an unclear definition that this may become a dustbin to include people who are not in any way suffering from Personality Disorders, who are not in any way suffering from mental health problems, who may be people who conveniently could be excluded from society without the appropriate mechanisms of protection of the law that this country is...has prided itself on over many many years. GROSSMAN: But such a law, say its supporters might have saved Lin and Megan Russell. Josie Russell only just survived the attack that killed her mother and sister. Before the murders their assailant Michael Stone was known to have had a Dangerous Personality Disorder but couldn't legally be detained. ZITO: The Zito Trust welcome this because we see it as a much better option, than allowing individuals who are very vulnerable, individuals with personality disorder, to be left within our Criminal Justice System, to serve a sentence and then to be thrown out onto our streets, sometimes to commit and repeat the same crimes again. So we see this again, as a preventative measure, that looks humanely at individuals who have complex diagnosis within our communities. GROSSMAN: But would such a law have been the only way to stop Michael Stone. The inquiry into the murders found that he'd actually been in contact with mental health workers and shortly beforehand had begged to be admitted to a secure hospital, only to be turned away. What's needed say critics, is an improvement to standards of mental health care, not a dangerous new law. FARMER: The homicide inquires that have taken place over the last ten years or so, really show very clearly that people were often either in contact with Mental Health Services and the services failed them for whatever reason, or that they tried to make contact with Mental Health Services, only to be turned away, because the service was too busy. The person wasn't considered to be sufficiently in crisis and if we are going to eradicate those issues, what the inquiries say time after time is that you need to make sure you've got decent quality, properly resourced Mental Health Services to address the needs of the individual. GROSSMAN: The government's ideas on mental health are at the moment only proposals. The consultation period on them has just finished and everyone is now anxiously awaiting a final version. Can it really be that given the level of opposition that these measures have managed to excite, that the government now intends to push on with them regardless. Well, recently the government's Mental Health Tzar Louis Appleby has suggested that changes may have to be made before a Bill is presented to Parliament. That suggestion that the government may be backing down would seem to fit in with our experience when we tried to get a minister, any minister, to come on to defend these controversial ideas. We were told that no minister from any government department involved in the Bill was available for interview. FARMER: I think this is a government which runs on headlines and I think it thought that it would get support from certain sections of the tabloid press. I think to everybody's credit, they have actually decided this is a hugely cynical exercise which purposely sets out to demonise and stigmatise people with mental illness which is a retrograde Bill and which should be overwhelmingly rejected. We intend to lead the fight in Parliament, to make sure that this Bill does not progress from this point. HINCHLIFFE As the Bill is currently drafted there are some key areas where I think there may be serious difficulties in convincing the House of Commons and certainly the House of Lords that the measure as it's currently drafted is right, is achieving the appropriate balance. There are some very genuine worries, but I hope these will be addressed by the ministerial team in the process of discussion prior to the Bill coming to Parliament. JAYNE ZITO: We will be very disappointed if the government actually withdraw the major recommendations that they've made within this review of legislation. We know that we only have one opportunity every ten/fifteen years to influence and change legislation in this country that will have a major impact on individuals who are vulnerable, and the...wider public. So we will be very disappointed if the government withdraw the recommendations 'cos we whole heatedly support the recommendations as they stand within the review of the Mental Health Act. GROSSMAN: In the treatment of the mentally ill there are no quick cures. In Mental Health Law too the answers aren't obvious or easy. The government has singularly failed to convince its critics that it's got the balance between patients' rights and public safety and now may be having second thoughts.
NB. This transcript was typed from a transcription unit recording and not copied from an original script. Because of the possibility of mis-hearing and the difficulty, in some cases, of identifying individual speakers, the BBC cannot vouch for its accuracy.