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
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
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.