The UK government's announcement that it has abandoned its eight year attempt to achieve a new Mental Health Act for England and Wales is an apparent victory for patients, professionals, and liberal democracy, writes Professor Nigel Eastman of St George's Hospital, London.

But faced with almost unanimous opposition from those with an interest in mental health care, the government has stated that it will instead introduce a shortened and streamlined bill amending the 1983 Mental Health Act.

This amending legislation will replace the Draft Mental Health Bill that had been described as a "Public Order Act" which would be "unethical, unworkable, and also ineffective," even in enhancing public safety.

The bill's most contentious proposals included widening the criteria for compulsory detention and treatment, and removing the "treatability test" for personality disorder (so that those with dangerous and severe personality disorder could be detained by doctors when not capable of being sentenced by criminal courts). It's uncertain whether the legal amendments now being proposed will be any less controversial, says Eastman.

The government's climb down on reform of mental health legislation is, almost certainly, merely a prelude to climbing up by another route, he warns.

Crucially, amendments should include introducing guiding principles into the act, including those of autonomy and reciprocal rights, in order to enhance consistent and ethical operation of the legislation. Unsurprisingly, this is resisted by the government.

He urges professionals working in mental health care, including general practitioners, to be vigilant in scrutinising the detail of the proposed amending legislation.

"There is a grave danger of being lulled into a false sense of
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Contact: Emma Dickinson
edickinson@bmj.com
44-207-383-6529
BMJ-British Medical Journal
30-Mar-2006