BBC HomepageWorld ServiceEducation
BBC Homepagelow graphics version | feedback | help
BBC News Online
 You are in: Health
News image
Front Page 
World 
UK 
UK Politics 
Business 
Sci/Tech 
Health 
Background Briefings 
Medical notes 
Education 
Entertainment 
Talking Point 
In Depth 
AudioVideo 
News image

Wednesday, 20 December, 2000, 16:08 GMT
Mental health: Analysis
Michael Stone
The case of killer Michael Stone prompted the plans
BBC Health Correspondent Richard Hannaford explains the thinking behind the government's plans for mental health reform.


It is thought some 630,000 people in England are in contact with specialist mental health services.

Some 12,000 are in special hospital units.

Meanwhile, the Home Office estimates that there are some 1,600 people defined as being Dangerous People with Severe Personality Disorders (DPSPDs) in British prisons, 400 in special hospital units, and a few hundred in the community.

Part of the problem previous governments have faced in dealing with people who may pose a danger to themselves of others is that of definition.

Who can be considered mentally ill, and therefore treatable, and who is mentally disordered and untreatable?

Existing legislation enables clinicians and specialist health workers to detain and restrain people who they consider mentally ill and a danger to either themselves or to others.

However, people who are mentally disordered cannot be "sectioned", because they cannot be offered any help of therapeutic value.

Broadened definition

The new idea will be to broaden the definition of what constitutes mental ill health so as to include DPSPDs.

At the same time the multitude of existing "sections" (that is sections of the existing mental health acts) will be scrapped.

They will all be replaced with a single Care and Treatment Order (CTO).

To issue a CTO, two doctors and another mental health professional will have to sign the document.

It can only be issued on the following basis:

  • that the person represents a significant risk of serious harm either to themselves or to others
  • it is in their best interests
  • the CTO offers a care plan with therapeutic benefit
It will also specify where the care must be provided - either in a special unit or in the community and will enable clinicians to say to those living in the community must take their medicines, or turn up for treatment.

To safeguard against abuse any order will have to be justified by the doctors using it.

Within 28 days, and regularly thereafter, they must persaude an independent team headed by a lawyer that their decision to impose an order was correct.

Patients will also have the right to an independent Specialist Advocate.

While only one order will now be needed when imposing restrictions on a person - care plan specifically tailored to their needs will need to be attached.

By broadening the definition of mental ill health to include DPSPDs, it means they will also be covered by these orders.

A new specialist service is to be created to cater for people with severe mental disorders with specialist units being set up all over the UK.

Two pilot projects are being set up in Rampton Special Hospital and Whitemore Jail.

Officials have clearly drafted this bill with one eye on the new Human Rights Act.

It is also certain that someone will seek to test the legality of these orders in the court.

The Bill's authors have tried to anticipate and eliminate any obvious grounds for a legal challenge by:

  • defining DPSPD's as having a mental condition
  • ensuring the CTO's have a clear review process and appeals mechanism
  • making sure the orders are made in a therapeutic environment
The government will now face the task of persauding people that this is the best way forward.

It is clear many civil liberties campaigners as well as those who work for mental health charities are concerned by the power this will give clinicians.

To do that Ministers will not only have to prove the safeguards are sufficient, but also that the extra beds, nurses and doctors needed to implement the new regime will be found as quickly as possible.

News imageSearch BBC News Online
News image
News image
News imageNews image
Advanced search options
News image
Launch console
News image
News image
News imageBBC RADIO NEWS
News image
News image
News imageBBC ONE TV NEWS
News image
News image
News imageWORLD NEWS SUMMARY
News image
News image
News image
News image
News imageNews imageNews imageNews imagePROGRAMMES GUIDE
See also:

04 Nov 99 | Mental health
Mental health: An overview
Internet links:


The BBC is not responsible for the content of external internet sites

Links to more Health stories are at the foot of the page.


E-mail this story to a friend

Links to more Health stories



News imageNews image