That is the question to be debated at this year’s Maudsley Debate.
In England and Wales, anyone who is classified as having a “mental disorder” can be detained and treated, against their will, under the provisions of The Mental Health Act (MHA). Many people, national and international organisations, have opinions on this being the case, for example the United Nations, has stated that it believes the UK should repeal legislation authorising compulsory treatment in healthcare.
Should The Mental Health Act be reformed or could reforms actually make the situation worse?
56th Maudsley Debate. 18:00, 22 November 2017, at King’s College London.
For Reform: Rt Hon Norman Lamb MP and George Szmukler, Emeritus Professor of Psychiatry and Society at King’s College London.
Unjust discrimination against people with mental ill health in relation to involuntary treatment, should be replaced with universal rules based on decision making ability. In non-psychiatric cases, the person’s decision-making ability (capacity) and what is in their best interests, are key to when treatment decisions can be overridden.
Yet in psychiatric cases, mental health law invokes two entirely different criteria operate:
- the presence of a (largely undefined) ‘mental disorder’ and…
- a perceived ‘risk’ to the person’s health or safety, or of harm to others.
The patient’s autonomy is thus not accorded equal respect.
We have accepted such discrimination for so long because of deeply rooted, stigmatising stereotypes of people with mental illness ‘that they are incapable of exercising judgement and that dangerousness is intrinsic to mental illness’.
We can create a legal framework governing involuntary treatment that is non-discriminatory and applies to everyone who has a problem with decision-making, regardless of their diagnosis, be it physical or mental or in any setting, medical, surgical, psychiatric, or in the community.
Northern Ireland has taken the ground-breaking step of enacting such a law. Why not the rest of the UK?
Against Reform: Professor Annie Bartlett and Scott Weich, Professor of Mental Health at the University of Sheffield
A world without compulsory mental health treatment is a commendable ambition, but could a change in the law open up all manner of legal distractions, that will not necessarily improve outcomes, while services remain stretched?
By abandoning the Act as in Northern Ireland, lives would be lost and more people in distress, could go without help. It would also mean contravening other human rights, including the rights to health, liberty, justice, and life. The most vulnerable people would likely suffer most.
The law is not the problem. A properly resourced mental health services would reduce rates of compulsion and assure decent, humane outcomes. But as the NHS is so thinly stretched, abandoning the MHA would discriminate against people with mental illness by denying them care.
One of the paradoxes of the MHA is that its application obliges services to provide care. Only patients deemed at most risk can access mental health beds. In other words, they get help only because the MHA (that is, the law) demands that they get treatment.
We can’t divorce the law from its setting and focusing on the MHA alone is a dangerous distraction. Unless services are properly resourced, changing the law won’t make things better for patients, and it might make them very much worse.
Chair: Professor Anthony David
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