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You and Yours - Transcript 大象传媒 Radio 4 |
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TX: 18.06.07 - Mental Health Bill PRESENTER: WINIFRED ROBINSON |
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THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE 大象传媒 CANNOT VOUCH FOR ITS COMPLETE ACCURACY. ROBINSON Now it's been eight years coming but could a new Mental Health Bill finally be delivered? Ministers have spent almost a decade trying to update the 1983 bill for England and Wales. It's been drafted and redrafted, rejected, faced huge resistance from service users, their families and professional bodies and clinicians before being completely scrapped. Now it looks like being back on again. The government published its amendment to the bill last week and today it's discussed in the House of Commons. Carolyn Atkinson has been talking to the government's Director of Mental Health, Professor Lewis Appleby and first to Andy Bell from the Mental Health Alliance, which represents 75 mental health organisations. BELL There are a number of concerns that have come from service users and their families and professionals as well which have been about increasing the scope of compulsory powers but also looking to positively create an act that brings in new rights as well as responsibilities for people. And there's been lots of very legitimately different perspectives and it's been about trying to reconcile those to take this forward. ATKINSON Let's sum it up: How do you feel about this? BELL It's a bill which we still have concerns about but it's definitely improving. ATKINSON Now the Director of Mental Health, Professor Lewis Appleby, is also here. Professor Appleby, we hear there there's been, as you know, a lot of opposition to this, have you been listening? APPLEBY Well we've been listening for eight years, I think it is. You have to remember this is a quite a - it's a difficult area where you have to balance patient autonomy with the need to get treatment to people when they're ill and perhaps don't recognise their treatment needs. So it's quite right in a way that it should be contentious and there should be some quite important arguments to play out. I don't think any of that is surprising but in the end what we aim to do is make sure that vulnerable and high risk people get the treatment they need when they need it. ATKINSON So Professor Appleby let's just run through some of the key amendments which you've published as the government and which are now going to be debated in the House of Commons. We're talking first of all about these community treatment orders where somebody who's perhaps come out of hospital in the past was just left on their own, what are you now saying should happen to them? APPLEBY The new power applies to people who have already been detained under the Mental Health Act in hospital for treatment, so it isn't something that would be used for everybody. But when people come out of hospital, sometimes for no fault of their own their illness makes it difficult to see their treatment need and those people run the risk that on refusing treatment they will get ill again and on getting ill they will be a risk to themselves. After all we have 200 patient suicides a year, which follow treatment refusal. And our new measure will allow clinicians to say to patients that the risk here is unacceptable, it's a requirement that your treatment carries on, not just in hospital but out into the community as well. And the debate has been whether we should place additional restrictions around the use of that power, whether we should say well one admission was not enough, we want people to have at least two admissions before we use those powers. We think that's unfair, we don't think that the number of admissions predicts risk and we have to allow clinicians to make a judgement about the individual patient, we have to say in this particular case the risk is unacceptable, the person needs treatment and not getting treatment is too risky. And we cannot also require the clinicians to say well we'd like to treat you because the risk is very high but actually you haven't had enough previous admissions. ATKINSON What sort of compulsion can you use though when the clinician decides somebody would be at risk? APPLEBY Well the main thing obviously is that the person would need to take their treatment. If you look at how these powers are used worldwide they're used for people with quite severe mental illness who are refusing their drug treatment. ATKINSON But how can you do that, do you go round to the house? APPLEBY Well it's part of the legislation that the drugs would not be administered in their house forcibly because you know we recognise that that would be an unpalatable thing for people. What will be in the law, assuming it becomes law, is that people will be required to take treatment when the clinician believes that that's in the interest of their health and safety. And I just should say that one of the things that's been for debate, there has been a little bit of concern, that the conditions that might apply to community treatment might be too broadly drawn and you may have heard people talking about maybe clinicians will impose curfews on their patients and some quite - I imagine - quite worrying things for patients to hear. What we're now announcing in the latest set of amendments, in the new phase in Parliament, is that the use of these committee powers will have to be linked to ensuring that people receive treatment, will be have to be linked to the health and safety of the patient or to risks to others. So we're very clearly linking it to health and to safety. ATKINSON Andy Bell from the Mental Health Alliance, you are concerned about those other restrictions, aren't you, where people may be told to stay in a particular place or live in a particular area to maybe not go out to certain places like a pub? BELL We are and I think we really, really welcome today's announcement that any restrictions placed on somebody will be very proportionate to the condition they have and we think that's a real advance. I think we still have some concerns about how you decide whether someone should go on to supervised community treatment or not but I think generally this is positive news that it's changed in that way. ATKINSON Professor Appleby you talked about, you know, you want the clinician to have the power and you want it to help the person, but if they don't take the medication what can you do about it? APPLEBY Well in the end the person can be recalled to hospital and either treated or readmitted. And if you think about it in hospital we already have compulsory powers in hospital and it isn't a battle everyday to get people to take their treatment, once people realise that there is a requirement to take treatment on the whole they take it. ATKINSON Andy Bell, are you happy that if somebody doesn't take their medicine there may be an element of compulsion and they will be going back into hospital? BELL I think for a specific group of people that is a useful provision. I think we do have some concerns about it happening after the first hospital admission and I think there are genuine differences which can be discussed further about that. ATKINSON Professor Appleby, another key element of the bill, as you would like to see it, is that children and young people who need treatment for mental health issues should be treated in what you're calling an appropriate setting. APPLEBY Yes, now this is an important government amendment to the legislation. We've spent quite a bit of time consulting with groups that represent children and the proposal now is that if you require - as a child, as somebody under the age of 18 - require admission to a mental health hospital then that has to be in an environment that is appropriate to your age and need. And it's up to the people who are running the hospital to make sure that that's the case. ATKINSON But you're going to be saying under 16 nobody will be on an adult ward? APPLEBY Well the aim is that we will get to the point where that will be the case. ATKINSON Andy Bell from the Mental Health Alliance, is this an improvement? BELL It's a huge improvement, it's very, very significant for people in those age groups and it's something that the alliance, and particularly the charity Young Minds within the alliance, has been looking for and I think with obviously the right investment and the right guidance to support it, and I'm sure that will be forthcoming, this will make a very significant difference to people. ATKINSON And finally Professor Lewis Appleby, the advocacy that you're now calling for and you're saying there will be statutory advocacy for anyone who's detained under the Mental Health Act, at the moment they've not had that right, have they? APPLEBY No. There is a growing culture of advocacy, there is increasing expertise in the field. But we did, you should remember, have advocacy in the original bill but we've respected and reflected the fact that people are very keen to have advocacy and we're very concerned about patient autonomy. Remember this is about the balance between autonomy and handling risk and we believe that it's sufficiently important to provide advocacy that we will require mental health trusts to provide it. ATKINSON Andy Bell from the Mental Health Alliance, just sum up your reaction to where we're at now because this is now going back to the House of Commons and by all accounts this actually could become law, all the others have failed, this may be it. BELL Absolutely and just to come back to the advocacy point, it is a real sign of progress, it's a sign that government has listened and I think all of our members will welcome the fact that there will be a statutory right to advocacy in there. Overall I think what we've got now is a bill that is improving from the perspective of our members. There are still legitimate concerns about it and we'll still be talking about those and campaigning to get further change but I think also very much hoping to continue to talk with government to look for an approach we can all agree on. ATKINSON Professor Appleby, you must be quite relieved that you're getting this response after such a long time, because you're still working from the 1983 bill at the moment and you've had drafts and redrafts and this great saga has gone on and on. APPLEBY Well I have no problem trying to get the right solution by talking to people with - who want to see genuine improvement. I think sometimes the debate has been just a little bit polarised where some of the criticisms have cast doubt on what the government's motives have been in reforming the Mental Health Act and if the way that Andy Bell has responded reflects the fact that there's an awareness that what we're trying to do is ensure that people get the right treatment when they need it and that their rights, as much as possible, are preserved then that can only be good. ROBINSON Carolyn Atkinson with Andy Bell from the Mental Health Alliance and with the government's Director of Mental Health, Professor Lewis Appleby. Back to the You and Yours homepage The 大象传媒 is not responsible for external websites |
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