Community Treatment Orders: the psychiatric ASBO

“The Bill is not about service provision. It is about the legal processes for bringing people under compulsion.” (Department of Health, 2005).

This week saw the second reading of the controversial Mental Health Bill. The Bill has faced a rocky read in getting this far and New Labour and the Lords are locked in a battle over Community Treatment Orders (CTOs) which the Lords in January this year amended and New Labour want to block when it gets to committee stage. As Patricia Hewitt argues:

"We are not prepared to accept the amendments that have been made there restricting the use of community treatment orders to patients who have been detained as compulsory patients at least twice. I believe that would be a wholly unacceptable restriction on clinicians."

One of the amendments from the Lords that New Labour wants to see gone: “Ensure that people with full decision making ability cannot be forced to have treatment imposed upon them against their will”.
Bizarrely, Hewitt goes onto argue that the Bill strikes a right balance between improving patient safeguards and protecting more people. Who is she trying to kid as there aren't no safeguards?! The first so-called safeguards were the substantial amendments by the Lords. And the amendments include safeguards for children which, again, New Labour want to scupper!

A CTO removes the right of a service user to choose whether or not to continue receiving their medication once they have been discharged from hospital. As Tony Zigmond, Royal College of Psychiatrists argues:

"Furthermore, there is the ethical issue of whether CTOs are fair. Should any person who is capable of making a decision about their treatment be forced to accept medical treatment they don't want solely to benefit their health?

New Labour are on their lonesome with this Bill as even that bastion of radical ideas, The Royal College of Psychiatrists oppose much of this draconian Bill along with over 80 organisations/individuals (though the voices of the service users has been drowned out by the of professionals and the carers. The mental health user movement is pretty much in a weak state).
The government claim that around 1,450 will be placed on CTOs yet according to research by the King’s Fund it is estimated that there will be a gradual year on increase of numbers. They believe it is more likely that between 7,000-13,000 service users could be placed on CTOs over the next 10-15 years....

The Bill also resembles CTOs currently used in Australia and New Zealand. CTOs are a way, New Labour claims, of reducing psychiatric admissions yet studies have shown in Australia, that CTO placement, aboriginal ethnicity, younger age, personality disorder and previous health service use were all associated with increased admission rates. The authors conclusion stated that we “should question the rationale for CTOs and advocate more effective treatments” (British Journal of Psychiatry, 2004).

The Institute Of Psychiatry’s “International experiences of using CTOs” (March 2007) noted as well that ethnicity data from Israel, USA, New Zealand and Australia,“indicate that relative to the proportion of the general population comprised by their ethnic group, most ethnic groups might be over-represented amongst CTO recipients.”

At the moment young Black men are 38% more likely than the average to be sectioned under the current Mental Health Act and with the lack of safeguards this disproportionate number of Black people being forced onto CTOs will remain.

The psychiatric system reflects the sexism, racism and homophobia that exists in this society and without any kind of anti-discrimination this will continue (though there is an amendment regarding this but New Labour want to see it ditched).

The Mental Health Bill can be reduced to the 3 C’s of New Labour (compulsion, coercion, containment). It is a retrograde act and will terrify mental health service users. It will destroy trust between service user and professional. Instead of support service users will feel policed. If a person can live in the community then they should be trusted in whether they take their medication. It is about choice. And surely the service user is the best person to know whether medication works or doesn’t work? And if the service user is experiencing dire side-effects are they expected to keep taking it?

The emphasis being on that panacea known as medication and alternatives aren’t given any credence. The voice and the rights of the mental health user will be lost to ever growing concerns about “protecting the public”. And during the past week there has been debate over “predicting behaviour” in light of the shootings in Virginia.

Mental health service users already, for good reason, feel stigmatised and victimised and this Bill only increases that fear. One of the biggest criticisms from mental health service users (and from my own personal experience I echo it) is not being listened to and your needs, demands, concerns regularly ignored by professionals this will indeed create more powerlessness and lack of control over your surroundings. This will add to the distress and will in no way increase better mental health.

Professionals will err on the side caution as they will be worried about the “what ifs” and these CTO’s will be handed out on a regular basis. How long will service users be expected to on CTOs? There is nothing in the Bill which explains length so in theory you could be put on one indefinitely.

A cross-party of over 100 MPs have signed motions expressing their concerns about this Bill.

This Bill, along with agenda of New Labour, attacks civil liberties and will instil fear, stigma, mistrust and create a tightly controlled passive society.....

The umbrella group which is campaigning against the Bill is the Mental Health Alliance (http://www.mentalhealthalliance.org.uk/). Their website seems to be down at the moment.

NB: Spending my Sunday afternoon trawling through the Mental Health Bill specifically the CTOs section I was unable (though correct me if I am wrong) to find any provision which gives the user right of an appeal against the decision for a CTO, implementation, review, right of service user to look at the information the CTO is based on and/or monitoring decisions on a regular basis i.e. discrimination. These important safeguards make professionals accountable for their decisions are conspicuous by their absence. Shows that New Labour don't give a damn for basic human rights.

(Have tried to upload suitable pic but Blogger is playing havoc maybe a suitable dose of cyber medication will resolve the problem).