Dear Ms Smith

 

I very much hope that it will be possible for me to meet with you in the near future for two reasons: Firstly, to offer my congratulations on your appointment and to indicate the wish of the Royal College of Psychiatrists to continue to work with the Department of Health on those mental health matters that so intimately affect the welfare of our patients. Secondly, to discuss the serious concern about the Government's White Paper, 'Reforming the Mental Health Act'.

 

I enclose the College's response to the White Paper which was drafted initially by the Mental Health Law Sub-Committee. The letter from the Registrar, Dr Shooter, who chairs the College's Public Policy Committee, specifically highlights the areas of concern expressed by psychiatrists and received by us through our democratic structures.

Undoubtedly there is a deep disquiet amongst psychiatrists about the principles of the new legislation and its practical implementation. The consensus presently achieved about the overall direction of mental health services could be rapidly undermined, including in particular community outreach, and the good collaboration achieved between mental health professionals, Government and patients.

 

We are particularly concerned that the pioneering principles established by the Percy Royal Commission of using compulsion only when all other methods of management have failed will be lost in the new legislation.

 

It is also important, if the new legislation is to work effectively, that it will command the support of the psychiatric profession who will have to operate it on a day to day basis. This cannot be said of the proposals as set out in the White Paper. We believe that the legislation will be best framed and best supported if there is an opportunity for Members of Parliament to take oral evidence at the committee stage of the Bill, as was the case in 1982 when the current legislation was enacted. We would also welcome an opportunity for close liaison with your Department when the Bill is going through Parliament.

 

It is indeed unfortunate that the White Paper gives the impression of a radical shift in balance towards social control and risk management and away from therapeutic concerns. It is extremely likely that this process would deter patients from seeking medical treatment for a mental disorder, and that psychiatry, one of the key medical specialties, would become an even more unattractive choice for young doctors. The recent workforce census indicates that 12% of consultant posts in England remain unfilled.

 

There is particular concern about the human rights of our patients and the ethical position of psychiatrists as doctors. Whilst the Human Rights Act allows detention on the grounds of 'unsound mind', it does not necessarily sanction preventative detention for 'mental disorder' in the most extended sense, where there is no mental illness, or where there is no direct medical benefit to the individual concerned. There is a danger that the United Kingdom, rather than leading on international standards in medical ethics, would be criticised in this important area.

 

Our key concerns therefore are the practical and ethical implications of the extended scope of the proposed new Act, especially in the area of personality disorder. There is a need to ensure psychiatrists' confidence in the law governing compulsory care. The College hopes to take every opportunity to communicate with your Department to ensure that new legislation is workable. Hence I would welcome an early opportunity for an informal meeting with you, so that I can discuss these key matters and how they can be resolved.

 

There are grave concerns within the membership of the College about an Act based on the existing White Paper.