Links to evidence and transcripts

Links to all of the Joint Committee meetings are now permanently on Scrutiny Watch's front page, in the sidebar on the right under "Evidence sessions".

The full corrected transcripts of all of the sessions, and all published written evidence submitted to the Committee, are now online here.

Mental Health Alliance welcomes scrutiny committee report

The Mental Health Alliance issued the following press release in response to the publication of the Joint Committee's report:

Alliance welcomes scrutiny committee report into Draft Mental Health Bill

"The Government's plans for a new Mental Health Act have reached a dead end following today's scrutiny committee report into its second draft Bill," Mental Health Alliance chairman Paul Farmer said today (Wednesday 23 March 2004).

Speaking on the day the report by a committee of MPs and Peers was published, Paul Farmer said: “The Mental Health Alliance now calls on the Government to withdraw its current proposals and consider in detail the committee’s report. We propose that Alliance members, the Government and all political parties now work together to formulate a new Bill that is based on these recommendations.

“The committee has clearly listened to service users, carers, professionals and charities. It has described Government’s proposals as ‘fundamentally flawed’ and warns that the powers in the draft Bill would lead to too many people being treated against their will.

“We welcome the report’s call for compulsory mental health treatment to be used only where there is no alternative; where it has therapeutic benefit; and when the person concerned is unable to decide for themselves about treatment.

“The committee has also clearly understood the stigma that surrounds mental illness and the important role the Mental Health Act should play in improving services and tackling popular prejudices.”

Members of the Mental Health Alliance also commented today on the report:

Gil Hitchon, Chief Executive of Maca, said: "Having submitted its draft Mental Health Bill to a thorough scrutiny the Government has to heed the committee's advice and radically alter its plans for reforming the law. For the past seven years the united voice of the mental health sector has been saying that the proposals are out of step with what is needed. The Government now has to work together with those with experience of mental illness and the organisations providing services to get the legislation right."

Sophie Corlett, Director of Policy at Mind, said: "It is now high time for the Government to go back to the drawing board. The committee's conclusion is a clear wake up call to supporters of this ill-conceived Bill. It cannot possibly deliver better healthcare for service users. It cannot even deliver better management of the tiny percentage of seriously ill patients who pose a risk to the public. All it can possibly deliver is fear and mistrust among ordinary people who rely on front line mental health services in times of crisis. What they want - and often fail to get - is help and support. The last thing they need are threats to their civil liberties and a health care system in crisis."

Lord Victor Adebowale, Chief Executive of Turning Point, said, “There are a whole host of people who do not receive appropriate support for their mental health problems, be it in the community or in hospitals under mental health legislation. This is particularly true amongst Black and Minority Ethnic communities whose needs are not met, and are under-represented in community treatment, but are over-represented and treated against their will under current mental health legislation. New mental health legislation will only be worthwhile if it does something to tackle this imbalance, backed up by the necessary investment to address the shortage of staff in hospitals and the community. I would urge the government to follow the committee's advice, scrap this unworkable Bill and start again.”

Cliff Prior, Chief Executive of Rethink, said: "The committee's report will be warmly welcomed by people with mental illness and their carers. It's time to bring all parties together and create balanced, workable and ethical leglislation."

Dr Tony Zigmond, Vice-President of the Royal College of Psychiatrists, said: "Patient care is markedly improved when there is a trusting relationship between a patient, their carer and psychiatrist. The draft Mental Health Bill would have undermined that trust. The Joint Committee's recommendations, if adopted by government, would ensure an ethical and practical framework for mental health legislation."

Angela Greatley, Chief Executive of the Sainsbury Centre for Mental Health, said: “The scrutiny committee has clearly listened to the evidence presented to it and produced a report that sets out a workable way forward for a new Mental Health Act. It rightly states that any Bill will need to have sufficient resources attached to it and clear national standards for staff to follow.”

Marjorie Wallace, Chief Executive of SANE, said: "We continue to fight for a humane mental health system which values compassion over compulsion and protects individuals affected by mental illness by achieving a better balance of rights between service users, their families and carers, and the community. But changing the law alone will not work unless we ensure proper care and treatment, which are still so often lacking. The government needs to make good the desperate shortage of doctors, nurses, skilled front-line staff and supervised accommodation, whether in hospital or the community, if patient and public trust in the mental health system is to be restored."

Dr Andrew McCulloch, Chief Executive of the Mental Health Foundation, said: “The Government should now withdraw its discredited Bill. It has a once-in a generation opportunity to improve the lot of those who use mental health services, and drive mental health care up the political and social agenda. Service users, professional organisations and charities have been and remain very willing to work constructively on a better way forward for everyone.”

Joint Committee report condemns "fundamentally flawed" Bill

The Joint Committee published its report on Wednesday, accompanied by the following press release:

Mental Health Bill Needs Radical Overhaul
Government plans to reform mental health provision will force too many people into compulsory treatment and will erode their civil liberties.

That’s the conclusion of a joint House of Commons and House of Lords Committee that recommends the draft Mental Health Bill gets a radical overhaul before it’s put to the vote.

MPs and Lords believe the bill places too great an emphasis on protecting the public from a small minority of dangerous mentally ill people. The Committee believes this will be at the expense of the civil rights of the majority who pose no risk to others.

Compulsion

The Committee accepts the merits of having a broad definition of mental disorder, but the draft Bill needs to have clear exclusions ensuring that legislation cannot be used as a means of social control.

The Committee fears that the powers granted in the current bill could potentially be used as the equivalent of a mental health ASBO – enforcing treatment on those who might be a ‘nuisance’ but who don’t pose any significant risk to the public.

Under current proposals, treatment can be enforced simply ‘for the protection of other persons’. The Committee believes that conditions should be tightened to ensure that legislation cannot be used inappropriately. It concludes:

• That people should only be forced into compulsory treatment if they pose a significant risk of serious harm to others.
• That patients should never be treated under compulsion unless their decision making is impaired.
• That compulsory treatment must be of therapeutic benefit to them.

The wide definition of treatment in the bill means people diagnosed with personality disorders or learning disabilities could be detained on the grounds of public safety rather than benefit to their health. Not all treatments may help a patient to recover from their mental illness, yet doctors may be forced to detain them regardless.

Separate Legislation

MPs and Lords also recommend that people who can’t benefit from treatment – which includes dangerous and severe personality disorders (DSPD) – should be dealt with by separate legislation.

As a consequence of the inclusion of criteria of therapeutic benefit and impaired decision making (see above), a small group of people with DSPD may not meet the conditions for the use of compulsory powers, hence the need for separate legislation.

What the Bill should focus on:

The primary purpose of mental health legislation should be to improve services and safeguards for patients and to reduce the stigma of mental disorder. The fundamental principles underpinning the legislation must be set out on the face of the Bill. This will provide clear guidance for professionals and tribunals and provide assurances to users of mental health services.

Whilst the committee supports compulsory treatment in the Community it believes it should be more restricted than under current proposals. There should be clear criteria about who can be treated at home and time limits should be set as to the length of their treatment. The Committee are concerned that people could be treated indefinitely with little hope of ending their compulsory treatment.

Finally, MPs and Lords also have major concerns about the resources needed to implement the Bill. Without adequate staffing and funding, the new tribunal, for example, will fail to improve patient safeguards, and mental health could remain the ‘Cinderella service’ of the NHS.

Lord Carlile said:

“This is an important reminder to the Government that the Bill is fundamentally flawed. It is too heavily focused on compulsion and currently there are neither the financial resources nor the workforce to implement it."

Far too many people could be forced into treatment unnecessarily.

They can be detained even though the treatment they receive does not help their condition. And they can be detained compulsorily even if they are perfectly capable of making their own decisions.

This is well beyond what is required and the Committee believes that ministers should consider redrafting significant sections of the Bill.

At present, the draft Bill is too focused on addressing public misconception about violence and mental illness, and does not do enough to protect patients' rights.”

You can download the full report here.

Report publication date announced

The Joint Committee on the Draft Mental Health Bill will publish its report on Wednesday 23 March at 00:01 am.

Tick-box exercises and discretion

In the thirteenth evidence session, Roger Hargreaves of BASW explains that the professionals who have to decide whether someone meets the conditions for compulsion will have much less discretion under the Bill than they do under the current Act. This would make it more difficult for them to decide not to detain someone - and could lead to an increase in the number of people receiving compulsory treatment (uncorrected transcript):

Q954 Baroness Pitkeathley: My question is for our colleagues from BASW, please. In your evidence you point out that there is an absence of a discretion in the Bill not to take action even where the minimum conditions are satisfied. Surely, if somebody meets the conditions in clause 9 they are going to be seriously mentally ill and therefore in need of treatment, so I am not quite sure what is the purpose of providing a discretion.

Mr Hargreaves: The conditions of clause 9 are so broad that they would in fact encompass thousands of people who are definitely not seriously mentally ill in the way that we generally understand that term. In Appendix 2 of our evidence we give as an example two very large groups of people who are constantly coming to the attention of mental health services but who are very rarely detained under the present Act although they are often admitted informally into hospital and who would very clearly meet all the conditions in clause 9 of the Bill.

The present Act would also allow many of those people to be detained, although not all of them because some of them would be explicitly excluded by the exclusions. At least they would be detained for the first 28 days until the conditions become tighter under the present Act. However, that does not happen automatically at present because the doctors and the approved social worker have discretion. They are not forced to detain somebody simply because the minimum conditions in the Act are satisfied.

The Bill, however, takes away virtually all of that discretion. It is basically a simple tick box exercise. If all the boxes in clause 9 are ticked then compulsion must be imposed and this means that the doctors and the AMHP cannot take into account any factors which have not been explicitly envisaged in clause 9. In particular, they cannot take capacity into account. There has been a lot of talk about the need for a capacity test in this Bill. I think it has been overlooked that the present Act does allow capacity to be taken into account because that is one of the areas where the doctors and the ASW can exercise discretion. In practice, that is one of the most common reasons for not detaining somebody when the minimum conditions are satisfied. The Bill therefore removes the capacity test which is inherent in the present Act even though it is not explicitly stated.

Hargreaves continues:

...it very much narrows the range of discretion and it would result in very large numbers of people being made subject to compulsion who we would never consider making subject to compulsion at present.

Carers, confidentiality and consultation

During the fourteenth evidence session, Imelda Redmond of Carers UK gives an example of what can happen when carers are left out of the decision-making process about what should happen to the people they care for:

Q1013 Baroness Pitkeathley: You talk about the human rights of the carer, but some would say that giving information to the carer against the wishes of the user would be a denial of the user's rights, so how do we wrestle with that?

Ms Redmond: I think there are two things. I think advance statements are absolutely key to quality mental health services and when the person is not so ill, better discussions can take place that involve the carer. If the person is adamant that they do not want the carer involved, then what you do is separate out the issues that specifically will impact on that carer and consult with the carer on those issues. It is absolutely reasonable for somebody to say, "I cannot be there when this person is discharged next Thursday because I work full-time".

A carer I was talking to just last week went for a planning meeting at the hospital and the hospital said, "You can take your husband home now. He could do with a day at home". She said, "No, I'm going back to work", and they said, "But you are here now". She said, "But I've only got half a day off work", and they said, "Well, you can take him home". She phoned in work and said, "Can I have the day off?", and she got carer's leave. Then they rang her and said, "Would you mind now keeping him?", and she said, "I'm afraid I can't. I really have to go to work, but he can come back in a taxi", to which they said, "No, he can't go out unescorted". That was the first point she had been told that. In that situation, he was not saying, "Don't tell my wife anything". Had he have been, she still has an absolute right to her own consultation about, "Are you prepared at this point to give up some work or to stop working and to remain in the house in order to support this person?" Now, that is not about the confidential issues of the service user, but it is actually about their own separate human rights.

Autistic Spectrum Disorders and the conditions for compulsion

A helpful exchange during the twelfth evidence session with the National Autistic Society, which helps to explain why the NAS and others think that the definition of mental disorder is currently too broad, and what they think should be done about it:

Q898 Mrs Blackman: ... The Government is currently saying there are sufficient safeguards, if we look at the definition of mental disorder and what clause 9 in the Bill has to say, to ensure that people with ASD are not wrongly taken down a pathway to compulsory treatment. Would you agree with that?

Mr Mills: No, but my colleague will answer that.

Dr Crocombe: No, we would not agree with that. In our opinion, the definition of mental disorder - as shared by a number of other psychiatrists and professionals - as currently defined is too broad, and could be applied to the majority of people with an autistic spectrum disorder. An additional concern is that the second condition is also too broad when the definitions of medical treatment are taken into consideration, and, taken to extremes, under the powers of the draft Bill it is conceivable that a person could be detained for no other reason than that they have an autistic spectrum disorder and that this is of a nature or degree as to require, for example, training in work. Finally, the third condition as currently stated in the draft Bill gives scope for an over-cautious interpretation of the requirements necessary for the protection of the patient from serious neglect by him of his health or safety.

Q899 Mrs Blackman: What should be done to safeguard somebody with ASD being inappropriately treated? Would you like to see something in the code of practice or a specific exclusion on the face of the Bill?

Dr Crocombe: We would have a number of suggestions. Firstly, we would recommend that the definition of mental disorder within the Bill be revised, we would believe to include reinstatement of the requirement that the mental disorder is also associated with behaviour that gives cause for serious concern. You will be aware that in the 1983 Act there was a requirement in the example of people with severe mental impairment that this be associated with abnormally aggressive or seriously irresponsible conduct on the part of the person concerned. At the time of the introduction of that Act, it was noted that the inclusion of that requirement was to acknowledge the need to distinguish the small minority of people who need to be detained from the majority who do not, and we believe that for people with autistic spectrum disorder it is important that this distinction continues to be made. We do however acknowledge that the exact wording in the 1983 Act did leave quite a lot of scope for interpretation of what was meant by abnormally aggressive or seriously responsible.

Q900 Chairman: Forgive me for interrupting, could you help us as to which of the words in clause 9(4)(a) you object to. You have: suicide; serious self-harm; serious neglect by him of his health; serious neglect by him of his safety. Which are the objectionable parts of that, so we are absolutely clear what you are saying?

Dr Crocombe: It is: serious neglect by him of his health or safety. With regard to that particular part we would recommend that there would be some clear guidance, possibly within the code of practice, for that respect, to assist practitioners in making sound judgments when considering what degree of neglect of health or safety warrants detention and treatment, and this would be to protect against over-paternalism which has been recognised ----

Chairman: I am glad I asked the question because I understand your answer more clearly now.

Aftercare and the abolition of section 117

During the twelfth evidence session the Committee questions the witnesses from the Alzheimer's Society at length on the Draft Bill's proposed abolition of section 117 of the Mental Health Act, which guarantees free aftercare services for as long as they are needed to patients released from compulsory detention. Professor Clive Ballard explains the difficulty of forcing someone to pay for care which is being imposed on them (uncorrected transcript):

It is a particularly difficult issue when you are imposing residential or nursing care on somebody as what you think is the only safe option, but then insisting that that individual pays for the care. I think it does create an ethical dilemma and also, often, a practical dilemma if you have to try and make the resources available to pay for that.

Lord Mayhew asks whether the cut can be justified for any reasons other than the need to save money:

Q947 Lord Mayhew of Twysden: Can there be any justification for fixing an overall period of time? Can there be any explanation for doing that other than an economic one, a desire to save money, and if you get it wrong in the case of an individual does that not suggest a greater likelihood of that person going back into residential care because the aftercare cannot be protracted to the extent that that individual requires?

Professor Ballard: It is difficult to see advantages other than economic of the time limitation, and I also would agree that it is true that if that jeopardises the long-term success of the care in the longer run that might increase the cost through hospital readmission.

Lord Carlile asks Clive Evers why there should be any difference between the level of aftercare provided for patients with a physical illness and those with a mental illness:

Q949 Chairman: Acting as devil's advocate for a moment, if I come out of hospital following a physical illness I am not entitled to on-going, permanent, unlimited aftercare free. Why should the situation be different for people who have been suffering from a mental condition; suppose people had been suffering from a physical condition?

Mr Evers: Because if you are discharged from hospital having suffered a physical condition, it is assumed that you are recovered. If somebody has a mental illness like Alzheimer's disease or another type of dementia, those conditions are not reversible. There are treatments to help but they do not stop or reverse the condition.

Prof Ballard adds the following key point to the answer:

For me, in addition to the other issues that Clive raised, the other thing that is actually different is that in a situation where you are imposing a particular care plan on somebody that they might not want to have imposed on them because you think that is the safe way or in their best interests within the definition of the Act, that is slightly different to somebody with a physical illness who is choosing to opt for particular types of aftercare.

Lord Carlile picks up on the suggestion that it might make sense for clinicians to use CTOs to provide aftercare for free for patients who would otherwise be charged for the care they receive in the community following discharge from hospital:

Q951 Chairman: Do you think the six week provision, if enacted, might lead to clinicians regarding a community treatment order as a neat way to get round the costs issue and therefore might lead to more community treatment orders than would otherwise be the case?

Professor Ballard: I think that is true and most clinicians would say that in somebody with a complex mental health problem six weeks is actually a fairly short period of time to see whether a particular treatment plan will actually be effective or not.

Finally, Lady Eccles asks how many people would actually be affected by the proposal. It isn't at all clear (this is true of patients in general, not just of those with dementia referred to by Prof Ballard) but it seems that the numbers involved are quite small:

Q952 Baroness Eccles of Moulton: Has any research been done into people who are at present receiving continuing services because there is not a six week cut-off period, how many people roughly that would affect and do we know what a difference it would make to existing users?

Professor Ballard: As we have said, it has been very difficult to obtain figures specifically for people with dementia. We might be able to get specific access to those figures, but at the moment the only figures available are for older people generally so I can only really talk to my own clinical experience; during the time I had a catchment area service for older people we would be probably be talking of a few people a year in one catchment area of about 10,000 older people. So I do not think it is huge numbers.

Police cells and places of safety

Lord Adebowale, giving evidence at the twelfth evidence session on behalf of Turning Point, argues that police cells should not be seen as "a place of safety" for people who are being assessed before compulsory admission to hospital - and that the problem disproportionately affects people from black and minority ethnic communities (uncorrected transcript):

In section 136 of the 1983 Act, the police can take a person from a public place to a place of safety for up to 72 hours for assessment to determine whether compulsory admission to hospital is needed. This is replicated in clause 229 of the draft Bill. While there are no official figures, we do know that section 136 could be used as many as 10,000 times a year. The detention of people with mental health problems in police cells has hit the headlines, and Nick Hardwick, who is the co-chair of the Police Complaints Commission, estimates that 50 per cent of deaths in police custody have involved people with mental health problems. He puts it quite bluntly: "Whatever a police cell is, it is not a place of safety for people with mental illness." Despite the fact that the current code of practice states that police cells should not generally be used in practice, they are. Mind estimates that police cells are used in about 80 per cent of occasions when section 136 powers are invoked.

This is very relevant to African and Caribbean communities, given the fact that black people are more likely, as you have already heard, to have a negative experience with the police and to be over-policed - without opening up that whole debate again, recalling the McPherson report and the death of Stephen Lawrence, etcetera. Racism aside, it acknowledges that the police, particularly custody officers, do not have adequate training, if any, about mental health issues and especially when a person is distressed and causes disturbed behaviour. To add to that, the Mental Health Act Commission has repeatedly stated in their biannual reports - as many other stakeholders have mentioned - that police stations should not be regarded as places of safety. A police station is not an appropriate place for the care of someone with a serious mental disorder. It is not appropriate for someone to be held there for up to three days whilst arrangements are made for their examination, and the Bill should state that, because we know it disproportionately affects members of BME communities.

CTOs: evidence and ethics

Lord Carlile asks Peter Bartlett and Graham Thornicroft in the fifteenth evidence session whether they support the introduction of community treatment orders.

Prof Thornicroft begins by explaining that the evidence for the effectiveness of CTOs is very weak. In any case the situation in England, in terms of existing patterns of compulsion, is different from that in the countries which already use CTOs. This means that it would be difficult to draw firm conclusions about their potential effectiveness here from any studies suggesting that they are effective elsewhere (uncorrected transcript):

Professor Thornicroft: I want to start with the evidence. There is not strong evidence that community treatment orders or their equivalent are effective. Most of the published work comes from Canada or Australia and there are few European studies. They tend to show conflicting results and they have different objectives, but they do not show consistently that these are effective with respect to any of the particular desired targets, such as increased medication compliance or reduced hospitalisation.

One of the most detailed reports came from the RAND Corporation published in 2001 and reviewed arrangements in nine of the United States where now 38 of the states do have outpatient treatment orders or similar arrangements, and they concluded, "There is no evidence to suggest that simply amending the statutory language is likely to produce the required results." I think we also need to look at the wider context within European regions. For example, four of the previous 15 EU States do have outpatient commitment orders. Britain is virtually alone in having an increasing rate of compulsion within its mental health system over the last ten years and although most countries see stable patterns of the use of coercion in these ways, we have seen increasing rates of section 135, which is the compulsory entry to premises, of three times over the last decade, of section 136, which are the place of safety detention orders, of five times, and use of section 3 by 1.4 times over that period. For some reason England is an exception in terms of the trends of compulsory treatment just within the European region, Western Europe in this case.

Prof Thornicroft goes on to argue that CTOs violate national and international principles of mental health care, that they will tend to reinforce the idea that violence and mental disorder are linked, and that they will deter people from seeking treatment for mental illness:

Perhaps I may move on to the ethical aspects. As I mentioned earlier in that summary table, I think the community treatment orders do cross-cut, in fact they violate many of the principles which are established in international as well as relevant national mental health policy, as set out in the relevant documents. I think this is a very difficult balance of judgment. I think the one practical way to increase patient compliance, meaning agreement with a recommended plan of treatment, is to offer choice.

For example, in my own practice in south London we now have home treatment teams, we have crisis houses for women and we have acute inpatient treatments. I can ask a woman who is in a crisis, "Would you prefer to go into hospital, to be treated at home or to go to a crisis house?", and this means that we use compulsion less than we would have done five years ago. We now have new arrangements in the form of a crisis card and there is accumulating evidence that these do reduce compulsory admission rates to hospital.

I think there is an offset or a balance here: on the one hand, it seems likely that CTOs, if properly and narrowly applied, would probably apply to less than one per cent of one per cent of the population, approximately the same numbers as were applied for supervision registers and supervised discharge orders; on the other hand, we need to understand the wider framework and that is this. Of all inpatients, there is evidence that one third of the voluntary inpatients believe themselves to be compulsorily detained and two thirds are not sure whether they are compulsorily detained or voluntary. So we have got forms of pressure and coercion that go well beyond the narrow legal restraints of the powers that are set by our Government.

Therefore, I think, on the one hand, this may provide a limited benefit to a small number of patients, but, on the other hand, I think we need to listen carefully to what service user groups are saying, which is that this will not just stop current patients from wanting to continue with treatment, but it will then reinforce a connection in the public mind between violence and mental illness. We know that of all people with mental illness in England about one quarter are getting effective treatment and that the proportion is far less in many other countries. I suspect that if we were to frame this too widely then we would see more people self‑stigmatizing and not presenting to services because they do not want to be labelled as a mentally ill person because that is connected with violence and we will see fewer people having treatment and that will serve no one for the best in the long term.

Lord Mayhew asks Prof Thornicroft to clarify his argument that introducing CTOs would increase stigma:

Q1142 Lord Mayhew of Twysden: Professor Thornicroft, I am sure it is my fault, but I lost you in the course of your last contribution when you said, as I understand it, that a CTO would serve to increase stigma in the public eye for mentally suffering people. I think the stigma was the propensity to violence. I am afraid I lost you at that point. I did not quite follow the reasoning. Can you help?

Professor Thornicroft: There is little evidence about the extent to which popular opinions of mental illness and the views of people with mental illness about their own conditions are related to the law in any country, so this is a matter of opinion. My view is that a law based upon one central tenet, among others, which is the connection between mental illness and violence, further serves to strengthen that view in the wider population and that will serve to deter people from coming forward when they have symptoms of mental illness for assessment and treatment and also may serve to further exclude mentally ill people from within the mainstream of our society.

Predicting risk

In the final session, Prof Graham Thornicroft is asked whether the Draft Bill would make it any easier for mental health professionals to predict and prevent violence by people with mental health problems. The answer is a clear no (uncorrected transcript):

Q1133 Chairman: In your general experience, both of you as experienced and distinguished experts in this field, do you believe that there is any evidence at all that the regime for control of mentally ill people, short of an obviously unacceptable regime, has any effect in terms of enabling clinicians to predict the sort of incident that Lord Carter has referred to [i.e. incidents where people kill after being released from psychiatric hospitals]?

Professor Thornicroft: If we look at the time trend in this country over the last 40 years, we see that the total number of homicides has gone up from about 150 to about 600 per year, of which those committed by people who are probably mentally ill at the time has been more or less constant, about 50 to 60 per year. Over that time period we have seen astonishing change from an institutionally based system to a largely community-based system. It would be hard to imagine a greater transition in the pattern of care than the one that we have been through during the last half decade and yet that has had no palpable effect overall upon the number of homicides committed by mentally ill people. I think that is pretty strong evidence.

Unfortunately mental health professionals are remarkably poor at being able to predict specifically who will commit a violent act in the future, and one of the best reviews was conducted by a Professor Buchanon and Dr Leese who gave an overview of the literature with respect to personality disorder. The question was how many people would need to be locked up to prevent one severe act from taking place and the answer was seven, which meant that the provision based upon, for example, dangerous and severe criteria would, therefore, lead to six innocent people who would not have committed that act being locked up for no particular reason.

Community Care: Cuts in free aftercare may lead users to seek community treatment orders

Click here for an article from Community Care reporting on the proposed cut in free aftercare for patients released from compulsory detention (section 117 of the 1983 Act) to just six weeks. Maca and the Alzheimer's Society argue that the cut would create "a perverse incentive" for patients to seek to be given free compulsory treatment in the community under a CTO instead. Maca's written evidence submission on the topic is here.

Lack of posts - an apology

Apologies for the fact that there has been no posting here for a while, and no detailed discussion of the final few Joint Committee sessions. This is due to a combination of my annual leave and the long delay in the posting on the Joint Committee's website of transcripts from the last few evidence sessions (the afternoon session from January 26 is still not online at the time of writing). Links will be updated, new detailed posts produced and normal service resumed over the next few days.

Two watches

Dr Peter Bartlett, who is a qualified lawyer in Canada, explains at the Committee's afternoon session on 2 February why Canadian laws in general do not include Codes of Practice. He says that a Code of Practice will either mirror the terms of the statute in clearer language (in which case, why not use the clearer language in the statute?) or it will not (in which case it may risk contradicting the statute, or at least introduce uncertainty). He goes on:

"A person with a watch knows what time it is; a person with two watches is never sure."

Fifteenth evidence session: 2nd February 2005, pm

In the afternoon session there were three sets of witnesses.

The first group represented the National Forum for Assertive Outreach, and consisted of Mike Firn, Michael Hicks and Judith Fairweather. The NFAO's written submission is here.

The second group gave evidence on international perspectives on mental health law. They were Dr Peter Bartlett, Senior Lecturer in Law at the University of Nottingham, and Prof Graham Thornicroft, Professor of Community Psychiatry at the Institute of Psychiatry, Kings College London, and Director of Research and Development at the South London and Maudsley NHS Trust. Links to their written evidence will be added as soon as possible.

The final group (postponed from last week) was from the British Medical Association (written evidence here) and the Royal College of General Practitioners (written evidence here). Dr Michael Wilks, Dr JS Bamrah and Dr Robin Arnold represented the BMA, and Prof Andre Tylee and Dr Alan Cohen represented the Royal College of GPs.

A full uncorrected transcript of the session is here.

Fourteenth evidence session: 2nd February 2005, am

In yesterday's morning session the Committee heard from witnesses representing carers, and then from witnesses representing mental health advocates.

Carers UK was represented by Imelda Redmond, and Mark Robertson. North Derbyshire Forum for Mental Health Carers was represented by Dr Gwen Wallace, and Linda Landsell. To read Carers UK's written evidence click here and to read North Derbyshire Forum for Mental Health Carers' written evidence click here.

The next set of witnesses were Rick Henderson and Karen Mellanby of Action for Advocacy (written submission here), Hilary Dyter of Leeds Mental Health Advocacy Group, Jonathan Coe of the Association for Mental Health Advocates (submission here), Peter Munn of Cymar (submission here) and Beverley Mills of UKAN (submission here).

A full uncorrected transcript of the session is here.