Hundreds of people with dangerous, incurable personality disorders could be locked up indefinitely in secure mental hospitals, without the need for evidence that they committed a crime, under far-reaching mental health legislation published yesterday by the government.
Jacqui Smith, the health minister, said the bill removed a loophole that allowed up to 600 people with dangerous and severe personality disorders to avoid treatment by arguing that they got no benefit from it. The legislation would also permit the compulsory treatment of mentally ill people being cared for in the community.
Under new powers they could be made to take medication, although any forcible treatment would be conducted in clinics and not in the patient's home as mental health charities had feared.
Ms Smith said the bill was the first big overhaul of mental health since the 1950s. She published it yesterday in draft form to allow 12 weeks of consultation before the government decides whether to put the measure in the legislative programme for next year.
Increased powers of compulsion were balanced by extra protection for patients to satisfy the human rights convention. A new mental health tribunal will decide if patients need compulsory treatment and review the decision at least once a year.
Ms Smith said: "Any use of compulsory powers is a very serious matter. This bill will ensure that there is a proper focus on patients' assessed needs and the risk they pose to themselves and to others."
The plan for detention of psychopaths who had not committed a crime followed public outrage at the murder by Michael Stone of Lin Russell and her six-year-old daughter Megan in Kent in 1996.
He had been left free to commit the crime because his severe personality disorder was considered untreatable and he could not be detained under the Mental Health Act.
Ms Smith said there were between 2,100 and 2,400 people in the UK with severe personality disorders. Of those, the vast majority were in prison or in a secure mental hospital. But between 300 and 600 were in the community.
The government had created 36 extra places for such patients at Whitemoor prison in Cambridgeshire and had plans to create a further 220 at Broadmoor and Rampton secure hospitals and Frankland prison, she said.
The Conservatives challenged Alan Milburn, the health secretary, to provide more details on key elements of the draft bill, while their leader, Iain Duncan Smith, questioned moves to detain those with severe personality disorders who may have committed no crime. Mr Duncan Smith, saying his party would champion the mentally ill, added: "Too many people with mental illness now languish in prison and the government plans to detain indefinitely people with personality disorders who have done no harm to others.
"The mentally ill have a right to be heard and we will give them a voice."
Conservative health spokes-man Liam Fox, speaking in a Commons opposition debate on mental health care, raised concerns over the planned new community treatment orders.
He called for more information on the circumstances under which patients in the community could be forced to take medication, and asked who would decide which patients should be subject to such orders and for how long.
If patients were compelled to take medication, would they not be better treated in secure units, Dr Fox asked, warning that carers might be reluctant to force those in their care to accept medicine.
Dr Fox - trying to further his party's efforts to reposition itself as compassionate and socially responsible - conceded that the care in the community policy, introduced under the last Tory administration, had gone "too far and too fast". A new balance was needed "where those that need treatment in a hospital setting receive it and only those able to cope in the community are placed there".
Evan Harris, Liberal Democrat health spokesman, condemned as "damaging and disappointing" the government's decision to combine essential updating of mental health laws with "repressive legislation" to lock up people with untreatable personality disorders.
Dr Harris also criticised moves to introduce enforced medication in the community as "obscenely premature" while many patients were still unable to get access to hospital beds or modern drugs.
Steps to treatment
The draft bill sets out three stages before mental health patients can be subjected to compulsory treatment.
Stage one
Two doctors and a mental health professional consider whether compulsion is appropriate.
Stage two
Patients assessed within 28 days. They can choose someone to represent their interests and have access to a new mental health advocacy service. Treatments requiring special safeguards, including electro-convulsive therapy, not permitted at this stage without authority from the Mental Health Tribunal, except in an emergency.
Stage three
The Mental Health Tribunal can make a treatment order specifying the compulsory elements of a patient's care plan. First and second orders last six months and subsequent orders a year.
The courts can also make a mental health order for a patient subject to criminal proceedings.
