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Millan Committee Proposes Widespread Reform Of Mental Health Law In Scotland
25/01/2001
The Millan Committee today presented its review of mental health legislation in Scotland to the Scottish Executive. The report recommends a new Mental Health Act to replace the current Act - which dates back to 1984.
Among the key recommendations of the Committee are:
- The new Act should incorporate a statement of basic principles;
- Compulsory care and treatment should only be used as a last resort, and be linked to a plan of care for the patient;
- It should be possible for some patients to be compulsorily treated in the community rather than hospital;
-There should be a new independent tribunal, replacing the role of the sheriff court in considering compulsory measures;
- The rights of carers should be clarified and strengthened;
- There should be reforms to the system for dealing with mentally disordered offenders, including new arrangements for discharge of restricted patients;
- New legislation will require to be accompanied by adequate resources for mental health services if it is to succeed.
The Chairman of the Committee, the Rt Hon Bruce Millan, said:
"We believe that a new Act is required, reflecting the huge changes in mental health care in recent years, and the greater recognition of the rights of mental health service users and their families.
"Our proposals are based on 10 key principles, which would enshrine the rights of service users and carers to be treated with fairness and respect.
"In line with these principles, the procedures for compulsory care and treatment should be reformed. Compulsion should be justified by clear and specific criteria. Linking compulsory treatment to a specific plan of care is a flexible approach which should help to ensure that patients receive the treatment that they need, without unnecessary use of legal measures.
"In particular, it should be possible for compulsory treatment to be delivered in the community rather than hospital, where this is the best option for the individual patient. In some cases, community orders might help to break the cycle of repeated admissions to hospital, followed by deterioration on discharge.
"At all stages, it is vital that patients and their families are involved, and given the support and advice they need, and we recommend enhanced rights to advocacy and information .
"Our proposals for a new mental health tribunal to replace the sheriff court as the forum for mental health hearings are intended to promote this greater involvement of patients and carers, and to improve the quality of decision making in mental health cases.
"For the small number of people with mental disorders who commit serious offences, there needs to be a more systematic approach to risk assessment and management. The Risk Management Authority, which has been proposed by the MacLean committee, would have a role in this.
"We propose that the Parole Board, sitting as a Restricted Patients Review Board, should take over from Ministers the responsibility for considering the discharge of 'restricted patients'. This would ensure a more open process, taking proper account of all relevant information about the risk presented by a particular patient.
"We believe that our recommendations form the basis for a comprehensive reform of the law, but we also emphasise that the success of any system of mental health care depends on adequate resources being made available."
BACKGROUND
1. The Millan Committee was appointed on 22 February 1999 by the then Scottish Office Health Minister, Sam Galbraith. The committee met formally on 24 occasions, and visited a range of mental health services. It issued several consultation papers, as well as holding a number of consultative events. Research carried out for the committee into the operation of the sheriff courts in mental health hearings, and a literature review, are being published alongside the committee's report.
2. Bruce Millan was the Secretary of State for Scotland from 1976-9, and a European Commissioner from 1989-95. The membership of the Committee was
Chair
The Rt Hon Bruce Millan
Committee members
Sheriff Douglas Allan, Edinburgh
Dr Caroline Blair, Consultant Clinical Psychologist, Young People's Unit, Royal Edinburgh Hospital (died February 2000)
Dr David Blaney, Director of Postgraduate General Practice Education, Lister Postgraduate Institute
Dr Lindsay Burley, Chief Executive, Borders Health Board
Mr James Connechen, Director of Nursing, Dumfries & Galloway Community Health Care NHS Trust
Dr James Dyer, Director and Medical Commissioner of the Mental Welfare Commission for Scotland
Mr James Kiddie, former Convener, Scottish Users' Network
Ms Linda Headland, Director, ELCAP
Mr Malcolm McEwan, Head of Social Work, Midlothian Council
Mr Roger Maxwell, former Chairman of Relatives/Users Action Forum, Forth Valley Primary Care NHS Trust
Mr Graham Morgan, Advocacy Development Worker, Highland Users Group, Highland Community Care Forum
Ms Hilary Patrick, Honorary Fellow, Faculty of Law, the University of Edinburgh
Dr James Strachan, Consultant Psychiatrist, Royal Edinburgh Hospital and Honorary Senior Lecturer, the University of Edinburgh
Dr Maureen Sturrock, Consultant Forensic Psychiatrist, Greater Glasgow Primary Care NHS Trust
Mr George Thorley, Chief Executive, South Ayrshire Council
Ms Mary Weir, Chief Executive, National Schizophrenia Fellowship (Scotland)
Adviser to the Committee -
Dr Anne Douglas, Consultant Clinical Psychologist, Greater Glasgow Primary Care NHS Trust
3. The committee's terms of reference were:
"In the light of developments in the treatment and care of persons with mental disorder, to review the Mental Health (Scotland) Act 1984, taking account of issues relating to the rights of patients, their families and carers, and the public interest; and having particular regard to:
- the definition of mental disorder;
- the criteria and procedures for detention in and discharge from hospital;
- leave of absence and care outwith hospital;
- the role of the Mental Welfare Commission for Scotland;
- the findings of the Committee set up to review the arrangements for the sentencing and treatment of serious violent and sexual offenders, including those with personality disorders;
and to make recommendations."
4. The report is available from the Stationery Office, priced £25.(ISBN 1-84268-892-8) An executive summary of the report is available from the Health Policy Department, Scottish Executive (tel. 0131 244 2451). Both documents are also available on the Internet at www.scotland.gov.uk/about/HD/PHPU1/0015216/page649280348.aspx
5. The report was passed to the Scottish Health Minister Susan Deacon by Mr Millan earlier today. Details of the Scottish Executive's response are contained in News Release SE0143/01 .
News Release: SE0142/2001
25 Jan 2001