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In 1982 the Mental Health (Amendment) Bill was criticised for its
potential manpower implications, and it was considered that there would be
considerable difficulty in implementing it (1). Nevertheless, it became
the Mental Health Act 1983 as we know it today.
The predecessor to this Act was the Mental Health Act 1959. It had
assumed that anyone compulsorily detained also lacked capacity to consent
to treatment. ‘Second opinions’ were informal and purely advisory, and
the ultimate responsibility for psychiatric treatment rested with the
patient’s own, not infrequently paternalistic, psychiatrist. The Royal
College of Psychiatrists battled for the status quo of the 1959 Act,
whilst MIND (National Association for Mental Health) under Tony Smythe and
Larry Gostin argued for a more complex system akin to mental health review
tribunals to make decisions on ‘suspect’ treatment(2), not dissimilar from
the current proposals. The 1983 Act was a compromise.
On consent issues, we need to take into account changes in the value
system of society such as on autonomy, self determination, best interests
and so on, and not just to discard a system because it is viewed as
‘unworkable’(3). Medical ethics and decision making have changed. No one
would want to return to the pre 1983 requirements of consent to treatment,
yet the establishment of the 1983 Act was controversial to say the least.
In terms the new Bill and consent to treatment, we must not throw the baby
out with the bath water.
(1). Beedie, M and Bluglass, R. Consent to psychiatric treatment:
practical implications of the Mental Health (Amendment) Bill BMJ 1982;
284: 1613-1616
(2). Gostin, L. A Human Condition. The Mental Health Act from 1959
to 1975: observations, analysis and proposals for reform. Vol 1 London:
MIND, 1975
(3). Eastman N. Reforming mental health law in England and Wales BMJ
2006; 332: 737-8
Competing interests:
None declared
Competing interests:
No competing interests
03 April 2006
Claire Hilton
Consultant Old Age Psychiatrist
CNWL Mental Health NHS Trust, Northwick Park Hospital, Watford Road, Harrow HA13UJ
The New Mental Health Bill and consent to treatment.
In 1982 the Mental Health (Amendment) Bill was criticised for its
potential manpower implications, and it was considered that there would be
considerable difficulty in implementing it (1). Nevertheless, it became
the Mental Health Act 1983 as we know it today.
The predecessor to this Act was the Mental Health Act 1959. It had
assumed that anyone compulsorily detained also lacked capacity to consent
to treatment. ‘Second opinions’ were informal and purely advisory, and
the ultimate responsibility for psychiatric treatment rested with the
patient’s own, not infrequently paternalistic, psychiatrist. The Royal
College of Psychiatrists battled for the status quo of the 1959 Act,
whilst MIND (National Association for Mental Health) under Tony Smythe and
Larry Gostin argued for a more complex system akin to mental health review
tribunals to make decisions on ‘suspect’ treatment(2), not dissimilar from
the current proposals. The 1983 Act was a compromise.
On consent issues, we need to take into account changes in the value
system of society such as on autonomy, self determination, best interests
and so on, and not just to discard a system because it is viewed as
‘unworkable’(3). Medical ethics and decision making have changed. No one
would want to return to the pre 1983 requirements of consent to treatment,
yet the establishment of the 1983 Act was controversial to say the least.
In terms the new Bill and consent to treatment, we must not throw the baby
out with the bath water.
Claire Hilton
claire.hilton@nhs.net
(1). Beedie, M and Bluglass, R. Consent to psychiatric treatment:
practical implications of the Mental Health (Amendment) Bill BMJ 1982;
284: 1613-1616
(2). Gostin, L. A Human Condition. The Mental Health Act from 1959
to 1975: observations, analysis and proposals for reform. Vol 1 London:
MIND, 1975
(3). Eastman N. Reforming mental health law in England and Wales BMJ
2006; 332: 737-8
Competing interests:
None declared
Competing interests: No competing interests