Abstract
The Mental Health Act 1983 was written for a predominantly hospital-based service. The closure of mental health institutions reduced the number of inpatient beds available and created a community-based service.
The move to community care was followed by a small number of high profile cases involving people with a mental illness. Media involvement incited a belief that mentally ill people were a dangerous sector of the community; as a result, public safety and compulsion for patients to accept treatment became powerful drivers to a review of the Act.
In November 1999, the report of the Expert Committee appointed to review the Act was published alongside the Government's Green Paper Reform of the Mental Health Act 1983 – Proposals for Consultation (Department of Health [DH] 1999a,b). The report advised that incapacity should be central to the recommendations for changing the existing legal framework. Despite the expression of concern by professional bodies and individuals, the Government chose to reject the notion of incapacity from the White Paper, Reforming the Mental Health Act (DH 2000). There is, however, a strong emphasis on the role of compulsion for the patient to accept treatment.
Although the White Paper is unsatisfactory in some aspects, those involved in the care of mentally ill people recognise that there remains a need for a legal framework within which to operate. This article discusses the issues of safety, capacity and compulsion covered by the White Paper, Reforming the Mental Health Act (DH 2000). Attention is drawn to the dilemmas for and impact on occupational therapists working with patients being treated under this Act.
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