Workload implications of the new Mental Health Act

The Department of Health, with the assistance of other organisations including the Royal College of Psychiatrists, is considering the workload implications of the proposed new Mental Health Act. The paper by Whyte and Meux (2003) is therefore both interesting and timely. I am, however, concerned at their statements in relation to general adult psychiatry.

They state that compulsory powers are used less frequently in general adult psychiatric services than forensic services. I would be interested to know if they have figures to support this assertion. There are approximately 15 times as many civil detentions as court detentions each year in England and Wales (Department of Health, 2001), 17 times as many if the private sector is excluded. There are approximately 9 times as many general adult psychiatrists as forensic psychiatrists (Advisory Committee on Distinction Awards Annual Report, 2002). Old age psychiatrists also use the Mental Health Act 1983 (although I suspect not as frequently as general adult colleagues). Addition of their numbers gives a ratio of 11:1. Adult psychiatrists will care for patients detained under forensic sections and vice versa, nonetheless these figures suggest that general adult psychiatrists use compulsory powers more frequently than forensic psychiatrists.

It is likely that the number of people subject to compulsion under the proposals in the Draft Mental Health Bill (Department of Health, 2002) will be markedly increased over the current number detained. This is because all patients who are currently detained will be detained under new legislation, as will those who currently meet the criteria for detention, but whom it is decided should not be detained (there will be no discretion not to make an order if the criteria are met). There will also be a new cohort of patients who do not currently meet the criteria for detention, but who will do so under the proposals in the Bill. There will be no limit to the number who may be subject to compulsion given the absence of a need for a bed to be available. Furthermore, the number of inappropriate assessments is likely to increase considerably as ‘anyone’ can require an assessment to be made.

All patients will have a Tribunal (we do not know how many will also appeal) and the number of ‘consultations’ with nominated persons and carers that will need to be undertaken is not quantified.

Given the limited community work undertaken by forensic psychiatrists, combined with the fixed number of forensic beds, it is likely that the increase in numbers subject to compulsion will become the workload of general adult psychiatrists.