THE MENTAL HEALTH ACT 1983
The introduction of the Mental Health Act in 1983, replacing the previous 1959 Act, was hailed by its proponents as a radical piece of legislation that embraced the principles of civil liberties, whilst affording protection to service users and the public at large. The then Chairman of the Royal College of Psychiatrists Working Party described the new act as ‘an event in the history of mental health care of the greatest importance’ (Bluglass 1983). Although it is now more than two decades since the act was passed, the legislation remains in force at the time of writing. Readers should be aware, however, that amendments to the act are pending. So what does the Mental Health Act 1983 contain?
PARTS OF THE ACT
As with all legislation, the act is arranged in parts. These parts are:
• Part I: Application of Act
• Part II: Compulsory Admission to Hospitals and Guardianship
• Part III: Patients Concerned in Criminal Proceedings or under Sentence
• Part IV: Consent to Treatment
• Part V: Mental Health Review Tribunals
• Part VI: Removal and Return of Patients within the United Kingdom
• Part VII: Management of Property and Affairs of Patients
• Part VIII: Miscellaneous Functions of Local Authorities and the Secretary of State
• Part IX: Offences
• Part X: Miscellaneous and Supplementary
It can be seen from a brief examination of the above headings that the act is primarily concerned with the admission, detention and treatment of those ‘patients’ that require it. (The word ‘patient’ is used here because that was the term employed within the act and was the language of the day.) The first part that is of key interest is Part I, for it is here that those people to whom the act is applied are defined.
PART I: APPLICATION OF THE ACT
We provide a legal, rather than a medical, defi nition of the types of mental health problems that the Mental Health Act 1983 is intended to cover, and identifi es the scope of the act:
‘1.–(1) The provisions of this Act shall have effect with respect to the reception, care and treatment of mentally disordered patients, the management of their property and other related matters.’
Mental disorder is divided into four types:
(1) Severe Mental Impairment,
(2) Mental Impairment,
(3) Psychopathic Disorder, and
(4) Mental Illness.
The two that are of particular interest to those working in the fi eld of learning disabilities are mental impairment and severe mental impairment, further defined thus:
‘Severe mental impairment means a state of arrested or incomplete development of mind which includes severe impairment of intelligence and social functioning and is associated with abnormally aggressive or seriously irresponsible conduct on the part of the person concerned and “severely mentally impaired” shall be construed accordingly; Mental impairment means a state of arrested or incomplete development of mind (not amounting to severe mental impairment) which includes significant impairment of intelligence and social functioning and is associated with abnormally aggressive or seriously irresponsible conduct on the part of the person concerned and “mentally impaired” shall be construed accordingly.’
It can be seen from these definitions that ‘mental impairment’ is, in effect, learning disability. However, learning disability alone is not sufficient justification to apply the act, as the definitions of both ‘mental impairment’ and ‘severe mental impairment’ include the condition of ‘abnormally aggressive or seriously irresponsible conduct’. So, the act only applies to adults with learning disabilities who also exhibit abnormally aggressive or seriously irresponsible behavior. In practice, this represents a tiny proportion of adults with learning disabilities.
PART II: COMPULSORY ADMISSION TO HOSPITAL
Part II of the act contains the sections which set out the criteria for compulsorily detaining people in hospital. An interesting feature of the act is that compulsory detention may not require any judicial involvement, unlike in many other countries (including Scotland), where compulsory detention requires a judge’s approval. In England and Wales, the decision to detain can be taken by doctors, social workers and, in certain circumstances, nurses. The most common civil sections of the act under which patients are compulsorily admitted to a hospital are sections 2, 3 and 4. There are other sections of the act that permit detention, but those will be explored later.
