This chapter will explore the development of mental health legislation from the introduction of the 1983 Mental Health Act (MHA) to the introduction of Community Treatment Orders (CTOs) in the reforms of 2007. The chapter ends with a brief discussion of the Wessely review of the MHA that was completed in 2018. Reform of mental health legislation reflects two potentially conflicting strands. One is the state's power to incarcerate the ‘mad’, the other is the move to protect the civil rights of those who are subject to such legislation.
The development of legislation reflects the broader pattern of community care as a policy. The initial optimism and progressive reforms of the early 1980s are overtaken by a more managerialist, pragmatic approach which focuses on risk and risk management. As discussed in Chapter 3, high profile cases and the way that they were reported in the media had a significant influence on the way that these policies were framed. Frank Dobson famously said in 1998 that community care has failed (BBC News, 1998). This may be a sweeping generalisation. However, I think it is possible to argue that the introduction of CTOs marks the symbolic end of official commitment to community care.
Mental health legislation before the 1983 MHA
The development of mental health policy is messy, complex and at times somewhat contradictory. It reflects not only broader social, cultural and economic trends but the relative positions of professionals, the strength of campaigning and service user groups, responses to institutional scandals and developments in treatments. In addition, there has always been a role for individual social reformers, who have challenged abusive conditions and practices. Finally, it would be naive to overlook the fiscal pressures that play such a key role in the implementation of any social policy.
Scull (1986) notes that the development of mental health and other areas of policy such as those in the criminal field have involved a greater role for the modern state. Within this field, one sees the emergence of new fields and new professionals who claim expertise in the identification, assessment and treatment/ management of conditions and individuals.