Policy Responses 2007 Bamford Review legislation reform.htm

1.1 Law Centre (NI) is a public interest law non-governmental organisation. We work to promote social justice and provide specialist legal services to advice organisations and disadvantaged individuals through our advice line and our casework services from our two regional offices in Northern Ireland. We provide a specialist legal service (advice, representation, training, information, practitioner fora and policy comment) in five areas of law: mental health, community care, immigration, social security and employment to almost 500 member agencies. Members include local Citizen Advice Bureaux, independent advice agencies, local solicitors, trade unions, social services, probation offices, constituency associations of local political parties, libraries and other civic organisations.

1.2 Our Mental Health and Community Care legal units provide advice and legal representation in relation to issues around admission to hospital for assessment, capacity, treatment, discharge delay, community services and other mental health related legal issues as well as advice and representation in relation to personal and support services for a range of people, including those who are elderly, ill, disabled, incapacitated and carers. We welcome the opportunity to respond to this consultation, which has been informed by our mental health law practitioners.

We welcome the majority of the proposals within the consultation report on legislative reform and are encouraged by the comprehensive work that the Review has undertaken in this area. We have some concerns, however, in relation to a number of the proposals. These are summarised with reference to the relevant paragraphs below.

In addition to the above, we also comment below on the following issues which require consideration before the implementation of new legislation:

3.1 We welcome the principles-based approach to the reform of mental health law in Northern Ireland and support the proposal that any new legislation should be based on four overarching principles of respect for autonomy, justice, benefit and least harm, which recognise and support the dignity of the person. The overarching architecture of human rights standards should provide the framework within which this new legislation is developed. We further support the Review’s determination to avoid the problems surrounding the implementation of the Mental Health Order 1986, namely, the unacceptable delay by five years in the issuing of a Code of Practice.

3.2 We support a rights-based approach to health and social services in Northern Ireland. Under a rights-based approach to mental health, human rights should be used as a framework for mental health development. The human rights implications of any mental health policy, programme or legislation should be assessed and addressed prior to implementation, as per the requirements of Sections 6 (acts of public authorities) and 19 (statements of compatibility) of the Human Rights Act 1998. We are encouraged by the Review’s recognition of the importance of human rights and would support the drafting of new legislation with a rights-based perspective to ensure that the right to the ‘highest attainable standard of [physical and] mental health’[1] is more firmly established in Northern Ireland.

3.3 A human rights approach to mental health underpins the principle of access to justice. People with mental health problems are suffering in many cases from distressing and disabling conditions, and are subject to detention as a result of what is ultimately an administrative process in the hands of health professionals. The law needs to provide a means to challenge this, as a fundamental aspect of Human Rights legislation. In England and Wales individuals who are applying for legal representation in proceedings before a Mental Health Tribunal are exempt from the requirement to have his/her means assessed. This is not the case in Northern Ireland, where means testing for legal aid representation at Mental Health Review Tribunals still occurs. The fact that legal aid for mental health patients in Northern Ireland is means-tested may affect access to justice for people with mental health problems. There is the need for an automatic right to legal advice and assistance and legal aid to ensure that people with mental health problems can challenge detention decisions. Alternatively, there is a need to ensure sufficiently well resourced specialist tribunal resource services are available to people who have been detained.

3.4 There is widespread recognition of the barriers to justice for people with mental health problems arising from the lack of sufficient advocacy services in Northern Ireland. Participation is a key element in the progressive realisation of any individual’s right to health. Ensuring free, meaningful and effective participation by individuals in decision-making processes which affect them is a fundamental element of the right to health.[2] Evidence establishes that the provision of an advocate increases a person’s ability to participate in their care and treatment and will enhance their access to justice. In Northern Ireland, many mental health patients are unaware of their rights and feel they can be branded as troublemakers if they raise legal or service issues.[3] Legislating for the right to an advocate may serve a dual purpose: to increase the awareness and acceptance of the important role of advocates and in turn to thereby greatly benefit many detained patients. The Strategic Framework for Adult Mental Health Services Report has already recommended a right to advocacy for persons detained and we would support the inclusion of this right in the legislation.

3.5 We note the proposal to adopt a ‘best interests’ test for any decision or action on behalf of a person with impaired decision-making capacity. We would propose the use of a benefit test as this is more in keeping with the autonomy principle within the framework and also reflects the language of the overarching principle of benefit. The inclusion of a benefit test is in keeping with the human rights approach to legislative reform as it ensures a welfare approach to any decisions made regarding an individuals care and treatment. It ensures an obligation to an individual’s autonomy and only allows for a derogation from that principle if there is an actual benefit rather than allowing for derogations in the person’s best interest without any assurance that the individual will benefit from the intervention.

3.6 We note that the Mental Capacity Act 2005 incorporates a best interest test. On the other hand the Mental Health (Care and Treatment) (Scotland) Act 2003 uses a benefit test. For the reasons outlined above we recommend the implementation of a benefit test as per the Scottish legislation for Northern Ireland rather than the proposed best interest test.

3.7 In assessing the proposed model for mental health law reform, Law Centre (NI) recognises the value of the Mental Health (Care and Treatment) (Scotland) Act 2003 as a helpful model and useful starting point for reform in Northern Ireland. The Act strengthens the rights of service users and provides vital safeguards covering the assessment and involuntary detention of mental health patients. We particularly welcome the development of the role of the Scottish Mental Health Tribunal, as both an administrative and decision-making body. We recommend careful consideration of the remit and work of the Scottish Mental Health Tribunal as a potential model for the reform of the Northern Ireland Mental Health Review Tribunal. We comment further on the role of the Mental Health Review Tribunal at paragraph 4.5.

3.8 We are aware that debate continues about the Mental Health Bill 2006 for England and Wales. We are disappointed that the latest draft of the Bill does not include many of the proposals for new mental health legislation made during the consultation process and in previous drafts of the Bill. We welcome the decision not to recommend this model for proposed legislative reform in Northern Ireland as it is preoccupied with public safety rather than the needs of people who might require help.

3.9 While public protection is important, high levels of stigma and discrimination already occur for people with mental health problems and learning disabilities. We urge caution against public protection becoming the focus of any legislative reform following the England and Wales experience with the Mental Health Bill 2006. The importance of public protection must be counterbalanced by measures to curtail the high levels of stigma and discrimination associated with mental health.

3.10 Research has found that respect for human rights in the context of mental illness leads to markedly better prevention and treatment. Respect for the dignity and privacy of individuals can facilitate more sensitive and humane care, while stigmatisation and discrimination thwart medical and public health efforts to heal people with disease or disability.[4] An appropriate and comprehensive education programme for service users, family members, carers, practitioners and the general public should therefore precede the introduction of any legislative reforms.

4.1 The Comprehensive Legislative Framework is a detailed and wide-ranging overview of past, current and future mental health law in Northern Ireland. We are encouraged by many of the recommendations within the consultation report and optimistic that the work of the Bamford Review, as a whole, will provide for a robust and progressive reform of mental health law in Northern Ireland. We have highlighted, below, some specific areas, which warrant further attention as part of the Framework.

4.2.1 We welcome the Review’s decision that the proposed Framework should only apply to those who have impaired decision-making capacity. Clearly, a decision by a person not to proceed with a particular recommended treatment does not mean that health professionals would not continue to explore options with the person about care and treatment, which would be acceptable. The State as a whole retains its obligations to offer services and take steps to protect the rights of everyone.

4.2.2. The review of mental health legislation will have an impact on many people in Northern Ireland, however, it has particular implications for those people with impaired decision making. Ensuring the correct approach in legislative reform is all the more critical in a situation where a person’s decision-making is impaired by their mental disorder and when their health, welfare or safety or the safety of others may be jeopardised by a refusal to consent to treatment which would be of benefit to them. In such situations, it is generally accepted that it can sometimes be right for society to override the individual’s right to self-determination, for their benefit. Clearly, it is important that an individual’s rights are only overridden in specific well-defined circumstances and under the controls put in place by legislation.

4.2.3 We are aware that the Office of Law Reform’s successor the Law Commission will be undertaking preparatory work on the possible introduction of new capacity legislation to bring Northern Ireland into line with the rest of the UK. We agree that capacity legislation should be underpinned by the principle that every adult should be assumed to be capable of making his/her own decisions unless proved otherwise. The focus and principle of capacity legislation must be centred on working to ensure that every individual is supported and encouraged to make his/her own decisions and to achieve capacity. Legislation already in place in Great Britain namely, the Mental Capacity Act 2005 (MCA) and the Adults with Incapacity (Scotland) Act 2000, aims to protect the rights of people whose mental capacity is in doubt and legislate who is entitled to make decisions on behalf of an individual who is deemed to lack capacity. The introduction of some form of capacity-based legislation in Northern Ireland is necessary to ensure greater legal protection for those with temporary or permanent impaired decision-making.

4.2.4 We welcome the Review’s proposals for legislation and a Code of Practice and see these as key to ensuring both the empowerment and protection of those with impaired decision-making capacity.

4.2.5 We note the Review’s use of the MCA as a model for capacity based legislation in Northern Ireland. While there is much to commend within the MCA, we have concerns regarding the relationship between the MCA and mental health legislation. The relationship between the powers under the MCA and the compulsory powers of admission to hospital and treatment for mental disorder in mental health legislation are unclear.

4.2.6 This dual model within the rest of the UK with distinct legislation to govern mental health and capacity is inappropriate. We welcome the Review’s recommendation for a single comprehensive legislative framework, which takes a common approach to issues relating to the care, treatment and detention of people diagnosed with a mental health disorder. We believe that the division of those likely to need treatment and care without consent into two groups, one group coming under Mental Health legislation and the other under capacity legislation, is inappropriate and confusing. In fact, two systems may create scope for discrimination in law and in practice.[5]

4.2.7 Segislative base for the detention and treatment of people with mental health problems.[6] Zigmond and Holland have argued that two separate systems dealing with capacity could be “damaging to the care of people with a mental disorder”.[7] Mind also argue that if two systems of applicable law apply to the same populations, there will be conflict and confusion about which to apply.[8] This may cause problems not only for mental health service users and their carers but also for the medical and health professionals working with and for services users. We are concerned that a differential approach may ultimately be stigmatising or discriminatory to some users because this may send an inappropriate message that the majority of people with mental health problems require compulsory treatment or lack capacity to make their own decisions.

4.2.8 The ongoing debate and dissent regarding the Mental Health Bill 2006 and the legislative confusion caused by the aftermath of the Bournewood decision (we refer to this in more detail at paragraph 4.6) further demonstrates the need for a fresh approach to mental health law reform in Northern Ireland. Northern Ireland has a legislative opportunity to introduce coherent and groundbreaking legislation to provide for a less interventionist greater autonomy based reform of mental health law.

4.3.1 Considerable safeguards are required to ensure consistency in the assessment process when determining decision-making capacity. We note the difficulty that may arise if a patient is assessed as having an impaired decision-making capacity and is compulsorily treated but regains capacity following treatment only to refuse ongoing treatment and relapses as a result. We are concerned that the Review seems to shy away from tackling this point within legislation instead advising that a Code of Practice should give detailed guidance on this matter. This is of particular importance given that only legislation binds decision makers. We would recommend that this issue is must be addressed in the legislative framework as this goes to the heart of the debate about the balance between the fundamental principle of autonomy and the need to ensure the sustained wellbeing of the patient. Case law on the legal status of guidance suggests that the Review’s intentions may not be effectively met through dealing with this issue within a Code of Practice.

4.3.2 We would welcome further information regarding the evidence base for proposals for a two-tiered approach to the assessment of risk. We are concerned by the application of a lower threshold test for people with mental health problems who are ‘known’ to have impaired decision-making capacity. We would urge for considerable caution regarding the introduction of differing tests in relation to compulsory assessment and would request a rationale as to why this is necessary.

4.3.3 We note the recommendation to replace ‘failure to so detain him would create a substantial risk of serious physical harm to himself or to other persons’ with ‘failure to assess would create a significant risk to the health, safety or welfare of the person or to the safety of others.’ We are concerned by the altering of this test and would welcome the justification and evidence base for the proposed changes to the qualifying test for the definition of mental disorder and the lowering of this test from serious harm to significant risk

4.3.4 Article 7 of the 1997 Convention on Human Rights and Biomedicine states that ‘a person who has a mental disorder of a serious nature may be subjected , without his or her consent, to an intervention aimed at treating his or her mental disorder only where, without such treatment, serious harm is likely to result to his or her health.’[9] We would be concerned by any move away from international standards in this area and would recommend that any legislative framework for Northern Ireland reflect international best practice.

4.3.5 Legislation should set out clear timetables for ongoing reviews of capacity, detention and compulsory treatment. Regular comprehensive reviews are vital to take account of fluctuating capacity and mental health. Any new legislation should include appropriate and specific triggers and safeguards. Consideration should be given to the right to request and receive a review of any capacity, detention or compulsory treatment decision when a change of circumstances can be shown on the face of the request for review.

4.3.6 We are concerned by the proposals within the Framework to alter the period of detention for assessment. Any increase in the period of detention for compulsory assessment from 14 days, under the 1986 Order, to 28 days warrants particular attention. This is a significant increase, which is inappropriate given the vulnerability of people with mental health problems and the gravity of detention as a deprivation of liberty. We recommend no change to the current timeframe.

4.4.1 We welcome the proposals to ensure that the needs of those detained for treatment are met by recommending that a corresponding obligation be placed upon service providers to deliver the essential elements of an intervention plan. We would welcome a similar statutory duty to meet the needs of those who voluntarily seek to access services.

4.4.2 Clearly, any recommendation for legislative reform must be backed up by a strong commitment to deliver the services required. Any reform of mental health legislation in Northern Ireland must ensure that the human rights of people with mental health problems are both protected and realised, through the provision of appropriate and timely services and support. The reform of mental health law in Northern Ireland cannot be seen in a vacuum and will be insufficient without a corresponding reform of service provision and the allocation of resources to ensure that services and support are available for individuals with mental health problems.

4.5.1 We are impressed by the development of the role of the Mental Health Tribunal for Scotland (MHTS) by the Mental Health (Care and Treatment) (Scotland) Act 2003 and recommend careful consideration of the remit of the MHTS as a potential model for reform of the Mental Health Review Tribunal (MHRT) in Northern Ireland. The MHTS operates as a decision-making rather than as merely a reviewing body. This provides for greater safeguards and consistency in the consideration of application for compulsory treatment orders, appeals and reviews. The MHTS has shown considerable success, despite initial lack of resourcing, in its first year of operation.[10]

4.5.2 We recommend a radical overhaul of the functions and process of the MHRT and the implementation of a new Mental Health Tribunal for Northern Ireland (MHTNI). The aim of the MHTNI should be to provide an independent and impartial service that is accessible and timely in making decisions on the compulsory care and treatment of people with mental health problems.

4.5.3 We recommend that all applications for compulsory treatment should be considered by the MHTNI and that some of the functions detailed within the Framework for the Regulatory and Quality Improvement Authority (RQIA) should transfer to the MHTNI. These include the proposals for the RQIA to review Intervention Plans, for those detained, at six-monthly intervals. We consider six months unduly long as reviews that are more frequent will ensure that a patient’s response to any intervention is monitored closely and that any changes in their presentation and their capacity are identified as soon as possible.

4.5.4 The Framework also proposes that the RQIA may request an independent ‘second opinion specialist’ when reviewing Intervention Plans. We would recommend that this function also transfer to the MHTNI and that the individual being assessed or their nominated person should have the right to request and receive a second opinion when he or she is being assessed for impaired decision-making capacity and/or any interventions.

4.5.5 We also welcome the wide range of disciplines from which the general member of the MHTS can come. We note the Framework’s recommendation to expand the role of the those who can be involved in the initial assessment process and would recommend that a similar approach be taken in regards to recommendation for the general member of the MHTNI

4.5.6 While we welcome many of the proposals regarding the MHTS, we do not support the two-year automatic review requirement under the 2003 Act for the Tribunal as it is too infrequent. We recommend consideration of a shorter timeframe in Northern Ireland legislation for an automatic review by the Tribunal.

4.5.7 Consideration will also need to be given to an appropriate format for appeals if an individual is unhappy with the decision made by the MHTNI. In Scotland if an individual is unhappy with the MHTS’s decision he/she may be able to appeal to the sheriff principal and then to the Court of Session for a review of the decision. A clear process for appeals will need to be included within new mental health legislation for Northern Ireland.

4.5.8 We welcome further information regarding the development of the role of the MHTNI. In particular we recommend that further public consultation occur in order to debate and inform the practical details of the remit and functions of the Tribunal. Careful consideration also needs to be given to how the MHTNI will be monitored, evaluated and resourced.

4.6.1 We note the reference within the report to the Review of Public Administration and the transfer of the functions of the Mental Health Commission to the RQIA. It is important that any new legislation complements and is informed by the Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003. As outlined above, however, we recommend the expansion of the role of the MHRT rather than the Mental Health Commission.

4.6.2 The RQIA should retain the functions of the Mental Health Commission as outlined in Articles 86 and 87 of the MHO to inspect and review policy and processes rather than taking on any decision-making role. The RQIA would be under a duty to make sure that individuals’ rights under legislation are being protected and should develop a wider role to promote best practice within the sector.

4.6.3 We also welcome further information and public consultation regarding the role and function of the RQIA in line with that recommended for the MHTNI at paragraph 4.5.8. We appreciate that these details may not be currently available, however, we wish to highlight the need for further public consultation on the exact role of the MHTNI and the RQIA once further details are confirmed.

4.7.1 The Framework also takes account of proposals to address the ‘Bournewood’ issue. We welcome the proposals to ensure legislation appropriately deals with cases where a non-objecting person with impaired decision making capacity is deprived of his or her liberty. Urgent consideration, however, must be given to the formulation of interim protection to address this legislative gap while legislative reform occurs.

4.7.2 The protections afforded to those detained in hospital should be the same for those effectively detained in other care environments as per the Bournewood decision HL v UK (2004). Legislation for Northern Ireland needs to ensure that appropriate protection and safeguards are enacted across the board. Strong safeguards should aid improvements to care and practice, which will in turn benefit mental health service users, carers and society as a whole.

4.7.3 We welcome the classification of Bournewood cases as formal interventions that can be undertaken only in accordance with procedures drawn up and regulated by, and under the authority of, a local Health and Social Services Trust. We are concerned, however, that the Framework recommends that decisions of deprivation in Bournewood cases should be reviewed at least annually, while also recommending that the RQIA review Intervention Plans, for those detained every six months. This differentiation is concerning and we recommend that the proposals outlined within the Framework in regards to Bournewood cases are not sufficient to ensure protection for non-objecting individual’s with impaired decision-making capacity.

4.8.1 The recommendation to repeal the special status accorded to ‘the nearest relative’ is welcome. As per the Scottish model, a category of ‘nominated person’ should be included within the legislation to ensure that a person with mental health problems can nominate his/her own representative to act on his/her behalf. Individuals should have the choice as to who this person should be, whether an independent advocate, legal representative, family member, carer or any other relevant party. While we welcome the widening of this category we recommend that the legal rights currently given to the nearest relative are retained but available to a nominated person who may or may not be the nearest relative.

4.8.2 We welcome further information regarding the default position if an individual is unable to or chooses not to nominate someone to act on his/her behalf. We recommend a similar structure to Scotland where, if an individual is 16 or over and decides not to choose a named person, or the person chosen is not willing to do it, his/her main adult carer will automatically be the named person. If an individual has more than one adult carer the carer can decide between them who it will be. If there is no adult carer who is willing to be the named person, then it will be the nearest relative, as defined within the Scottish legislation. If there are no carers or relatives who are willing or able to be the named person, a mental health officer can apply to the Tribunal to have someone appointed as the named person. Anyone else who has an interest in the welfare of the individual can apply to the Tribunal asking it to appoint someone to be the named person.[11]

4.8.3 Alternatively consideration should be given to Rethink’s proposal in relation to the Mental Health Bill 2006 that the nearest relative ‘set list’ should have carers at the top of the list rather than defining people’s relationships in terms of family relationships.[12]

4.8.4 We welcome the proposal that it should be possible to engage the services of an independent (accredited) advocate if no ‘nominated person’ is available. We would welcome the regulation of advocates available to people with mental health problems through some form of accreditation process. However, if a claimant wishes to nominate a family member or other interested party as their advocate there should not be a requirement for them to be accredited. Care will need to be taken to ensure that the accreditation process is not overly onerous, which may limit the number of people available to act as advocates, while ensuring that only genuine and appropriate advocates are accredited to act on behalf of people with mental health problems. We do not agree, however, that this should be an essential requirement as a person with mental health problems may choose not to have a nominated person or advocate. If a person with mental health problems without a nominated person is assessed as lacking capacity then an independent advocate should be engaged on their behalf, if it appears to be for his/her benefit.

4.9.1 Personality disorder as a mental disorder is excluded with regard to compulsory treatment within current legislation in Northern Ireland. Legislation in the rest of the UK explicitly recognises those with personality disorders within the definition of mental disorder. We note that people with a personality disorder will come under the Review’s proposed definition ‘impairment of, or disturbance in the functioning of, the mind or brain.’

4.9.2 We note the Review’s comments that experience in Scotland suggests that personality disorder on its own is very rarely considered to be associated with significant impairment of decision-making ability under their legislation. In most situations this may be the case, however, the removal of the exclusion will enable those with personality disorders who do lack capacity to be treated under compulsion when legislative change is in place. The Review has stated that for people with personality disorder compulsion is likely to be counter therapeutic. It may however, help to counter the incorrect assumption by some mental health service providers that because people with personality disorders are excluded from compulsory in-patient treatment they do not have access to mental health services and treatment in the community and voluntary in patient treatment.[13]

4.9.3 Legislation should require the provision of accessible treatment, services and support for people diagnosed as having a personality disorder. Although personality disorders are generally not treatable by medication, evidence suggests that people can be helped by group or family therapies. Certainly those with a diagnosis of personality disorder can be helped to live less disruptive lives through the provision of regular supervision and social support.[14]

4.9.4 Alongside any legislative reforms we would recommend the issuing of some form of Code of Practice in respect of personality disorders. There is a clear need for the issuing of specific information on personality disorder to require health authorities to comprehensively assess the person and any carers’ needs, devise a written care plan, formally identify any areas of unmet need and provide access to appropriate care and treatment as with any other mental health problem.

5.1.1 We welcome the commitment to the need for the confirmation of the reasons for impaired decision-making capacity prior to detention for compulsory treatment. We recommend that this be developed to ensure that a diagnosis is also confirmed as part of the Intervention Plan. There is a need for a diagnostic assessment prior to or at the same time as a capacity assessment to ensure that the proposed treatment is appropriate for the particular diagnosis. A diagnostic model also protects the rights of the individual to know the basis on which they are being treated and will assist in the ongoing assessment of the therapeutic effect of treatment.

5.2.1 We share the Review’s concerns regarding the lack of effective transfer arrangements between Northern Ireland and the Republic of Ireland. Work needs to be undertaken to ensure that cross-border transfers are not unduly delayed or complicated by the lack of formal transfer arrangements. This should be rectified within any new legislation.

5.3.1 We welcome the use of the term ‘intervention’ within the Framework and the recognition that, in practice, many situations involve a mixture of health and welfare elements. We would welcome a change in legislation to ensure that a wider definition of intervention is developed and enforced to ensure that interventions are not solely focused on medication. We would encourage the provision of more active rehabilitation for patients to include talking therapies, occupational therapy and other interventions as appropriate.

5.4.1 We would welcome further information regarding the development of the proposed inter-agency risk assessment and management framework including what its remit will be, what agencies will lead its development and how they will engage with the sector and user-groups and how its work will be monitored and evaluated.

5.5.1 One of the more controversial aspects of the Mental Health Bill has been proposals to introduce supervised community treatment to prevent relapse and the readmission of patients. Recent research by the Institute of Psychiatry on international experiences of using community treatment orders has found that it is not possible to state whether community treatments orders (CTOs) are beneficial or harmful to patients. The research, funded by the Department of Health stated that ‘there is currently no robust evidence about either the positive or negative effects of CTOs on key outcomes, including hospital readmission, length of hospital stay, improved medication compliance, or patients’ quality of life.’[15]

5.5.2 In light of the above mentioned research and the backlash against the introduction of such orders in England and Wales we recommend that such orders are not introduced within a legislative framework for Northern Ireland at this stage until further evidence on the value or such orders or otherwise is available.[16]

6.1 Northern Ireland has the opportunity to develop balanced, integrated and modern mental health legislation. We welcome the Framework and the work of the Bamford Review. We believe the consultation document is a basis for the development of progressive reform of mental health legislation in Northern Ireland. It is vital it is carried forward alongside the other work streams created by the Review in other areas of learning disability and mental health.

6.2 Law Centre (NI) will continue to work on the reform of mental health legislation in Northern Ireland. Our work will be informed and shaped by cases brought to our mental health legal service. This provides a unique and exciting opportunity for campaigning and lobbying on policy issues to be directly informed by people with mental health issues, their carers or family members.

6.3 Law Centre (NI) welcomes the opportunity to respond to the Working Group. If there is any further way in which we could contribute to this process we would welcome the opportunity to do so.

[1] Article 12(1) of the International Covenant on Economic, Social and Cultural Rights

[2] World Health Organization, 25 Questions and Answers on Health and Human Rights, 2002, pg 17

[3] Northern Ireland Human Rights Commission, ‘Connecting Mental Health & Human Rights’, December 2003

[4] J Mann, S Gruskin, M Grodin and G Annas (eds), Health and Human Rights: A Reader, 1999, Introduction

[5] See Lucy Scott-Moncrieff, Crossing Boundaries to Break New Ground in Mental Health and Mental Capacity Law, October 2006

[6] Mind, Response to Bournewood Consultation, March 2005

[7] Anthony Zigmond & Anthony J Holland, Unethical Mental Health Law; history repeats itself, Journal of Mental Health Law, February 2000 at pgs. 50-57

[8] Mind, Response to Bournewood Consultation, March 2005

[9] CM, 2000, Article 7

[10] For further information see Mental Health Tribunal for Scotland website, Quarterly Statistics Report Sep 2006

[11] Scottish Executive Publications, A New Mental Health Act: A Guide to Named Persons, October 2004

[12] Rethink, Briefing Paper on the Mental Health Bill, 2006

[13] See Northern Ireland Human Rights Commission, ‘Connecting Mental Health & Human Rights’, December 2003

[14] Rethink, Policy Statement 16: Personality Disorders, at www.rethink.org

[15] Rachel Churchill, Gareth Owen, Swaran Singh and Matthew Hotopf, International Experiences of Using Community Treatment Orders, 2006

[16] For further information regarding the debate about CTOs in the Mental Health Bill 2006 see Mental Health Alliance website at http://www.mentalhealthalliance.org.uk