The compulsory powers which mental health professionals may exercise in respect of mentally abnormal offenders have been largely governed during the past 20 years in England and Wales by the Mental Health Act 1959. This Act is now under review and Her Majesty’s Government has issued a White Paper (H. M. Gov’t 1978) setting out the changes it proposes to make as soon as Parliamentary time can be found. The Act has a special section, Part V, which concerns admission to hospital following criminal court proceedings, the Home Secretary’s powers with regard to restricted patients, and the transfer of mentally disordered prisoners to hospital. There is general agreement that this aspect of the Mental Health Act is not working very well; indeed as the recent White Paper submitted by the Government to Parliament in preparation for a new Mental Health Act admits, “the last ten years has seen a steady decline in the number of offenders compulsorily admitted to hospital.” In 1966, 1440 hospital orders were made by courts under Section 60 of the Mental Health Act, whereas in 1976 there were only 924. There has been disquiet about the difficulties confronting the offender patient for some years. The Home Office and the Department of Health and Social Security jointly set up a special committeee to examine the problems confronting the mentally abnormal offender as far back as 1972: this committee (usually known as the Butler Committee) reported in 1975. Since then continuous discussions have taken place within the medical, nursing, and social work professions. Another important contribution to the debate has been A Human Condition Volume 2 (Gostin, 1977) published by the National Association for Mental Health (MIND). More recently the Prison Department, and in particular the Prison Medical Service have begun to complain about the increasing burden which they believe is being laid at their doorstep because of the inability of the National Health +-vice to cope with this important group of patients [Home Office, 1976). The Government White Paper acknowledges the problem and relates it in part to an increasing reluctance to admit offender patients to local hospitals. They believe that there are several reasons for this reluctance, in particular the continuing move away from the concept of long term custodial care of patients to a more open therapeutic environment in which the vast majority of patients admitted are informal and short stay. The White Paper expresses the
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