Letter: Nurses or enforcers?

Sir: The Scoping Study Committee, commissioned by the Department of Health to review the Mental Health Act, published draft proposals in April. Although the proposals are wide-ranging, they pivot around the vexed issue of the compulsory treatment of particular individuals in the community.

The proposals note that a "responsible clinician" will be charged with overviewing compulsory treatment. History suggests that this will be a psychiatrist or psychologist, who will "delegate" enactment of compulsory treatment to a mental health nurse.

Although we acknowledge that there are times when it may be appropriate to enforce treatment, we fear that such enforcement could, if used inappropriately, further marginalise an already dispossessed section of the community.

As mental health nurses, we believe that little attention has been paid to the fact that the primary mandate of nursing is to "care for", rather than "treat" people in mental distress. The proposal for us to act as enforcers will generate a major ethical dilemma for community mental health nurses, and may place their physical and emotional security in jeopardy.

The interests of people with serious mental illness, and the country at large, would be better served if more consideration were given to reasons why people reject treatment, rather than merely prescribing the extension of legal powers.

Professor P J BARKER, University of Newcastle; Professor P BURNARD, University of Wales; Professor M CHAMBERS, University of Ulster; Dr L CLARKE, University of Brighton; Professor B DAVIS, University of Wales; Professor H P McKENNA, University of Ulster; Dr P NOLAN, University of Birmingham; Dr S PARSONS; University of Newcastle; Dr B REYNOLDS, University of Stirling; Dr C STEVENSON,

University of Newcastle; MARTIN WARD, Royal College of Nursing

Oxford