inform the supervisor in order that they may consider the options. However, how
this will fit with duty of confidentiality is a further ethical dilemma, but one which
would generally fall in favour of disclosure in the public interest.
9.9 Reforms
As mentioned at the start of this chapter, the Government has carried out a con-
sultation exercise into reforming mental health law and treatment of individuals
with mental disorders. The result of this consultation was the publication of a
White Paper on 20 December 2000 [61], although it is clear that no new legislation
will be enacted as a matter of urgency since the White Paper states When Parliamentary time allows, we will introduce a new Bill. ..' [62]. While the White Paper contemplates a radical shake-up in mental health legislation, and does contain many changes, it is suggested that many of the practicalities and ethical aspects of caring for mentally ill patients will not alter in any fundamental way. In terms of general themes for the legislation, the expectation will be thatpeople with
mental illness or other mental disorders should ... be treated in the same way as
people with other illness or medical conditions' [63], which is no different to the
MHA. However there will be increasing emphasis on the need to protect the public
from harm where patients refuse treatment or do not realise they are in need of
care and attention; hence the legislation will seek to ensure that high risk patients
are dealt with as highlighted earlier in this chapter [64]. The provision of care and
treatment will be expected to follow a clear Care Programme' which should be designed to meet the needs of the individual patient in the least restrictive manner wherever possible, taking into account the best interests of the patient and having discussed it with the patient's relatives or another person [65]. In terms of ethics, this may mean dealing with breaches of patient confidentiality and consent, although this is not discussed in the White Paper in any way. One of the major changes introduced is that in detaining patients all powers will be subject to consideration by a new, full time Mental Health Act Tribunal [66]. The Tribunal will be required to authorise all use of compulsory powers of detention after the initial stages of assessment of the patient, a change that will clearly bring the legislation within the European Convention on Human Rights. The means to detain patients, in the context of the procedure to be followed, will also be a major departure from the current system, although the need to comply with formalities and the consequences ethically for the nurse practitioner will remain the same. Detention using formal powers under the new regime, if enacted, will be a three stage process [67] and will be related to a different, and broader, definition of mental disorder. This definition will coverany disability or disorder
of mind or brain, whether permanent or temporary, which results in an impair-
ment or disturbance of mental functioning' [68]. The stages of detention will `have
to be followed consecutively in every case' [69]; however it is not expected that the
time taken on each stage will be the same, subject to any maximum time frame
specified.
The first stage will be the decision to begin assessment and initial treatment of a
patient, this decision being made by two doctors and a social worker or other
180 Nursing Law and Ethics