Mohammed T. Abou-Saleh

790 PRINCIPLES AND PRACTICE OF GERIATRIC PSYCHIATRYfinally abolished in 1959. More recently, the Health AdvisoryService, established by Richard Crossman’s health ministry in the1960s, was perceived to be unable to stop hospital scandals andwas gradually denuded of its powers and eventually extrudedfrom agency status to make a living from consultancy as best itcould. Now the Mental Health Act Commission predictably givesway to a new-style Commission, with more circumscribed,focused powers, and it remains to be seen whether the new onewill fare any better in the eyes of services and the government thanthe old one.It has been estimated that there are approximately 44 000informal admissions to institutions annually in England andWales of mentally incapacitated patients who are compliant withtreatment but lack the capacity to consent to treatment 4 . This farexceeds the 13 000 detained under formal powers. The new Actwill provide them with extra safeguards, the right to a secondopinion for long-term treatment and the right to appeal to aTribunal. Some psychiatrists will regard an extension of legalpowers to informal incapacitated patients as an unwelcome extraburden of work on them and their clinical teams. On the otherhand, the new provisions will ensure that older people will receivegreater attention from the regulatory bodies and their legal rightsto decent care and treatment will be enhanced.When they work well, central regulatory Mental HealthCommissions can be strong allies to clinicians seeking to improvetheir patients’ lives. Psychiatrists need to understand the role andremit of the Commission and be willing to serve during part oftheir career. The effectiveness of the new Commission will begreatly enhanced if the profession adopts a strategy of supportingand involving itself in its work and also ensures that the needs ofolder people are kept firmly in the forefront of the regulators’considerations.REFERENCES1. Reforming the Mental Health Act. Part I. The new legal framework.Cm5016-I; 6, 7, 49–51.2. The Times. Leading Article, 21 September 1833.3. Shaftesbury, Lord. Minutes of Evidence to the Select Committee onLunatics. 25 May 1860; BPP 495.XXII.349: 22–36.4. Mental Health Act Commission. Petition to the House of Lords tointervene in the Bournewood Case and submissions. London: MentalHealth Act Commission, 1998.5. Mental Health Act Commission. Eighth Biennial Report 1997–1999.London: Stationery Office, 1999; 73.