by Jenna Ward

BERKELEY, Calif., February 25 - Calling existing mental health laws "draconian," a Scottish government commission released a report last week recommending new guidelines for care of the mentally ill. The 65-page report says the power of social workers to supervise mentally or physically "vulnerable" patients living at home should be defined and expanded. According to a press release, the report, issued by the Scottish Law Commission, calls for establishing a gradated series of powers of intervention.

The first step would be investigating people considered at-risk due to a confused mental state or physical illness such as a stroke. Social workers would then have the right to enter and inspect the person's home, carry out "various assessments," provide services and protective measures, and, as a last resort, remove the person to a hospital or place of safety. If the person does not agree to home inspection or hospitalization, a sheriff's warrant could be obtained for police assistance. Current Scottish law is tilted toward putting people in institutions - for example, social workers can hospitalize someone without any previous notice and without any subsequent right of appeal. However, outpatient and follow-up care is said to be inadequate. "These proposals are more sensible than the current all-or-nothing approach," said Dr. James Dyer told the Scotsman newspaper on February 21. Dyer is director of the Mental Welfare Commission for Scotland, the government watchdog that oversees care for the mentally ill. In recent months, the group has stepped up calls for reform, advocating implementation of the "Care Programme Approach," where a key worker coordinates a patient's care and provides detailed planning to ensure he or she receives the services needed. "In terms of Care Programme Approach, schizophrenia would be the kind of prototype of the patient who would benefit," Dyer told the Daily Mail in October of 1996. "The most important thing to say is that the majority of people with schizophrenia can live in the community without any risk to themselves or other people." "It is up to the services to detect the small number who do present a risk and make sure they have adequate care and provision." The Scottish government endorsed the Care Programme approach in 1992, but most of the services are still not widely available.