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Labour is often accused of rushing through ill-considered laws whenever its appearance of competence is cracking. The mental-hea

admin2017-03-15  59
问题     Labour is often accused of rushing through ill-considered laws whenever its appearance of competence is cracking. The mental-health bill, which came back to the House of Commons from the Lords this week, hardly fits this pattern. Discussions about a new law began nine years ago, not long after Michael Stone, who suffered from a personality disorder, killed a mother and her daughter with a hammer while they were walking down a lane in Kent. Since then the bill has been introduced, thrown out, brought back, re-worded and tinkered with. And yet it still sets the Mental Health Alliance, which represents 80 organisations that think the bill represents a sinister grab at civil liberties, against the government, which says that those who oppose it are guaranteeing a "right to suicide" by allowing patients of precarious stability to go untreated.
    Two questions are at the root of the conflict. The first is whether patients who are able to make decisions about their own treatment should sometimes be compelled to take medication. The second is whether people with illnesses that may not respond to treatment should be forced to try anyway. The answer to the question of how far the state should deprive people of their liberty for their own sake and for the sake of everyone else is likely to affect mental-health care not just in England (Scotland and Wales have different systems), but in the rest of Europe too, where England is seen as a model of how to look after the mentally ill.
    Sick people can be treated either in hospitals or outside them. Britain decided earlier than elsewhere that outside was better. Care in the community, as this is known, has meant a reduction in the number of beds in grim psychiatric hospitals from 150,000 in 1950 to 30,000 now. It was underfunded to begin with, and "the community" sometimes meant a flat next to a motorway rather than a cosy family home.
    But things have improved over the past ten years. Whereas other west European countries tend to have a single community mental-health team, England has three: one to go out and look for people who have a history of illness; another that concentrates on young people who have become ill for the first time; and a third to treat people at home. Matt Muijen, who studies different systems from his vantage point at the World Health Organisation, reckons that "England is ten years ahead of the rest of Europe".
    There are still plenty of problems. Lots of mentally-ill people end up behind bars: they constitute some 80% of female prisoners, according to the Howard League, a charity. And patients being cared for at home frequently fail to take their medicines, some of which can have unpleasant side effects. This often leads to a crisis, or worse: some 1,200 patients kill themselves each year. There is also a risk to others as schizophrenics, for example, account for 1% of the population and 5% of murders. When care at home breaks down,, the mentally ill go back to hospital and the cycle begins again.
    One of the bill’s proposals, the introduction of Community Treatment Orders, aims at breaking it. A patient who is deprived of his liberty and taken into hospital, regains it on release. Under the government’s plan, a psychiatrist would then assess the patient and decide if nurses should be given the power to try to make sure he takes the pills prescribed, sending him back to hospital if he does not. Each order would be reviewed by a tribunal each year. Doctors in most states in America and in Australia already have this power. Psychiatrists in Scotland gained it in 2005.
    But compelling patients to take medicines when they may be well enough to decide they do not want to makes doctors nervous. Some patients may prefer the ups and downs of their ill selves to their humdrum medicated versions. The provision in the bill for psychiatrists to supervise people with personality disorders that, unlike schizophrenia or depression, may not respond to treatment, is controversial too. Most psychiatrists are aware that the history of their profession includes a spell as gaolers to the awkward and the extraordinary and do not want to reprise that role.
    Yet the case for the bill is strong enough to sway some libertarians. For the choice is not between treating patients in institutions and allowing them to roam free, but between treating them in hospital or outside. If the latter is to be made to work, some of the compulsory features of hospitals may have to come into the home.
What does "behind bars" (Para.5) mean?
选项 A、In prison.
B、In pubs.
C、Home treatment.
D、In charity.
答案A
解析
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