Finally, the 1983 Mental Health Act has been amended. [1] Much stays the same. What is new? The two most noteworthy changes are that the definition of mental disorder has significantly broadened to 'any disorder or disability of mind' and that community treatment orders" have been introduced.

Parliament's 'guiding principles' behind the Amendment are: [2]

• To treat and minimise the undesirable effects of mental disorder
• To provide the least restrictive treatment setting which is consistent with protection of the patient and the public
• To respect the rights of patients
• To involve patients and carers in care
• To provide effective, efficient and equitable care

Why has it taken so long to change apparently so little? The government was besieged by a coalition of professionals, civil liberty and patients' groups who saw the widening of the definition of mental disorder and the introduction of Community Treatment Orders as gross infringements of liberty. However, after the murders committed by Michael Stone on the Russell family, the government wanted to ensure that those with personality disorder would not be ineligible for treatment, as long as 'treatment is available'. Community Treatment Orders will have greater power than the current 'supervised discharge', but it will still not be possible to enforce an injection while the patient is in the community – the patient must be brought back to hospital.

There are a number of other changes – no persons under 18 will be allowed admission to adult mental health wards after 2010; independent mental health advocates will be brought in; others, besides doctors, can be 'Responsible Clinicians' and those, besides social workers, can act as 'Approved Mental Health Professionals'; the 'Nearest Relative' can be a civil partner; and other than in an emergency ECT cannot be given to an unwilling patient who retains capacity.

Christians welcome the following principles:

• Compassion – the basic purpose of the Act is to provide care for suffering people
• Justice – care should be provided for all, regardless of income, employment, race
• Truth – each case will be subject to independent review by a tribunal

The big unknown factor is whether any future government might abuse the wide definition of mental disorder. At this stage all one can say is that the stated principles of respecting and involving patients and the necessity to provide 'appropriate treatment' might act as a defence against any future abuse.