Mental Health News

WRITTEN STATEMENT BY THE WELSH ASSEMBLY GOVERNMENT

 

Title:   Mental Health  

Date:   29 September 2008 

By:      Edwina Hart, Minister for Health and Social Services    

 

  

On 3rd June 2008 I initiated a discussion with interested parties on the report I had commissioned from Professor Michael Williams. His paper, ‘Iechyd Meddwl Cymru – A Well Being and Mental Health Service Fit For Wales’ envisaged the establishment of a single body for mental health that would provide a comprehensive service combining the expertise of NHS trusts and social services to deliver care throughout Wales in conjunction with primary care and the voluntary sector.

 

I am sincerely grateful to Michael for the care and diligency he gave to the preparation of this paper and for the excellent way in which he conducted the discussion on his ideas and raised the profile and interest in mental health in Wales. I was very encouraged that this wide debate has taken place.  368 written responses were received and 3 Regional consultation events were held, attended by almost 500 delegates.

 

The one consistent message that came through these discussions was that mental health services in Wales must improve and urgently.  However no overwhelming view was expressed either to support or to reject the ideas for improving services in Professor Williams’s paper. An analysis of the responses show that 41% were in favour of his proposals, with 44% against leaving 15% undecided.

 

Health organisations, local authorities and the learning disability sector were overwhelmingly against the proposals whilst service user groups, individual service users and some local and national charities were in favour of his ideas.

 

I have considered carefully all the points made and whilst there is a great deal of merit in the ideas put forward by Professor Williams, on balance I have been persuaded by the arguments against establishing a separate mental health organisation for Wales.

 

In coming to this decision I have specifically noted the following arguments:

 

  • There is good evidence of co-morbidity of mental illness and physical illness. This requires close working across mental and physical health and social services particularly for older people. A separate mental health organisation could make this more difficult
  • A single all-inclusive mental health organisation would stand the risk of becoming isolated and stigmatised. It will also depend on a complex weave of partnerships which could confuse and create boundaries to seamless working
  • There was great concern about the inclusion of learning disabilities within a single health organisation model. These services have been driven by a social model of wellbeing and any such proposed new body could medicalise these services.

 I have decided that mental health services will become a fundamental part of the new integrated local NHS bodies. However I am determined that the resources currently available for mental health services, at a minimum will be fully protected in the new organisations. I shall expect significant progress to be made to implement fully the NSF for mental health across Wales over the next 3 years.. I intend to ensure that mental health services are no longer a “Cinderella” service but have a strengthened presence within the new organisations.

 

Whilst much has been achieved over the last 6 years since the original National Service Framework (NSF) for mental health was published there has to be an improvement in the access to and quality of the services available throughout Wales.  No change is not an option and I will ensure that in the re-organised NHS mental health services have a very high priority

—————————————————————————

 Sainsbury Centre for Mental Health:  The Community Order and the Mental Health Treatment Requirement

Summary.  The prison population has soared in the last decade. On 23 November 2007 there were 81,454 people in custody, 2 per cent more than a year earlier (NOMS 2007), and an increase of more than 20,000 since 1997. The Home Office has predicted that the prison population could rise to 101,900 by 2014 (Home Office 2007a).

In parallel with the upsurge in the prison population, the number of people receiving community sentences has also increased, while there has been a steady decrease in the use of fines. In the decade between 1995 and 2005 the number of people sentenced to community sentences rose from 129,922 to 204,247 (Home Office 2007b).

In April 2005, the Community Order became the new generic community sentence (for crimes committed after April 2005) available to magistrates and judges as an alternative to prison. The Community Order gives a choice of twelve different requirements including unpaid work, electronic curfew, supervision, drug and alcohol treatments and mental health treatment.

The Community Order should not be confused with the Community Treatment Order enshrined in the Mental Health Act 2007. Also known as supervised community treatment, these orders will compel someone to have treatment while in the community, following detention in hospital under the Act.

The average length of a Community Order is 14 months. The vast majority (85%) of Orders comprise one or two requirements. The two most frequently used are Supervision (37 per cent) and Unpaid Work (31 per cent). Five of the requirements – Residential, Attendance, Mental Health, Prohibited Activity, and Exclusion – make up less than one per cent of total use. In 2006, 725 Mental Health Treatment Requirements (MHTRs) and 11,361 Drug Treatment Requirements were issued. Despite the low numbers to date the use of MHTRs has been steadily increasing month by month.

Only 19 of the 60,253 single-requirement orders issued in 2006 were MHTRs. In contrast 39,392 were for Unpaid Work. 72 per cent of all MHTRs used with a Community Order were combined with a Supervision requirement.

There are significant regional, gender and ethnic variations in the way the requirements are issues and which ones are given. The London probation region used the MHTR more, both numerically and proportionately, than any other region.

25 per cent of the prison population is comprised of people with a non-‘white British’ ethnicity (Home Office 2006), but only 9 per cent of the general population of England and Wales derives from these groups. Some 28 per cent of all MHTRs issued in 2006 were given to non-white ethnic groups. One MHTR in eight was issued to a black or black British offender.

Women are as likely to receive an MHTR as men. Proportionately women were more likely to be given a drug treatment requirement than men, more likely to receive a supervision requirement, but less likely to receive an accredited programme requirement.

The courts may face a number of difficulties in issuing the MHTR. There are several legislative obstacles placed upon the courts that may hinder sentencers issuing an MHTR. For example, an offender must have enough of a mental health problem to warrant the requirement, but not a problem that warrants more help i.e. hospital admission. The stigma of mental illness can be a powerful influence on offenders in open court and prevent offenders who might otherwise qualify for the requirement from consenting to it. One of the most substantial factors that prevents the court from issuing an MHTR is the difficulty in obtaining access to psychiatric assessment, on which the requirement depends. And many offenders are not given an MHTR because their mental health needs have not been identified.

The Sainsbury Centre is setting up a research programme to address the knowledge deficit in this important area of policy and statute.

To read this report in full, and it is very interesting reading, go to the following link:

http://www.scmh.org.uk/80256FBD004F6342/vWeb/wpKHAL6S2HVE

NEW: 

SUMMARY OF THE MENTAL HEALTH ACT 2007 As at 19th July 2007.  

The Mental Health Act 2007 gained Royal Assent on the 19th of July 2007; it amends the Mental Health Act 1983, the Mental Capacity Act 2005, and the Domestic Violence, Crime and Victims Act 2004. 

 Key provisions within the Mental Health Act 2007 

Although the structure of the Mental Health Act 1983 remains intact, some significant changes have been made to it by the 2007 legislation.  They include:

§     The introduction of a simplified definition of mental disorder that will apply throughout the Act, and the abolition of the current four separate categories of mental disorder

§     A requirement that appropriate treatment must be available if patients are to be subject to detention or the new provisions for supervised treatment in the community

§     The introduction of supervised community treatment, which will be available for patients following an initial period of detention and treatment in hospital

§     The replacement of the Responsible Medical Officer with a Responsible Clinician, who need not be a consultant psychiatrist (but must be an ‘approved clinician’)

§     The replacement of the Approved Social Worker with an Approved Mental Health Professional; in addition to registered social workers other mental health professionals will be able to take on the role of AMHP after suitable training

§     A new ground for an application to be made to the county court for the nearest relative of a patient to be displaced, and a new power to enable the patient to apply to the county court for the displacement of their nearest relative

§     A duty on hospital managers to ensure that an age-appropriate environment is provided to all patients who are under the age of 18 years

§     For capacious 16 or 17 year old patients their consent or refusal to admission informally may not be overridden by a person with parental responsibility for them

§     A requirement that those performing functions under the Act have regard to the Code of Practice published under the Act, and that the Code includes a statement of principles that must inform decisions taken under the Act

§     Abolition of the power to impose electro-convulsive therapy (ECT) on a capacious detained patient in a non-emergency situation

§     The introduction of a new independent mental health advocacy scheme for qualifying patients

§     Changes to the provisions that require the Hospital Managers to refer a patient’s case to the Mental Health Review Tribunal (MHRT)

§     The abolition of finite restriction orders

§     The power to transfer a s136 patient from one place of safety to another

§     A new power to “take and convey” a guardianship patient to the place where they are required to reside

§     Increase the tariff for an offence of ill-treatment

The amendments to the Mental Capacity Act 2005 will provide a procedure for the authorisation of the deprivation of liberty of persons resident in hospital or care home, who lack capacity (for the decision to reside there), and who are not subject to the mental health legislation safeguards.  These are known as the Deprivation of Liberty Safeguards (DoLS).

The amendment to the Domestic Violence, Crime and Victims Act 2004 will extend victim’s rights to information about the discharge of mentally disordered offenders.

Next steps

The Welsh Ministers are preparing the subordinate legislation arising from the 2007 Act and the Acts that the new legislation amends.  The Lord Chancellor will be preparing the MHRT Rules.

There will be a new Mental Health Act Code of Practice for Wales, and a new Code for England.  The Mental Capacity Act Code of Practice (which covers England and Wales) will be amended to include guidance on the Deprivation of Liberty Safeguards.

It is anticipated that most of the provisions of the 2007 Act will be brought into force in England and Wales in October 2008.

 Mental Health Act Implementation Project 

The Welsh Assembly Government has established an implementation project to secure full and successful transition to the amended legislative frameworks without detriment to either service users, carers, staff or public, within the timescales set by the legislative process.

The Assembly will be issuing revised Implementation Guidance shortly, and further guidance and information will also be made available in due course.

For further information on the Mental Health Act 2007 or the Assembly’s Implementation Project, please contact:

                        Claire Fife, Mental Health Act Implementation Project Manager

                        Welsh Assembly Government, Cathays Park, Cardiff. CF10 3NQ

                        Email: Claire.fife@wales.gsi.gov.uk

A copy of the Act is available online at the Office of Public Service Information: http://www.opsi.gov.uk/acts/acts2007a.htm

NEW – copy about Mental health Bill from the Mental Health Alliance:

Mental Health Bill remains a missed opportunity for humane and progressive legislation, says Alliance

3 July 2007

The Government has missed an historic opportunity to achieve a modern and humane new Mental Health Act, but has made important concessions to protect patients and their families from abuse and neglect, the Mental Health Alliance said today.

As the Mental Health Bill nears completion, Andy Bell, chair of the 77-member Alliance, said: “The tireless commitment of people who use mental health services and their supporters has achieved real improvements to this controversial Bill.

“We now have a Bill that for the first time gives people a right to an advocate when they are detained and that protects children from being put on adult wards inappropriately. We also have new safeguards over the use of electro-convulsive therapy, for people detained under the Mental Capacity Act, and for the renewal of detention. These are hard-won improvements that are a credit to the persistence of activists from across the country.

“But our members will be disappointed today that the Government has rejected changes to many other aspects of the Bill. It has failed to heed the evidence about the risks of significant over-use of community treatment orders and the excessive powers the Bill gives to clinicians. And it treats people with mental health problems as second class citizens by allowing treatment to be imposed on those who are able to make rational decisions for themselves.

“We are now at a crossroads. We call on the Government to start listening to the people who are affected by the Act when it writes the new regulations and to ensure that sufficient resources are made available to mental health services to implement the changes fairly.

“We also call on ministers to take seriously the warnings made by the Commission for Racial Equality about the impact of the Bill on Black communities and to take action before it is too late to put this right.”

Members of the Alliance and its supporters today gave their views of the Bill:

Marion Janner, a user of mental health services, said: “It is a real relief that the most punitive, counter-productive aspects of the Bill have been removed. But it is equally frustrating that the chance to create a law which protects and constructively treats mentally ill people has been squandered.”

Fiona Woolf, Law Society President, said: “This Bill falls way short of what is needed for modern mental health legislation. We are deeply disappointed that the Government has failed to achieve ethical mental health law that has the full support of patients, carers and professionals. In particular the Bill fails to provide for exclusions from the wide definition of mental disorder and fails to restrict the imposition of community treatment orders to a small and tightly defined group of patients – and is likely to be challenged under the Human Rights Act. The Law Society will continue to campaign for a new Mental Health Act that is both humane and effective.”

Dr Andrew McCulloch, Chief Executive, Mental Health Foundation, said: “Taken as a whole, the Bill is disappointing and represents a missed opportunity to provide truly progressive mental health legislation. However, we welcome the concessions made by government, in particular the decision to provide advocacy to service users. This is a fundamental change that should protect the rights of many people. In the months to come, it is vital that energy is directed to developing a Code of Practice that details how the various measures contained in the bill and community treatment orders in particular, should be applied in the best interests of service users and their carers.”

Diane Hackney, a user of mental health services and project manager at Mental Health Media, said: “The Government has repeatedly said that its aim is to reduce the numbers of people who are at risk of self-harm and suicide. It is difficult to see how Community Treatment Orders will achieve this. It is highly likely that people like myself will start to avoid services altogether if we are not getting the care and treatment we need.”

Paul Farmer, Chief Executive of Mind, said: “The new right to advocacy should help people who lose their liberty under the Mental Health Act to get their voice heard. However, a historic opportunity has been missed to tackle other fundamental problems – to fight race inequalities, give people with mental health problems the same rights to make choices as people with physical health problems, and to ensure that people can get help when they ask for it. It will be vitally important that the legislation is properly implemented so that the fears of many people with mental health problems are not realised.”

Marcel Vige, chair of the National Black and Minority Ethnic Mental Health Network, said: “The law already disproportionately impacts people from black and minority ethnic communities. We are disappointed that the Government has chosen to press ahead with the Bill in its current form despite evidence that it is likely to make the situation far worse. The Commission for Racial Equality has stated unequivocally its belief that the Government has failed in its duty to properly assess the degree to which the legislation will have differential impacts on different ethnic groups. A proper assessment may well have prompted adjustments to measures such as Supervised Community Treatment. In its current form, the Bill will undermine government efforts to improve services through the Delivering Race Equality strategy.”

Paul Jenkins, Rethink’s Chief Executive said: “Rethink pays tribute to the Mental Health Alliance for campaigning for so long to get a better Bill than was first proposed back in 2002. It welcomes the Government’s amendments, including the proposed changes on advocacy, but still believes more is needed to create a Mental Health Act that is fair and workable and which will not add further barriers for vulnerable people seeking help. We urge MPs to help make the Mental Health Act more workable by ensuring the Bill’s code of practice will not allow someone to be detained because of their behaviour.”

Dr Tony Zigmond, Vice-President, The Royal College of Psychiatrists, said: “Advocacy, treatability and the additional protections for children are all important and welcome gains for people with mental health problems. We hope sufficient resources will be provided for mental health services to ensure the legislative changes can be made to work properly.”

Sainsbury Centre for Mental Health chief executive Angela Greatley said: “Community treatment orders will have a dramatic effect on mental health services. The number of people subject to CTOs must be kept to a minimum. If CTOs get used as a first, not last, resort, they will silt up community services and set back the modernisation of mental health care.”

Marjorie Wallace, Chief Executive, SANE, said: “We are pleased that some of the concerns have been taken on board by the Government, but any new legislation will be counterproductive unless services are improved to provide high standards of care and treatment so that crises are better prevented and coercion is used as a last resort.”

Andrew Voyce, a user of mental health services, said: “I accept that at times I have been severely psychotic and not realised that I was, and I have needed compulsory treatment. But what has worked under those circumstances has been that I have been given hope for the ultimate outcome, some aspirations, along with the compulsory restriction.”

Barbara Herts, Chief Executive, YoungMinds, said: “A thousand vulnerable children a year will benefit from the changes to mental health legislation. To make this work the Government must ensure this is a key priority for the NHS over the next three years. The intention is excellent – now we need to see the delivery. Although the Government’s commitment to providing advocacy for children who held under the Mental Health Act or who require ECT (Electroconvulsive Therapy) is welcomed, it is regrettable that this service will not be a right for those 2,700 children who are admitted voluntarily or under parental consent.”


Notes

The Mental Health Bill was debated in the House of Lords yesterday evening. The House voted to keep the changes made in the House of Commons but added three new amendments:

  • A respect for diversity principle which will be included in the Code.
  • That renewals of detention must be agreed by the person’s responsible clinician (RC) and a professional who has been professionally involved with the patient.
  • That when making a CTO the RC must have regard to the patient’s history and the risk of deterioration if the patient is not detained in hospital.

The Bill is expected to return to the House of Commons for the final time next week.

NEW – another link from Sainsbury Centre for Mental Health.   SHIFT is an interesting site for an organisation dealing with stigma and discrimination.   Have a good look around under media and other headings. 

 Link: http://www.shift.org.uk/media/mental-health-in-the-media.html

Current topics.   The four topics which follow are taken from the website of the Sainsbury Centre for Mental Health – a valuable resource.

New commissioning approach needed for better mental health * ————————————————————– In our response to the Government’s Commissioning Framework for Health and Wellbeing we call for a new strategy that sets out how to promote good mental health and what skills are needed to do it. We believe that public services will struggle to promote good mental health without radical changes in the way they are commissioned. You can read our full response here: http://www.scmh.org.uk/80256FBD004F6342/vWeb/pcKHAL73NCH6 Priorities for patient-carer centred services – research complete The results of our research into the priorities for patient-carer centred services is now available. The project ran from 2001 – 2007 and we carried out a literature review and a consultation on what the priorities should be. They include all aspects of mental health care. For details, see the websiteat http://www.scmh.org.uk/80256FBD004F6342/vWeb/wpKHAL6VUEQ3.

Breaking Down Barriers: reconfiguring mental health services ————————————————————11 May 2007 In this new report, Louis Appleby, the National Clinical Director for Mental Health, sets out the case for further reform of mental health services, with more focus on social inclusion and barriers to recovery. More and links at: http://www.scmh.org.uk/80256FBD004F6342/vWeb/wpKHAL6LJHZ7   Mental Health Network report on the future of mental health care     ———————-——————————————17 May 2007The NHS Confederation has a new Mental Health Network which replacing the National Mental Health Partnership.  On its launch, the network issued an apology to those who have been failed by mental health services. It also published a poll which says that mental health services have been adversely affected by targets. More and links at: http://www.scmh.org.uk/80256FBD004F6342/vWeb/wpKHAL6LJHZ7    

 

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