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Welfare Reform on the Web (August 2008): Mental health services - UK

'Confidentiality smokescreens' and carers for people with mental health problems: the perspectives of professionals

B. Gray and others

Health and Social Care in the Community, vol. 16, 2008, p. 378-387

The protection and use of information in mental health are firmly rooted in ethics and professional codes, law and policy, as well as values and professional practice. While government initiatives have attempted to augment the role and rights of carers, policy guidance involving information sharing between professionals and carers has failed to deal with the practical dilemmas of patient confidentiality. Professional codes and training fail to explore the moral and ethical ground that stands between the service user's need for privacy and the carer's need for information. Policy guidance on confidentiality is scattered, ambiguous, confusing for professionals and inconsistent. There is uncertainty in practice about what information professionals may share, and many do not take into account carers' rights to basic information to help them look after service users. Professionals sometimes find it easier and safer to say nothing.

Holding services to account

J. Clegg

Journal of Intellectual Disability Research, vol. 52, 2008, p. 581-587

Recently, the frequency of audit inspections of health services for people with intellectual disabilities in the UK has increased, from occasional inquiries to a systematic audit of all services. From 2008, a process of continuous audit 'surveillance' of specialist health services is to be introduced. Similar regimes of inspection are in place for social care services. Audit is distinct from evaluation because it neither provides opportunities for staff to give an account of their work nor represents a search for knowledge. It merely investigates adherence to government policy. While basic checks on minimum standards are necessary, service excellence requires not audit but research-driven evaluation.

Imprisonment for public protection: genesis and mental health implications

M. Rutherford

Mental Health Review Journal, vol. 13, June 2008, p. 47-55

Imprisonment for public protection (IPP), implemented in 2005, has become the fastest growing custodial sentence in the prison estate of England and Wales. By March 2008, nearly 4,000 IPP sentences had been imposed. This paper charts the genesis of IPP and its historical antecedents. It also explores IPP as an exemplar of the 'rise of risk' and focuses on its links to the 'dangerous and severe personality disorder' pilots. It also presents two hypotheses on the mental health implications of IPP: 1) there will be an increase in transfers from prisons to forensic mental health services; and 2) the IPP population may become a new depository for those who can no longer be warehoused in mental asylums.

Money matters

D. Abbott

Learning Disability Today, July 2008, p. 35-37

This article outlines the findings of a study of financial issues for people with learning disabilities. The research showed that people with learning disabilities need better-planned, hands-on packages of financial support and education, especially when they move into independent living settings and/or take more control of their money through an individual budget. People with learning disabilities said that they wanted more help with specific issues such as the benefits trap, banks accounts, budgeting, and how to earn more money. Banks and other financial services providers need to produce more accessible information about what they offer. Parents, carers and support workers also need training on how to increase the financial autonomy of people with learning disabilities.

Promoting choice and control in residential services for people with learning disabilities

W.M.L. Finlay, C. Walton and C. Antaki

Disability and Society, vol. 23, 2008, p. 349-360

Recent UK government policy promotes choice, control and empowerment for users of social care services. However, there are still barriers to empowerment in services for people with learning disabilities. Drawing on a nine month ethnographic study of three residential services, this paper identifies a number of obstacles to user choice and control that were routinely observed in the culture of the institutions. These include conflicting service values and agendas, inspection regimes, communication difficulties, and the pervasiveness of teaching.

'Strengths' assertive outreach: a review of seven practice development programmes

S. Morgan

Mental Health Review Journal, vol. 13, June 2008, p. 40-46

Assertive outreach has been promoted in the UK under the National Service Framework for Mental Health since 1999. However teams were set up without adequate training and left to assimilate research results and apply them locally with minimal support. They were then subjected to outcomes-focused research scrutiny and generally criticised for not having matched the results of international research. The author calls for more investment in service development before engagement in evaluation.

'Unacceptable' levels of violence on mental wards

J. Laurance

The Independent, July 23rd 2008, p. 9 & 28

According to the results of a comprehensive survey of mental health hospital care in England, published by the Healthcare Commission, thousands of seriously ill mental health patients are enduring 'unacceptable' levels of violence on overcrowded NHS wards where they are vulnerable to sexual predators. Almost 5,000 patients reported being physically assaulted in 2006/07 - 15 per cent of the total - and one in six trusts had levels of violence 'significantly above' this average.

A Yes man no more

K. Webster

Learning Disability Today, July 2008, p. 32-34

The author, who has Asperger's syndrome, and his mother describe how an individual budget has transformed his life, enabling him to move out of residential care and live independently in his own home, employing his own support staff.

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