Welfare Reform on the Web (July 2004): Mental Health Services - UK

DEATH DEFYING

L. Greenwood

Health Service Journal, Vol. 114, June 3rd 2004, p.33

Statistics show that three out of four people who commit suicide are not in contact with mental health services. The article describes a suicide prevention project which seeks to involve schools, youth groups, the police, housing authorities and voluntary organisations in reaching out to people before they come into contact with mental health services.

HOME FOR GOOD? PREPARING TO SUPPORT PEOPLE WITH A LEARNING DISABILITY IN A RESIDENTIAL SETTING WHEN THEY DEVELOP DEMENTIA

H. Wilkinson and others

Pavillion Publishing, 2004

The study explored the experience of 18 people with learning difficulties who developed dementia while living in small residential homes. The research showed that lack of planning led to ad hoc arrangements that often failed to meet the needs of people with dementia, fellow residents and staff. Lack of coherent strategies and resources led to people being inappropriately moved to nursing homes for older people. The use of consistent, good quality, practice-based staff training was crucial in enabling people to "stay put". Staff often provided unpaid support and played down difficulties in order to avoid people having to be moved. Waking night staff were essential both for dealing with night-time disturbances and providing one-to-one support. Staff in all settings struggled with pain management and persuading people to eat well.

INTEGRATION AND TARGETING OF COMMUNITY CARE FOR PEOPLE WITH SEVERE AND ENDURING MENTAL HEALTH PROBLEMS: USERS' EXPERIENCES OF THE CARE PROGRAMME APPROACH AND CARE MANAGEMENT

J. Carpenter and others

British Journal of Social Work, Vol. 34, 2004, p.313-333

The article reports the experiences of a sample of 262 people with severe and enduring mental illness living in four districts in the North of England. It found that the Care Programme Approach can work well from the users' point of view, at least in well established districts. Closer integration of health and social care services appeared to be preferred by users. However, there is considerable room for improvement with respect to the involvement of family carers in the planning process, the provision of information about the effects of medication, and making formal complaints.

MENTAL CAPACITY BILL

London: TSO, 2004 (Session 2003/04; Bill 120)

The Bill provides a statutory framework for dealing with health and welfare decisions made on behalf of people who lack capacity. It provides a checklist to help carers work out what is in a person's best interests, including a legal obligation to take into account the views of family and friends. People with no friend or relative to advocate for them would be provided with an independent consultee to help ensure decisions are made in an individual's best interests. People will be able to appoint an attorney to act on their behalf should they lose capacity in the future. These Lasting Powers of Attorney would have to be registered in advance with the new public guardian. A new court of protection would be set up under the Bill which could remove attorneys found to be acting inappropriately The court could also appoint deputies to make decisions on healthcare, welfare and financial matters on behalf of people lacking capacity.

ON THE BORDERLINE? PEOPLE WITH LEARNING DISABILITIES AND/OR AUTISTIC SPECTRUM DISORDERS IN SECURE, FORENSIC AND OTHER SPECIALIST SETTINGS

F. Myers

Scottish Executive Social Research, 2004

The study looked at the numbers of people with learning disabilities and/or Autistic Spectrum Disorders (ASD) in secure settings in Scotland and the arrangements for assessing their needs and providing them with care. The research comprised a literature review, a scoping exercise of 57 secure settings and case studies of 7 of these settings. It found that the numbers of people with ASD and/or learning disabilities in secure settings was not accurately known. Data on a sample of 49 people with ASD and/or learning disabilities in secure settings revealed a multiply disadvantaged group in terms of their past histories. The majority had been in local authority care as children and many had attended special schools or had been in psychiatric care.

ONE TOWN FOR MY BODY, ANOTHER FOR MY MIND: SERVICES FOR PEOPLE WITH PHYSICAL IMPAIRMENTS AND MENTAL HEALTH SUPPORT NEEDS

J. Morris

York: Joseph Rowntree Foundation, 2004

Research on this group of people's experiences of care services found high levels of dissatisfaction. Respondents said they had difficulty accessing mental health services because of their physical impairments. They also had difficulty using physical disability services because of inadequate recognition of mental health needs. In-patient experiences were often characterised by inaccessible physical environments and a lack of assistance even for simple things. Medication required for a physical condition was commonly withdrawn on admission to a psychiatric ward and was not always available when needed. There was commonly poor or no communication between mental health and physical disability services. Respondents found that services accessed because of physical disability ignored mental health needs, and some staff had negative reactions to such needs.

THE REEL PICTURE

T. Whitehurst

Health Service Journal, Vol. 114, June 17th 2004, p.35

Mental health services need to move beyond meeting current national targets towards whole-systems thinking. This means no longer seeing targets in isolation from one another, but integrating services across a number of key domains including housing, education, health, employment, criminal justice and regeneration.

STIGMA OF MENTAL ILLNESS 'RUINS LIVES'

J. Carvel

The Guardian, June 14th 2004, p.8

An investigation by the government's Social Exclusion Unit will today expose

how millions of lives are destroyed by the stigma attached to mental health problems. It found increasing discrimination at every level of society against people with such ailments as depression and anxiety, which affect one in six adults at any one time. The report will be used as a springboard for the first attempt to get concerted action across the government to address the problem.

The government's action plan will include:

• providing an employment adviser for everyone with severe mental health problems;
• clarifying benefit rules for those wanting to work;
• removing unnecessary barriers to jury service and other community roles;
• new guidance to housing authorities on lettings ;
• improved access to financial and legal advice;
• redesigning mental health day centre services.

TO BE LABELLED OR NOT TO BE LABELLED: THAT IS THE QUESTION

A. Ho

British Journal of Learning Disabilities, Vol. 32, 2004, p.86-92

The article discusses problems in diagnosing and labelling people with learning disabilities. Much time and energy has been spent enacting legislation to ensure that those with a learning disability have equal rights within the community. Such a label provides legal protection - an "admission ticket" to entitlement to opportunities and special accommodations. It can help children, parents and teachers cope with the condition, give children access to specialised help and allow teachers to focus on a more homogenous class. However, diagnosis of a learning disability does not always help the sufferer. Stigma is still attached to the condition and children often find it hard to "fit in" with their peers. Being diagnosed with a disability can lead to treatment simply as a "disabled person", with other aspects of the personality being ignored, and special needs statements, far from being beneficial to students, can be used as an excuse to ignore deficiencies in our social and educational structures. The article argues that this unacceptable. To gain inclusion and equality it is vital to acknowledge the different social, cultural and economic contexts that contribute to different learning patterns and to recognise that children all learn in different ways. The article concludes that education and social structures must change to provide a flexible curriculum that accommodates learning diversity. Such changes would serve those with learning disabilities much better than diagnosis or labelling.

SOCIOCULTURAL STUDY OF INTELLECTUAL DISABILITY: MOVING BEYOND LABELLING AND SOCIAL CONSTRUCTIONIST PERSPECTIVES

J. Klotz

British Journal of Learning Disabilities, Vol. 32, 2004, p.93-104

The article critically reviews the work of a number of authors famed for their pioneering development of the sociocultural study of people with intellectual disabilities. Although it finds that their research is focused on people with mild disabilities, whilst those with profound, multiple impairments are ignored, the article stresses such studies are necessary in order that we might gain a greater understanding of intellectual disability and recognise that those suffering from such disabilities can and do lead socially meaningful lives.