Welfare Reform on the Web (October 2005): Mental Health Services - UK

Increasing returns

S. Lawton-Smith

Mental Health Today, Sept.2005, p.16-18

Article presents estimates of how many people might be subject to compulsory community treatment orders if the Mental Health Bill becomes law. It is estimated that

• About 10% of patients currently detained in hospital will be on community treatment orders in the first years of the new legislation, i.e. about 1450 people.
• Up to 1600 people currently subject to guardianship and supervised discharge orders will be placed on community treatment orders, alongside some 5000 assertive outreach clients.
• In the longer term, numbers will build to between 15 and 25 per 100000 population, that is between 7800 and 13000 people.

Making a real difference

K. Newbigging

Mental Health Today, Sept.2005, p.27-30

Article discusses how well the National Institute for Mental Health England (NIMHE) has succeeded in involving service users and carers in its policy-making, work programmes and activities. A review has shown that service users and carers are involved in events, training, staff recruitment, membership of networks, membership of management and advisory groups, research and evaluation, and even direct employment. However review respondents felt that:

• There was insufficient awareness of NIMHE among service users and carers
• There was a lack of understanding of how NIMHE related to other organisations
• User and carer involvement was marginal to NIMHE
• NIMHE was not engaging minority groups
• Users and carers had little impact on decision-making

Mental Capacity Act 2005

A. Brammer

Journal of Adult Protection, vol.7, Aug. 2005, p.44-48

Presents a summary of the main provisions of the new Act which is expected to come into force in 2007. Covers the definition of capacity, regulation of care or treatment, lasting power of attorney, the new Court of Protection, the Independent Mental Capacity Advocacy Service, and the new criminal offence of ill treating a person lacking capacity.

Mental health at the crossroads: the promise of the psychosocial approach

S. Ramon and J. E. Williams (editors)

Aldershot: Ashgate, 2005

This book is a challenge to the enduring status and domination of bio-medical approaches in mental health services. Contributors from four continents argue that this domination, along with modernization and multidisciplinary work, will not improve people's lives unless social and psychological perspectives are appreciated and integrated. This implies new forms of relationships and social arrangements.

Mental Health Bill 'may become a burden'

N. Hawkes

The Times, September 20th 2005, p.22

A study by the King's Fund suggests that thousands of mental patients are likely to be placed under compulsory treatment in the community if the Mental Health Bill becomes law. The increase in numbers will place a heavy burden on doctors and nurses. This represents a real challenge for mental health service commissioners and planners, who will need to meet the extra demand.

Milk and honey

C. George

Mental Health Today, Sept.2005, p.10-11

The recent green paper on adult social services proposes empowering users through greater use of direct payments, introduction of individual budgets and emphasis on preventative services. However the draft Mental Health Bill with its emphasis on compulsion and managing risk conflicts with this vision and proposes greater state control of people with mental health problems.

Poorly served

C. Hatton

Community Care, Sept.15th-21st 2005, p.36-37

Learning disability partnership boards have a responsibility to eradicate barriers to services experienced by people with learning difficulties from ethnic minorities. A national survey of partnership boards shows that progress has been slow, and some boards view people from ethnic minorities as a low priority.

Stand by your beds

E. Forrest

Health Service Journal, vol.115, Sept.15th 2005, p.29-30

Crisis resolution teams were set up to treat people with acute mental health problems in the community and reduce psychiatric inpatient bed use. Following an assessment, a range of intensive support services are supplied to the client at home, including visits three times a day if required. Decisions about whether a client should be admitted to hospital are made by the whole team, not by clinicians acting alone. In theory, crisis services should be available 24 hours a day, but financial constraints may render this impossible. There are concerns that some new teams are understaffed and are not following the classic model. This could lead to underperformance which could undermine the credibility of the whole movement.

We need additional powers of compulsion in mental health

M. Howlett and A. Greatley

Health Service Journal, vol.115, Sept.15th 2005, p.18-19

The government's response to the House of Commons Joint Scrutiny Committee's report on the Draft Mental Health Bill has reopened the debate on compulsory treatment. Howlett argues that the Bill's definition of when compulsion can be used would protect mentally ill people who disengage from services from themselves and give people with personality disorders, who are currently turned away as untreatable by the NHS, rights to assessment and therapy. Greatley argues that the current system of care in the community has been successful, and cases of violence by mental health service users have been due to human error or communication failures. The Bill's extension of the circumstances under which compulsion can be used would not have prevented these.