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Welfare Reform on the Web (March 2000): Mental Health Services - UK

BRIBE AND PREJUDICE; NHS STILL FAILS MENTALLY DISABLED

M. Shallcross

British Journal of HEALTH CARE MANAGEMENT, VOL. 5, 1999, P. 494-496

Anticipating the government's Learning Disability Strategy, this article questions whether people with learning difficulties are well served by the NHS. Drawing on several recent surveys and the inquiry into surgical standards at the Royal Brompton, the author discovers scandalous evidence of thoughtless behaviour and discriminatory rationing.

COMING IN FROM THE COLD

D. Dunn

Community Practitioner, vol. 72, 1999, p. 383-384

Shows how mental health service users, both young and old, are victims of social exclusion.

DEVILS IN THE DETAIL

C. Jackson

Mental Health and Learning Disabilities Care, vol. 3, 1999, p. 82-83

The national service framework for mental health sets standards in the areas of mental health promotion, primary care and access to services, services for people with severe mental illness, support for carers and suicide prevention. It has been broadly welcomed, but its effectiveness will depend on how it is implemented at local level.

A DUTY TO CARE

K. Ashton

Community Living, vol. 13, Oct./Nov. 1999, p. 20-21

The courts have ruled that local and health authorities have a duty to provide aftercare services for people detained under certain sections of the Mental Health Act, and that it is illegal to charge for such services. Article looks at the implications of this ruling.

THE EFFECTS OF EXCLUSION

A. Taylor

Community Care, no. 1297, 1999, p. 12

Argues that segregating people with mental illness should be seen as a last resort, as they are better helped by being supported in the community.

ESTATES OF MIND

J. Hirst

Community Care, no. 1297, 1999, p. 22-23

Argues that the social exclusion and isolation experienced by many mental health users could be combated by improved education, training and employment opportunities, provision of good quality community support services, and reduction of the stigma associated with mental illness through a public education campaign.

EVALUATION OF THE IMPLEMENTATION OF THE MENTAL HEALTH REVIEW

E. Peck et al

London: King's College, Centre for Mental Health Services Development, 1999. (Report 1)

Research aimed to identify the impact of joint commissioning and integrated service provision in the implementation of the Somerset Mental Health Review. Report identifies the aspirations and beliefs of agencies involved in joint commissioning and joint provision of mental health services in Somerset. It also identifies the impact of the changes on service users and carers, and on the professional staff involved.

HUTTON PLANS MAJOR SHAKE-UP TO MENTAL HEALTH EMPLOYMENT

R. Winchester

Community Care, no. 1301, 1999, p. 2-3

Reports the launch of a new Workforce Action Team that will be charged with setting up a national strategy for recruitment and retention of mental health staff. Part of the Team's remit will be to consider if people who had experienced mental health problems and recovered and "professionally unqualified workers" could be recruited.

MAKING DECISIONS: the government's proposals for making decisions on behalf of mentally incapacitated adults

Lord Chancellor's Department

London: TSO, 1999 (Cm 4465)

Proposes replacing Enduring Powers of Attorney (EPAs), which are confined to financial matters, with new Continuing Powers of Attorney (CPAs). A CPA would give authority to make welfare and healthcare, as well as financial, decisions on behalf of a mentally incapacitated donor. There will also be a new single court of jurisdiction which will deal with all areas of decision-making for adults without capacity. The court will have the power to make decisions on behalf of a person without capacity, or to appoint a manager to do so.

MAKING THE RIGHT MOVES: RIGHTS AND PROTECTION FOR ADULTS WITH INCAPACITY

Scottish Executive

Edinburgh: TSO, 1999. (SE/1999/24)

Sets out plans to introduce comprehensive legislation in the Scottish Parliament to protect the rights and interests of adults who lack capacity for any reason. Managers of care homes would be able to manage funds of adults up to £5000. Doctors would be given a general power to treat adults unable to give their consent. Relatives would have to be consulted, although the final authority would remain with doctors. The Medical Ethnics Committee would be asked to draw up procedures, while attorneys and guardians with welfare powers would play an advocacy role. Sheriff courts would play a major role, such as resolving disputes on medical or financial matters. All the new powers would be overseen by the Public Guardian, a new court office.

MENTAL HEALTH GROUPS ATTACH PLANS FOR COMPULSORY TREATMENT

R. Winchester

Community Care, no. 1299, 1999, p. 2-3

Mental health charities have strongly criticised government plans to reform the mental health service outlined in the Review of the Mental Health Act 1983. The element of compulsory treatment proposed would cause people living in the community to avoid the mental health service at all costs.

THE MENTAL HEALTH NSF: an ambition too far?

Mental Health Strageties

Manchester: 1999

Results of a postal survey of health authorities and trusts reveal a mismatch between faith in the new mental health service standards themselves (57% of respondents described the framework as definitely worth waiting for) and confidence that they can be achieved on current funding. Primary care standards and provision of 24-hour access were flagged as presenting real problems.

(For summary see Health Service Journal, vol. 109, Nov. 4th 1999, p. 5)

THE NATIONAL SERVICE FRAMEWORK FOR MENTAL HEALTH

D. Richards

Mental Health and Learning Disabilities Care, vol. 3, 1999, p. 136-139

Summarises the National Service Framework for Mental Health Standards and implementation mechanisms.

PATIENTS WILL PAY FOR GOVERNMENT CHERRY-PICKING

R. Winchester

Community Care, no. 1300, 1999, p. 10-11

The government's Green Paper on reform of mental health legislation was supposed to have been based on a review of the Mental Health Act 1983 by an expert committee. Unfortunately the Green Paper ignores the principles of non-discrimination and patient autonomy which were at the heart of the original document and introduces a heavy emphasis on compulsory treatment and public safety.

REFORM OF THE MENTAL HEALTH ACT 1983: PROPOSALS FOR CONSULTATION

Department of Health

London: TSO, 1999 (Cm 4480)

Proposes that compulsory treatment orders (CTOs) could be given to patients deemed to require supervised treatment. They could be issued without the patient's consent if there was a substantial risk of serious harm to the patient or others. Failure to adhere to treatment regimes would most likely mean recall to a hospital, but could mean treatment in the community.

(For comment see Health Service Journal, vol. 109, Nov. 25th 1999, p. 11-13)

THE SENSE OF BELONGING

S. Dunn

Mental Health and Learning Disabilities Care, vol. 3, 1999, p. 114-116

Mental ill-health is a key determinant and consequence of social exclusion. Article summarises the concerns that witnesses expressed to the Mind Inquiry into social exclusion and mental health problems. These concerns centred on questions of participation, the balancing of rights and responsibilities, and the importance of recognising the absolute and equal value of every individual.

SEVEN NEW STANDARDS SET IN MENTAL HEALTH

J.A. McFadyen

British Journal of Health Care Management, vol. 5, 1999, p. 487-489

Summarises and assesses the new National Service Framework for Mental Health. The framework is realistic but does not show how managers and clinicians can be persuaded to change their ways

in the face of the confusion caused by too many initiatives, the stasis that is inherently offered under the guise of partnership working, and the conflicts presented by local politics it would be possible to comply with the letter of most of the procedural and process issues without having a significant impact on services.

TIME TO DECIDE

P. Letts

Mental Health and Learning Disabilities Care, vol. 3, 1999, p. 118-119

Summarises the government's proposals for a new mental incapacity law. Proposals include the establishment of a new Court of Protection to deal with all areas of decision-making for adults who lack capacity, and the introduction of a new continuing power of attorney, whereby donors can appoint an attorney to make decisions relating to their personal welfare, health care and finances. Proposals exclude living wills, independent supervision of medical and research procedures, and protection under the public law for vulnerable people at risk.

TRADITIONAL SOLUTIONS NO LONGER APPROPRIATE

P.J. Connelly

British Journal of Health Care Management, vol. 5, 1999, p. 499-500

Successful clinical governance in mental health can only occur if staff, managers and commissioners are prepared to accept that traditional solutions are not necessarily the most appropriate. Acurate assessment of clinical risk, and the development of strong and effective clinical teams with clear leadership, multidisciplinary appraisal and clearly defined implementation plans will help to shape good practice.

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