Welfare Reform on the Web (March 2007): Mental health services - UK

Bill of wrongs?

A. James

Mental Health Today, Feb. 2007, p.8-9

Government introduced a Bill to amend the Mental Health Act 1983 into the Lords in November 2006. There has been severe criticism of the Bill by mental health professionals and activists on the grounds that:

• Compulsory treatment should only apply to people who lack capacity to make decisions about their own mental health care needs
• Treatment should only be compulsory if it offers some clear therapeutic benefit
• There should be safeguards for patients subject to Community Treatment Orders, such as statutory rights to assessment, advocacy and legally binding advance directives
• The Bill should include a right of access to advocacy
• There is no statement of principles underpinning the new legal powers
• Principles of non-discrimination and respect for diversity should be included on the face of the Bill

Catching them early

S. Lawton-Smith

Mental Health Today, Feb. 2007, p.25-27

In 2005 the King’s Fund undertook a selective review of projects in London supporting the emotional well-being of children of primary school age. The research found that: 1) children as young as five could experience serious mental health problems due to chaotic lives; 2) partnership work was essential to the success of projects; 3) it was vital for projects to engage with families; and 4) securing funding was a challenge.

Change can’t come too soon for campus and hospital residents

H. McCormack

Community Care, Jan. 25th - 31st 2007, p.16-17

There is evidence that a culture of institutional abuse persists in residential homes and campuses for people with learning difficulties. Government is tackling the problem by moving responsibility for commissioning services for people with learning difficulties from the NHS to local authorities. In the meantime, reform is hindered by problems making existing staff understand that their practices are unacceptable.

Community care in perspective: care, control and citizenship

J. Welshman and J. Walmsley (editors)

Basingstoke: Palgrave Macmillan, 2006

The book charts the history of community care provision for adults with learning difficulties in the United Kingdom since 1948. It examines key debates in social policy, including care versus control, charity versus rights, the role of the market in providing for vulnerable adults, the pros and cons of labelling, the changing construction of social categories and the challenge of preventing abuse. It also gives an international perspective on the development of community care in the Western world. Finally, it includes accounts of the history of the period from the perspectives of different stakeholders, and draws extensively on oral accounts.

Daring to dream: learning the lessons of leadership for service improvement in mental health services

S. Onyett

British Journal of Leadership in Public Services, vol.2, Dec. 2006, p. 4-14

This article identifies nine practices that recent national and international experience suggests are most likely to ensure that service improvement initiatives fulfil positive expectations, and describes ways in which some of these ideas are being incorporated into local UK systems interventions.

New “mental health” legislation for England and Wales: some aspects of consensus and conflict

D. Pilgrim

Journal of Social Policy, vol.36, 2007, p. 79-95

This article traces the New Labour government’s attempt to introduce new legislation replacing the Mental Health Act 1983. The government’s authoritarian proposals for greater compulsion and the detention of people with severe and dangerous personality disorder before they committed any crime provoked determined opposition from service users, charities and professionals. These banded together to form an umbrella body called the Mental Health Alliance. In the face of this opposition, the government eventually abandoned its Mental Health Bill and announced its intention of amending the 1983 Act to increase the efficiency of risk management instead.

Order in the house

M. Gould

Health Service Journal, vol.117, Feb. 1st 2007, p.22-24

Supervised community treatment orders for people with mental health problems aim to stop patients being returned to hospital because their condition has deteriorated due to failure to take medication. There are concerns that the threshold for imposing a community treatment order has been set too low, and could infringe patients’ human rights.

Person-centred planning: factors associated with successful outcomes for people with intellectual disabilities

J. Robertson and others

Journal of Intellectual Disability Research, vol. 51, 2007, p. 232-243

In the UK person centred planning is central to current government health and social care policy for people with intellectual disabilities. This study is the first to consider the factors associated with the success of person-centred planning. Results showed that people with mental health, emotional or behavioural problems, autism, or a large number of health problems were less likely to receive a plan. Those with mental health, emotional or behavioural difficulties were less likely to benefit if they did receive a plan. A range of contextual factors were also associated with the likelihood of people receiving or benefiting from a plan. The results also point to the vital importance of a committed facilitator to ensuring the success of person centred planning.

“Policies don’t protect people, it’s how they are implemented”: policy and practice in protecting people with learning disabilities from abuse

R. Northway and others

Social Policy and Administration, vol.41, 2007, p.86-104

In 2000 the National Assembly for Wales published guidance entitled In Safe Hands which provided a framework for the development of local policies to protect vulnerable adults from abuse. However, the translation of guidance into concrete local policies is a complex process that relies on collaboration between a wide range of stakeholders at various different levels. Furthermore, the development of local policies alone is not sufficient to bring about changes in practice. This article reports some of the findings of a study that gathered information on policy development and implementation in the context of services for people with learning disabilities in Wales.

Reforming the appeals process

Y. Marsen-Luther

Mental Health Today, Feb. 2007, p.18-20

When patients in England and Wales are detained for assessment and/or treatment under the Mental Health Act 1983, they are given protection against wrongful detention through appeal to the Mental Health Review Tribunal (MHRT) service. The MHRT service will be unaltered by the Mental Health Act Amending Bill which was introduced into the Lords in November 2006. A pilot study of the day-to-day working of the MHRT service has uncovered a number of flaws, including:

• Poor communication between the clinical team and the Mental Health Act administration
• Delays on the part of social workers and RMOs in producing reports for the Tribunal
• Absence of ethnic monitoring

Safe and sound

P. Bates

Mental Health Today, Feb. 2007, p.32-34

When people are asked what they get from attending a mental health day centre, they often talk about the feeling of safety. As day centres are being modernised and are moving away from building-based services to services which are primarily community based, it is important to retain those elements that offer this feeling of safety. In creating day services that provide safe spaces, balances need to be achieved in the areas of:

• Occupational safety - the right mix of directed activity and freedom from pressure
• Social safety - maintenance of a culture where safety is mingled with adventure, so that people can select new challenges from time to time
• Therapeutic safety - determining the extent to which people are expected and supported to engage in therapeutic activity

When the spirit is weak

G. Slay and P. Gilbert

Professional Social Work, Feb. 2007, p. 16-17

The National Institute for Mental Health in England set up a Spirituality Project in 2001. The project focuses on two main issues:

• Spirituality as part of an individual’s essential humanity, and its impact on how they live their lives and deal with crises. As such, spirituality becomes an essential element in assessment and recovery for mental health service users, while also becoming integral to the creation of person-centred organisations
• Forming relationships with the major faith-based organisations

This article presents a case study of a Spirituality Project pilot in West Sussex.