Select Committee on Health Minutes of Evidence


Memorandum of Evidence from MIND (National Association for Mental Health)

INTRODUCTION

  1.  Mind is the leading mental health charity in England and Wales. It works for a better life for people diagnosed, labelled or treated as mentally ill and campagins for their right to lead an active and valued life in the community. Mind is concerned to contribute, wherever possible, to new thinking on mental health services and to the improvement of standards in the treatment of those with mental distress.

OPTIONS FOR STRUCTURAL CHANGE

  2.  Mind recognises the importance of the interface between health and social services in delivering well coordinated services to people experiencing mental distress. However, this is just one amongst many elements which need to be in place to ensure high quality, responsive service provision. The fundamental aim should be to deliver a package of services which address the range of needs experienced and expressed by people with mental distress, including health, social care, employment, housing, leisure facilities and an adequate income. In providing services the focus should be on working in an active partnership with service users, and seeking to engage users with services which are acceptable and helpful to them. The organisational framework needs to be designed around this objective rather than vice versa.

  3.  It is tempting to believe that structural change can solve problems in delivering coordinated and sensitive services, but reorganisation is not a panacea for inadequate resources or inappropriate service patterns. Any organisational change must be designed to make it easier for staff to deliver sensitive services and must remove rather than create blocks to working in partnership. It should also avoid creating excessive bureaucracy and layers of management as happened with the NHS changes under the previous Government. Democratic accountability is also essential and does not currently exist for health authorities.

  4.  Mind rejects major structural change such as the creation of a new Mental Health and Social Care Authority single authority responsibility as proposed in options one and two of the former Administration's Green Paper—Developing Partnerships in Mental Health. These options would damage existing good practice and introduce another major upheaval, creating confusion for service users and demoralising staff. There is also a grave danger that these models could lead to a health or medically dominated approach to service provision (unless the commissioning lead was given to local authorities). This could result in users' wider social needs being ignored. While health care, including physical health care, has an important role to play in responding to service users' needs, it is by no means the most important component of services, nor do health based models of mental distress capture many aspects of users' lives and needs. These options also carry the grave danger that the authorities which lose their role in mental health withdraw investment and commitment as soon as any announcement is made. Mind sees many advantages in the current diversity of services which include statutory social care services and the voluntary sector. Any model which damages this diversity should be rejected.

  5.  Mind generally favours a joint health and social care body. Such a body would be accountable to the local authority for the funds allocated for social care and to the health authority (or the new primary care groups) for funds allocated to health care. This would be a way of improving co-ordination whilst minimising damage to existing good practice. Mind supports the concept of a universal requirement for local joint plans for mental health. Mind's support for such an option depends on the following points being taken on board:—

    (i)  service users are fully engaged including as members of the joint body, and that wider service user views are considered by that body through representation, stakeholder consultation, surveys and so on; structures need to be in place to ensure that consultation is effective and that adequate time for consultation is allowed;

    (ii)  a joint plan prepared with service user involvement is published and disseminated locally;

    (iii)  the voluntary sector (whether or not user-led) is also closely involved in planning as well as service delivery and that it has a flat playing field in securing funding for services and projects;

    (iv)  GPs are engaged in an effective way;

    (v)  co-ordination between providers is also addressed in an effective way.

  If these aims cannot be achieved under a new structure, then Mind believes it would be better to try to build on existing arrangements, perhaps with limited enabling legislation to remove blocks to joint commissioning, than to opt for radical change.

  6.  Mind believes that there should initially be piloting of any proposed new structure. Thereafter it should be introduced universally rather than on a voluntary basis. Otherwise it is hard to see how the option could address poor performance.

WIDER ISSUES

  7.  Mind believes that consideration of structural change only tackles a small piece of the jigsaw which needs to be put together to provide responsive services. There is a clear need for more resources for mental health services across the country and for greater training, including user-led training and inter-agency training, for staff. There is also a need to move away from coercive styles of service towards services which work with and alongside users.

  8.  Structural change can only be helpful if it forms part of a programme of change to tackle these issues, specifically including:

    (i)  developing those elements of services which help to engage users rather than those which damage partnerships. This means building a welcoming style of service—which has implications for example, for staff training and the hospital environment—and removing those measures such as supervision registers and supervised discharge which discourage engagement;

    (ii)  developing services which are welcoming to and meet the needs of people from black and ethnic minorities. It is widely recognised that services are often very weak in this area. There are limited numbers of senior staff from black and ethnic minorities, while some black people are over-represented in secure services and on Mental Health Act sections. There may be a variety of reasons for this, but the emphasis must be on making the full range of services more accessible to people from black and ethnic minorities and in enabling them to have a much greater say in the style and content of services. In many areas people from black and ethnic minorities are already alienated from services and considerable effort will be required to rebuild trust;

    (iii)  developing services which are welcoming to and meet the needs of women. Single sex provision for those who want it is essential in in-patient services and in other services such as day centres.

    (iv)  it is clear that the particular problems services have in responding to people from black and ethnic minorities reflect wider problems in addressing the needs of service users generally. There has been a disturbing increase in the use of the Mental Health Act and the environment of many in-patient units remains unacceptable;

    (v)  it is vital that improvements in co-ordination of services at commissioning level are reflected by improvements in providers. In particular, much more could be done to develop the "linkworker" concept where staff work to support users in accessing the full range of services they need. There should be a single assessment of users' needs across health and social care which is formulated in partnership with the individual affected. Mind would like to see national adoption of the assessment model known as the Avon Mental Health measure which has the user at its centre and in control. This measure has already been successfully piloted in a number of health authority areas;

    (vi)  it is also important that partnerships are built between all the local agencies concerned with mental health, including housing authorities, the benefits agency, employment services, leisure services and the voluntary sector including user groups. This process needs to take place at national as well as local level, with better co-ordination of policies across Government Departments and user involvement in central policy formulation;

    (vii)  in driving up standards amongst providers it is important that some national standards for mental health care are promulgated by the Department of Health. These should be developed in partnership with users who should also be involved in assessing individual providers.

  9.  Mind would also wish to draw attention to the current difference in charging policies between health and social services. Health services are free at point of use whereas social services now charge for many services including day centres and domiciliary care. Mind opposes the introduction of charges for mental health services and is concerned about the impact of such charges on the take up of services by those with mental health problems. Mind would be very concerned if one effect of structural reorganisation was to extend such charging into areas currently free at the point of use. Local authorities also have the power to make direct payments to users and Mind encourages the use of this power for mental health service users. Again Mind would be concerned if reorganisation were to lead to the loss of this opportunity for users of mental health services to take more control of their lives.

12 January 1998


 
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