Memorandum by the Department of Health
PROVISION OF NHS MENTAL HEALTH SERVICES (MH
1)
EXECUTIVE SUMMARY
1. Mental health services are a priority
for this Government, confirmed in the most recent National Priorities
Guidance (2000-03). Developments in mental health services are
being carried out in the context of the Government's White Paper:
The new NHS, Modernising Social Services and Saving Lives:
Our Healthier Nation.
2. The Government's strategy for mental
health is set out in Modernising Mental Health Services (published
in December 1998) and is designed to improve mental health services
as part of the overall programme to modernise the health and social
care system. It proposed action in three areas:
— New investment and systems to manage
resources more effectively;
— Revised legislative powers, taken
forward through the review of the 1983 Mental Health Act and consultation
on the management of dangerous people with severe personality
disorder;
— Properly integrated care processes,
which cross professional and organisational boundaries, taken
forward through the implementation of the National Service Framework.
Mental Health National Service Framework
3. The National Service Framework addresses
the mental health needs of working age adults, and sets out seven
standards of care which cover health promotion, assessment and
diagnosis, treatment, rehabilitation and care, and encompasses
primary and specialist care and the roles of partner agencies.
4. Implementation of the National Service
Framework will begin in April 2000 and will represent a long term
programme requiring sustained, concerted and systematic action
to combat long-standing and complex problems. The initial focus
will be on providing safe services.
5. The National Service Framework contains
a clear set of timetables, national milestones with high-level
performance indicators covering inputs, processes and outcomes.
6. As well as ensuring continuing financial
support for the National Service Framework, local delivery of
the Framework is being supported by four other underpinning national
programmes:
— Research and development.
— Clinical decision support systems.
Additional Investment
7. Additional investment of £700 million
has been provided for health and social services over the three
years 1999-2002 to modernise mental health services. In 1999-2000
£128 million extra has been invested in mental health services
for adults of working age, and £20 million for children and
adolescents.
Secure Mental Health Services
8. The Government believes that partnerships
and integrated service development within the wider NHS and other
statutory and voluntary agencies are priorities for modern secure
psychiatric services, and will end the isolation of the high security
service. The provisions in section 41 of the Health Act 1999 are
designed to help address the current problems of isolation by
allowing the high security hospitals to join with other mental
health NHS Trusts.
9. Following the publication of Judge Fallon's
report into the personality disorder unit at Ashworth Hospital,
the three high security hospitals have been working closely with
the NHS Executive Regional Offices to implement the recommendations
of the inquiry and improve service delivery and security at the
hospitals.
10. To ensure the continued development
of appropriate low and medium security mental health services,
£14 million was specifically made available from the Modernisation
Fund for Mental Health in 1999-2000 for new additional secure
places, and a further £15 million has been allocated for
2000-01.
Prison Health Care Services
11. A report on The Future Organisation
of Prison Health Care undertaken by a joint Prison Service and
NHS Executive Working Group (March 1999) recommended that prisoners
should have access to the same quality and range of health care
services as the general public receives from the National Health
Service. The Working Group made several recommendations regarding
the provision of mental health services to prisoners, in particular
that the care of mentally ill prisoners should develop in line
with NHS mental health policy and the National Service Framework,
including new arrangements for referral and admission to high
and medium secure psychiatric services.
12. The Government has accepted the Working
Group's recommendations and two new joint units have been created,
located within the NHS Executive, to lead and manage the process
of change. The Prison Health Policy Unit is working to ensure
that the right policies are in place to give a clear strategic
direction and guidance, and the Prison Health Care Task Force
supports the delivery of change in the field.
Dangerous People with Severe Personality Disorder
13. A consultation paper, Managing Dangerous
People with Severe Personality Disorder: proposals for policy
development, was published in July 1999 by the Department
of Health and the Home Office. The paper set out options which
include both legislative and organisational changes. The consultation
period ended on 31 December 1999 and the responses will be considered
alongside those from the Reform of the Mental Health Act 1983.
The Government recognises that, whatever option is chosen
for longer-term policy development, there is a need to develop
capacity within existing prison and health service structures
to manage dangerous people with severe personality disorder more
effectively. As a first step a number of pilot projects will be
set up to test the procedures that might be used to assess risk
and symptoms of personality disorder.
Child and Adolescent Mental Health Services
14. Since 1997, when the Government published
its response to the Health Select Committee's report on Child
and Adolescent Mental Health Services, the focus of the Department's
work in this field has been to address acknowledged deficiencies
in the range, quality and distribution of services. In particular
this has involved up-dating the information base and setting specific
development objectives underpinned by additional resources.
Reform of the 1983 Mental Health Act
15. The Government published proposals for
a modern legislative framework for mental health in a Green Paper,
Reform of the Mental Health Act 1983, on 16 November 1999.
These proposals are out to consultation until 31 March 2000. The
Green Paper is broadly based on the framework suggested by the
expert committee chaired by Professor Genevra Richardson, although
not all of their proposals are accepted. The focus is on managing
risk and providing better health outcomes for patients in a way
that strikes the right balance between public safety and the rights
of individuals.
Conclusions
16. This represents an ambitious agenda,
developing modern mental health services which are culturally
appropriate and which reflect the needs and wishes of service
users and their carers.
Annexes
18. Four annexes to this memorandum cover
the specific issues raised by the Committee in their terms of
reference:
Annex A: Current Government Definitions and
Categorisation of Mental Illness.
Annex B: The ability of "Care in the
Community" to cater for people with acute mental illness.
Annex C: The transition between acute and
secure mental health sectors.
Annex D: The transition between adolescent
and adult mental health services.
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