Memorandum by Manic Depression Fellowship
MENTAL HEALTH SERVICES (MH 73)
SUMMARY OF
EVIDENCE
1. Mental health services as they are currently
configured demonise and exclude service users by creating an arbitrary
divisive category called severe and enduring mental illness. Most
mental health problems are intermittent and episodic. With effective
community support, people can live full ordinary lives. Mental
health care services need to be holistic in approach.
2. Community Care has not failed as this
government asserts. It has never been properly tried. Overloading
and the breakdown of acute care facilities means that users in
crisis cannot access help when they need it, and that ward conditions
are unacceptably poor.
3. The introduction of compulsory treatment
orders in the community will undermine the basis on which effective
community care is delivered—informed consent and good working
partnerships between users and professionals.
1. GOVERNMENT
DEFINITIONS AND
CATEGORISATIONS OF
MENTAL ILLNESS
1.1 The ghettoisation of the "severely
mentally ill".
MDF views with alarm the government approach to services
for people experiencing mental health problems. Categorisation
is made between people with "severe and enduring mental illness"
and "others". Manic depression for example, can be severely
incapacitating if untreated and unmanaged, but with a balanced,
holistic, and educational approach to treatment, many people with
this diagnosis can lead full and busy lives, often holding down
demanding professional jobs.
1.2 The arbitrary division of services
By creating this category of users and then
basing access to services, the delivery of service provision and
the funding infrastructure around this categorisation, users become
trapped in a socially excluding ghetto of limited and over-stretched
services. For example, recent research has shown that the most
effective treatment for severe manic depression is a combination
of medication and talking therapies. However, talking therapies
are almost never funded or easily available on the NHS.
1.3 The need for holistic service provision
The government has not to date, recognised that
treating people's severe mental health problems needs more than
merely clinical treatments. Good mental health comes from a sense
of well-being and sufficiency, with people's basic needs being
met—adequate income, food, housing, purposeful activity.
The new references to these essential social and economic support
needs for users in the National Service Framework (NSF) is to
be very much welcomed. However, no indication is given in the
NSF of how these needs are to be met—who will deliver them
and who will fund them.
1.4 The demonstration of the mentally ill
It is MDF's view that the government itself
has done much to perpetuate the myth that mental illness is usually
if not invariably associated with dangerousness and a random propensity
to violence. Recent research has completely discredited this misperception.
The widespread use of the term "mental disorder" itself
creates increased stigma, fear and misunderstanding. Most users
of mental health services have only intermittent periods of crisis.
2. THE ABILITY
OF CARE
IN THE
COMMUNITY TO
CARE FOR
PEOPLE WITH
ACUTE MENTAL
ILLNESS.
2.1 Community Care has not failed.
The government has stated on record that community
care has failed. MDF opposes this view. From the extensive experience
of our members, carers and users, we know that where community
care services are properly resourced and predicted on genuine
user involvement they are successful and highly valued by users.
2.2 Effective services need to deliver a range
of options.
Effective mental health care needs to be built
on partnerships between the user and the mental health professional.
Users need access to full information about treatments and to
a range of different support systems, such as help with independent
living and sheltered accommodation. These support systems are
rarely available.
2.3 Community care can work if properly managed.
Community care has not been properly resourced
nor realistically evaluated based on the quality of users lives.
Instead, frenzied media coverage of the relatively rare cases
of breakdown in community-based care (Ben Silcock, Christopher
Clunis), have contributed to a climate of hostility and fear and
the officially endorsed perception of failure.
2.4 Acute care facilities are grossly over-stretched.
MDF believes that with increased provision for
acute care, community based mental health services can then concentrate
on providing support and preventative mental health care. For
the last 15 years at least, pressure on acute facilities has meant
that users going into crisis cannot access help when they first
need it and therefore, usually end up requiring to be sectioned,
depending on the availability of beds. The King's Fund, for example,
has produced an in-depth report (1997) documenting consistent
bed occupancy rates of 140 per cent in inner city London boroughs
such as Hackney. This creates poor quality and ineffective acute
care—containment rather than treatment.
3. COMMUNITY
CARE PRESENT
AND FUTURE
3.1 Of particular concern to MDF members
are the new proposals for reform of the 1983 Mental Health Act.
These proposals create a new set of criteria for
the imposition of compulsory treatment and care in the community—the
assessment of the risk to public safety.
MDF believes that this is an unsupportable and
unproven basis on which to forcibly treat people experiencing
mental health problems, and has at its root, the fallacy that
severe mental illness has an association with violence to others.
All inquiries into homicides and suicides by people with mental
health problems have shown that it is failures of professional
care services that have been responsible—the failure of
managers to co-ordinate care, failures in communication between
different care providers, the failure to adequately follow up
and support people on discharge from hospital.
Risk assessment is a subjective and unproven
area in psychiatry. There are an infinite number of variables,
which contribute to any level of risk—and these include
whether substance abuse is occurring and the level or absence
of provision of appropriate after-care.
Community Care works today because users have
some limited faith in its ability to deliver. Acute psychiatric
care consists of medication or ECT in a secure setting.
Wards that should be open are routinely locked
in order to control entry and exit. The implementation of compulsory
community care/treatment orders reduces mental health services
to compliance with medication.
MDF has extensive evidence from members to show
that medication is not on its own an effective treatment, nor
is forced treatment a long term solution to very deep and complex
emotional difficulties that often contribute to the onset of mental
health problems. Monitoring and implementation of these community
treatment orders will damage the therapeutic relationships on
which modern mental health care is founded. Users view these new
powers as so oppressive and unfair that they will not willingly
keep in touch with services nor access help when they need it,
for fear of being subject to forced treatment orders in the community.
In MDF's view, compulsory treatment powers as
proposed will undermine and destabilise the principles on which
community care is based—partnership, informed consent and
trusting relationships between users and professionals and as
such are regressive. Much as supervision orders and the existing
compulsory powers to convey have proved—workable, ineffective
and unused.
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