Memorandum submitted by The Princess Royal Trust for Carers (MH 11)
The Princess Royal Trust for Carers wishes to submit evidence to the Public Committee for the Mental Health Bill. This submission aims to guide policy-makers to produce an Act which is more responsive to carers' needs. As such, this would create a framework for better, more sustainable and effective mental health service provision in England and Wales.
We highlight three issues for further consideration with the Bill:
· Widening the definition of 'relative', 'named person' and 'nearest relative' within the Bill, to better reflect the diversity of individuals caring for mental health service users.
· Inclusion of safeguards for carers and service users' human rights when implementing Community Treatment Orders.
· Greater emphasis on carers' needs and rights for sufficient information about their loved-ones condition to care effectively.
1. Who we are
1.1 The Princess Royal Trust for Carers is the largest provider of comprehensive carers support services in the UK. Through its unique network of 129 independently managed Carers' Centres, 81 young carers services and interactive websites (www.carers.org; www.youngcarers.net), The Trust currently provides quality information, advice and support services to almost 290,000 carers, including over 15,000 young carers. Information is also collected directly from carers by Carers Centres to inform the Trust's work, including from carers of people with mental health conditions.
1.2 Within this framework, The Princess Royal Trust for Carers has a number of different specialisms and work areas, one of which is the development of support services for carers of mental health service users. The Mental Health Policy Officer (Drew Lindon) is responsible for this area of work, including the development of mental health carer services and support on a UK-wide level. This submission is authored by the Mental Health Policy Officer.
1.3 The Princess Royal Trust for Carers defines "carer" as someone, who, without payment, provides help and support to a partner, child, relative, friend or neighbour, who could not manage without their help. This could be due to age, physical or mental illness, addiction or disability.
2. Our perspectives on the Amended Mental Health Bill 2006
2.1. We accept and welcome the need for an updating of the 1983 Mental Health Act. However, there are three key elements of the current Bill which we must highlight, given their impact on the welfare of carers of mental health service users. These are outlined below.
Nearest relative and carer definitions
2.2. We welcome the amendments in the Bill's 3rd Reading in the House of Lords relating to the widening of 'relative', 'named person' and 'nearest relative' definitions within the Bill. Individuals with mental health problems may have carers who are not related, or are not their closest relative, who provide much needed support. This is currently highlighted in the Mental Health Foundation's theme for this year's Mental Health Action Week: 'Friendship and Mental Health'.
2.3. We ask that these amendments are retained in the final Act. For some carers, they may find their wishes being ignored in favour of another person (defined as the 'nearest relative') who may have less insight into the service users' condition. There needs to be this level of clarity on these 'carer concepts', to provide more provisions for the service user to nominate a different person, and to ensure the involvement of the primary carer.
Community Treatment Orders
2.4. We wholeheartedly support Baroness Pitkeathley's concerns on the impact of Community Treatment Orders on both service users and carers. Certainly, if formulated or applied incorrectly, the model of Community Treatment Orders could lead to greater intrusion into carers' and service users' homes, creating more stress for families overall. Given that some Community Treatment Orders would restrict the conduct of service user, in practice pressure may be placed on the carer to help uphold this order. Many carers will be justifiably unwilling, or unable to assist. As a result, carers may face increased pressures of being 'stuck in the middle' between service users and local services. We join the Baroness in requesting a greater consideration to carers' and service users' human rights when formulating the final model of Community Treatment Orders.
Informing and enabling carers
2.5. We also share Baroness Pitkeathley's concerns about the information provided to carers to enable them to care safely and effectively. We are concerned to have this gap remedied in the final Act and its Code of Practice. Certainly, 47% of carers say they do not have sufficient information to care effectively, and this is particularly prevalent for carers of people with functional mental illnesses or dementia-related conditions. Hence, there needs to be a focus in the Bill on mental health carers' need to be given enough information to care effectively, in order to manage risks associated with the patients condition as well as being involved with decisions relating to treatment if deemed appropriate.
2.6. We welcome consultation and discussion with policy makers on these issues; we feel that the changes above are vital to ensure improved and sustainable support for mental health carers, as well as those cared for. Indeed, carers and mental health service users' wellbeing is intimately, and inevitably linked; improvements for the support of service users are likely to improve the well-being of their carers also, and vice versa. In this way, we also welcome the changes to the Bill recently enacted by the House of Lords as positive steps towards a more appropriate and modern Mental Health Act.
 Amendment no.2, in Clause 24, see http://www.mentalhealthalliance.org.uk/mentalhealthbill/MentalHealthBill_Lords_3rdReading.doc.
 "For example, if it is with a carer, and particularly in the carer's home, and the person with mental illness and the carer no longer want to live together, then the treatment order needs to be sufficiently flexible to allow that to happen rather than to trap individuals into situations that might involve breaches of the Human Rights Act as well as a great deal of distress." (Baroness Pitkeathley, p.37, House of Lords Second Reading, available at http://www.mentalhealthalliance.org.uk/mentalhealthbill/MentalHealthBill_Lords_2ndReading.doc)
 "All too often carers are denied any access to information about the condition of the patient or of the likely prognosis, while at the same time being expected to provide care in the most stressful of circumstances." (Baroness Pitkeathley, p.36, House of Lords Second Reading, available at http://www.mentalhealthalliance.org.uk/mentalhealthbill/MentalHealthBill_Lords_2ndReading.doc)
 The Princess Royal Trust for Carers Health Survey, p.3, Partners in Care Handbook, produced by The Princess Royal Trust for Carers and The Royal College of Psychiatrists, August 2005. Available through www.rcpsych.ac.uk.