Memorandum submitted by Hafal (MH 12)
1. About Hafal
Hafal (meaning "equal") is a patient- and carer-led organisation working with people with severe mental illness and their families in Wales. Many of Hafal's membership of nearly 1000 have extensive personal experience of the Mental Health Act 1983. Hafal operates over 60 projects across Wales providing a range of services for people with severe mental illness: these include employment/training projects, supported accommodation, resource centres, club activities, befriending schemes, advocacy and carers' support services. Over 700 people use a Hafal service every day. In addition Hafal campaigns vigorously through research and publications to remove the stigma and isolation associated with severe mental illness.
Hafal acknowledges that there are some improvements to the 1983 Act contained in the Amending Bill. However, there remain fundamental weaknesses in relation to:
· Reciprocal rights
· Compatibility with Welsh Policy and Services
We also support the amendments to the Bill voted for by the House of Lords.
Hafal is a member of the Mental Health Alliance and shares their general concerns about the Bill: we have not attempted to repeat these here but rather we reflect on specific issues for our members in Wales.
3. Reciprocal Rights
Reciprocal rights are frequently argued for as "compensation" - offering something in return for the invasion of individual rights which compulsion necessarily involves. This is a valid argument but Hafal's members seek legal rights to treatment for much more concrete reasons. Typically patients and families who seek help at the early stages of illness receive too little help too late: subsequent deterioration frequently leads to the use of compulsion. It is staggering to note that 50% of people with psychosis find compulsion their first experience of specialist care. More than a third of patients who are treated under the 1983 Act have previously been refused treatment which they sought voluntarily. Long experience tells our members that the quality of support (if any) when it counts at the early stage never matches the methodical and relatively consistent application of legal compulsion (which of course will always also win the case for resources.)
Reciprocal rights would ensure access to
early treatment. From our own experience we are convinced that this would
prevent much suffering, improve safety for all, and significantly reduce the
need for compulsion which the Bill so emphatically focuses upon. We believe that
a new Mental Health Act should incorporate:
• A stipulation that Codes of Practice are based on that balance between compulsion and patients' rights.
• A right to assessment on request within a set time
• A further
right to defined treatment and care including access to a psychiatrist when a
basic threshold (for example the occurrence of delusional behaviour) is reached
- a threshold well short of that required for compulsion to be applied
4. Compatibility with Welsh Policy and Services
One of the key issues for people in Wales is how the amendments would affect the Assembly Government's plans for improving mental health services in Wales. The Assembly Government's Adult Mental Health National Service Framework provides plans to create services that are "effective, comprehensive and responsive" (Standard 6) and that promote "service user and carer empowerment" (Standard 2).
Reciprocal rights in the Bill would take forward these goals.
However, a compulsion-led Mental Health Bill that skimps on patient and carer rights contradicts these aims.
Hafal would like to highlight the Mental Health Act 2003 introduced by the Scottish Parliament. Their legislation was developed in careful liaison with patients and other interested parties and guiding principles are included in the Act. These include the principles of reciprocity (compulsory treatment and care in return for safe and appropriate services) and benefit (whereby any intervention under the Act should be likely to produce a benefit to the service user which could not reasonably have been achieved without compulsory intervention). The Scottish Act includes a statement establishing ten guiding principles which should be 'taken into regard' in all decisions relating to the use of compulsory powers under the Act. Many in England and Wales support guiding principles, and the joint scrutiny committee on the draft 2004 Bill called for them to be incorporated into English and Welsh legislation. The Scottish Act requires decision-makers in mental health to 'have regard' to the guiding principles. In practice this means that whilst the guidelines should be considered in every instance, there is potential and freedom to depart from them if appropriate and necessary.