Memorandum submitted by the Social Perspectives Network (MH 16)
1. Role and scope of Social Perspectives Network (SPN)
SPN is a broad based national network which develops critical thinking around the evolving mental health policy, practice, research and legislative agendas. We seek to develop social understanding of mental health and to promote a social model of mental health which takes account of the many social factors that impact on mental well being. Our 1400 members and affiliated organisations include service users, health and social care professionals at all levels, carers, educators, researchers and policy advisers. Our activities include national and regional study days, published papers, research activities, an interactive website and direct lobbying. SPN is affiliated to the Mental Health Alliance.
2. The impact of the Bill
The primary purpose of mental health legislation as stated by the Report of the Joint Committee on the Draft Mental Health Bill is to create better services and reduce stigma. The original draft works against this. It goes against progressive and evidence based policy and legislation including the Government White Papers -Choosing Health and Our Health Our Care Our Say - and recent legislation such as the Mental Capacity Act (and in Scotland, the Mental Health (Care and Treatment) Act (2003). These collectively emphasise capacity, choice, improving services, autonomy for service users and more concentration on prevention and early intervention as well as access to advocacy.
The Bill's unbalanced concentration on risk and compulsion will increase the stigma of mental disorder and levels of discrimination with a negative impact on individuals struggling to recover or cope with mental health conditions.
As well as the human cost, there will be huge associated social and financial costs because of stigma. Yet de facto the Government is reducing spending on mental health even to the extent of topslicing the budgets of Mental Health Trusts which have not overspent.
The Bill will adversely affect all service users but particularly those from black African and African Caribbean communities who are already over represented in the secure end of the mental health system. This runs counter to the principle of race equality.
An already overworked and demoralised mental health and social care workforce will be damaged by the extra workload generated by this Bill particularly around exercise of compulsory powers. It will strain professional-service user relationships by casting workers as unwilling jailers. Professionals have not asked for the additional powers and they should be listened to. The dangerously vague and loose language used in the Bill, particularly around "appropriate treatment" and the wide definition of "medical treatment" is not only dangerous for individual service users' liberty but will make it hard for professionals to keep cases under meaningful review at Tribunal stage.
Whilst there is need for flexibility around new working arrangements, SPN is particularly concerned that the new AMHP workers be properly trained to execute their duties and be empowered to offer a truly independent view reflecting broadly social perspectives in the context of the largely clinically based teams they will be working with.
We are very disappointed that even after 8 years of united opposition from service user and carers groups, mental health and social care professional bodies, the Law Society and civil rights groups and after evidence from the Expert Committee report 1998 and its own Parliamentary Joint Scrutiny Committee, the Government has still retained substantially the same unbalanced vision for mental health legislative reform. However we welcome many of the amendments made by in the House of Lords which could provide the basis for a Mental Health Bill fit for the 21st century.
Below SPN sets out recommendations for future mental health legislation based on feedback from our members, and also recent initiatives bringing progressive thinking to mental health such as the Report of the Parliamentary Joint Scrutiny Committee (2005), the report of the Social Exclusion Unit on Mental Health and Social Exclusion (2004), the White Paper Our Health Our Care Our Say (OHOCOS) and the Scottish Mental Health Act.
SPN's vision for mental health legislation fit for the 21st century
· Focus on improving services by bridging the gap between acute and continuing care services, early intervention and assessment not coercive powers especially coercive treatment in the community
· Coercive powers to have more safeguards and exclusions by tightening the definition of mental disorder and the conditions for compulsion by retaining a therapeutic benefit, impaired decision making, treatability test and restrictions to revolving door patients on Supervised Community Treatment. The Lords amendments cover these points and should not be overturned by MPs.
· Increasing patient power by having right to advocacy from point of detention, same level of autonomy as for non mental health patients, right to advance directives and decisions and right to choose a nominated person as well as rights to assessment
· New AMHPs to receive proper training of sufficient duration so they can offer a truly independent social perspective within predominantly clinically based teams, particularly during Tribunals
· AMHP role to have one regulatory body to cover all professions to avoid anomalies around different professional codes of conduct
· Adequate resourcing for fast tracking of Tribunals
· Similar safeguards for Bournewood patients as for people detained under the Mental Health Act7 including access to free aftercare services and a second medical opinion to any treatment provided during detention; right of relatives to discharge a patient and decrease the duration of a detention order and to whistle blow and request an assessment on whether a person is being wrongly deprived of their liberty; eligibility for non means tested legal aid. Appeals to go to Mental Health Review Tribunal not the Court of Protection
· Safeguards for children and young people treated without their consent including the right to an individual care plan; regular reviews or representation by a nominated person; a right of access to the tribunal and the right to advocacy; provision of special safeguards for children including the right for children to be admitted to a unit which will meet their particular needs, removal of the anomaly whereby 16 and 17 year olds who are deemed competent can consent to admission to hospital and treatment but if they refuse treatment they can be admitted under parental authority
· Retention of the Mental Health Act Commission as watchdog
 "The primary purpose of mental health legislation must be to improve mental health services and safeguards for patients and to reduce the stigma of mental disorder" Report of the Joint Committee on the Draft Mental Health Bill, 2005. Summary page 5
 This states that the Government's role is to "empower people, support people when they want support and to foster environments in which healthy choices are easier"
 As recommended by the Report of the Joint Committee on the Draft Mental Health Bill, 2005. Summary p. 5
 Powers under the Act should be exercised without any direct or indirect discrimination on the grounds of physical disability, age, gender, sexual orientation, language, religion or national or ethnic or social origin
 Even now, one in four people report they were denied access to care when their problems were developing (Rethink (2003) Just One Per Cent; the experiences of people using mental health services
 Compulsory treatment in the community does not achieve positive outcomes in a number of indices including: health service use, readmission to hospital within a year, social functioning, likelihood of being arrested, mental state, quality of home, homelessness or satisfaction with care. It has also been calculated that 85 people would have to be subject to compulsory community treatment to prevent one hospital admission and 238 to prevent one arrest according to Compulsory community and involuntary outpatient treatment for people with severe mental disorders (Review): the Cochrane Library 2005, Issue 3
 This view is endorsed by the Making Decisions Alliance (a consortium of 40 charities set up to campaign for new legislation on mental capacity and to support the implementation of the Mental Capacity Act)