Memorandum submitted by The Royal College of Nursing (MH 50)


With a membership of over 390,000 registered nurses, midwives, health visitors, nursing students, health care assistants and nurse cadets, the Royal College of Nursing (RCN) is the voice of nursing across the UK and the largest professional union of nursing staff in the world. RCN members work in a variety of hospital and community settings in the NHS and the independent sector. The RCN promotes patient and nursing interests on a wide range of issues by working closely with the Government, the UK parliaments and other national and European political institutions, trade unions, professional bodies and voluntary organisations.


Whilst the RCN is a member of the Mental Health Alliance and supportive of many aspects of its campaign the Mental Health Bill covers many highly complex areas of which we would like to highlight some of the clinical concerns of our members:


1. Community Treatment Orders

2. Professional Roles

3. Criteria for Compulsion

4. Age Appropriate Treatment


1. Community Treatment Orders (CTOs)

CTOs are most likely to be implemented by community mental health nurses. The RCN has always maintained that CTOs should only apply to a carefully defined minority of patients meeting explicit criteria. The principle of least restrictive environment and conditions is a primary concern of our membership.


We are not convinced that the proposed trigger for implementing a CTO should be multiple in-patient admissions. It is clearly in the client's interest that they incur the full benefit of treatment packages offered without suffering the trauma of further compulsory admission or relapse. Contemporary nursing interventions such as medication management and working with clients to identify potential relapse triggers can indicate at an early stage, ambivalence to treatment that would clearly indicate the appropriateness of a CTO.


2. Professional Roles

The RCN has already made a submission to the Committee in collaboration with Unison, the British Psychological Society, Amicus and the British Association and College of Occupational Therapists highlighting our joint concerns about some of the amendments made in the Lords which we believe will have a negative impact on the roles of many health workers and the experiences of mental health service users.


The RCN welcomed initial measures in the Bill that redefined key professional roles and strengthened in legislation much of the multi-disciplinary work already in practice. Mental Health Nurses, psychiatrists, psychologists and social workers all have clear roles to play in the care of mental health patients. There should be no grey areas in the identification of "responsible" and "approved" clinicians. If clinicians meet the criteria in the regulations whether they are Doctors, Nurses, Psychologists or Occupational Therapists they should be enabled to make clinical decisions in the best interest of their patients. Approved clinicians will be highly experienced members of staff working in mental health for a number of years and will have met strict criteria to be approved as such. For example Mental Health Nurses are currently meeting the stringent requirements to be independent prescribers and have the clinical knowledge to undertake significant clinical judgements for their patients in conjunction with another approved clinician in their multi-disciplinary team.


This legislation could potentially be in place for the next 30 years and will have a huge impact on Government proposals for modernisation of mental health services and professional roles. We feel that the Bill as amended in the Lords could undermine much of the good work already achieved. We would therefore urge you to support the Government in amending the Bill such that its initial intention is restored in this area.


3. Criteria for Compulsion

The RCN welcomes measures to support good practice in avoiding detention in the absence of appropriate treatment. However, this does raise the issue of how clinicians can detain patients for clear benefit when the necessary treatment is unavailable. Treatment should always be of clear benefit to the individual and not exercised in the interests of others. The RCN considers that any treatment must be tested on the basis of whether it will, or is likely to incur therapeutic benefit to the individual.


4. Age Appropriate Treatment

At our annual congress the RCN membership mandated our governing Council to lobby the Government on age appropriate settings and specialist services to manage the transition clients have to make from child to adult services. Young people with mental health problems who may require detention should not be subjected to care and treatment in adult settings. However, we do acknowledge that in emergency situations a young person's needs may require an urgent intervention.


We would urge the Government to ensure that the necessary resources are targeted to meet the needs of this vulnerable group to ensure that, even in emergency situations, they will not be required to be placed on adult wards.


April 2007