Joint Committee on the Draft Mental Health Bill Written Evidence


Joint Select Committee

DMH 315 Barnardos


Draft Mental Health Bill

Memorandum of Evidence

Introduction

Barnardo's is the UK's leading children's charity, with 359 projects across the UK. Each year we work with more than 100,000 children, young people and families, providing a range of services, from SureStart to support for young people leaving care.

Our commitment to working with children and young people in greatest need means that many, if not most of the children and families we work with have experienced or are experiencing some degree of mental distress. As a consequence we have a wealth of experience of supporting children young people and families to become or remain emotionally healthy. In addition to this, we also provide a range of more specialist services, including therapeutic projects for children and young people who have survived abuse.

Child Centred Working

Barnardo's is concerned that the Draft Mental Health Bill 2004 continues to enable the compulsory treatment of children and young people, and yet fails to incorporate child welfare principles that have underpinned children's services since the passage of the Children Act 1989. The bill as it stands does not take into account crucial elements of child welfare legislation relevant both to children and young people subject to compulsory treatment, and to children and young people whose parents or carers are subject to compulsion.

Under the Children Act 1989, children in need are supported through a care planning process which places great emphasis on the wishes, views and feelings of the child concerned, and draws on the expertise of professionals from a range of disciplines. Children subject to compulsion under this bill, and children whose parents or carers are subject to compulsion, should be entitled to the same quality of care planning.

Further, this bill fails to reflect Clause 11 of the Children Bill 2004, which creates a new duty binding all NHS Trusts to co-operate in safeguarding and promoting the welfare of children:

'ensuring that

a. their functions are discharged having regard to the need to safeguard and promote the welfare of children; and

b. any services provided by another person pursuant to arrangements made by the person or body in discharge of their functions are provided having regard to that need.'

We feel that it will be impossible for NHS and independent mental health care providers to comply with the duty under Clause 11 of the Children Bill, without employing a far more child centred and multidisciplinary process than is envisaged by the Draft Mental Health Bill.

Barnardo's would like to see:

  • Child welfare principles included on the face of the bill
  • A care planning process that reflects best practice under the Children Act 1989 and the meets the requirements of the Children Bill 2004, with children's views wishes and feelings at its core.

Child Centred Structures

Barnardo's believes that in order to provide child-centred care and treatment, professionals involved in the assessment and planning process, as well as Tribunal members, must have specific expertise and experience in working with children and young people.

We feel it is essential that where a child or young person is assessed at least one of the assessors is professionally trained in child development and/or child psychiatry. Children and young people are not adults in miniature; a 'normal' emotional state or reaction for a 10 year old would perhaps be symptomatic of severe emotional disturbance in a 20 year old. We are mindful that Clause 3 allows for Local Authorities to stipulate specific competencies for approved clinicians and mental health professionals, but feel that this is not a sufficiently robust mechanism to ensure that where children and young people are assessed for compulsory treatment the process is age appropriate and child centred.

Likewise, given the enhanced role of the Tribunal, responsible for approving care plans as well as detention and discharge, it is essential that Tribunal composition reflects the necessary expertise in children and young people's mental health and emotional development. Inclusion of expert panel members should not be at the discretion of the Tribunal, rather it should be a statutory requirement where the Tribunal is considering the care and treatment of a minor.

Whilst welcoming the focus on safeguards for patients under the new bill, Barnardo's is concerned that these safeguards will remain inaccessible to many children and young people being treated in inpatient settings. All children and young people in receipt of inpatient psychiatric care are extremely vulnerable, not least because many continue to be inappropriately placed on adult wards. Consequently, statutory safeguards should be extended to all children and young people in inpatient settings, not simply those subject to compulsory treatment.

Barnardo's would like to see:

  • Consideration given to the drafting of a separate CAMHS chapter for the bill, in order to ensure that the structures outlined are appropriate as they apply to children and young people
  • Involvement of professionals with expertise in child development and/or child psychiatry as a statutory requirement where children and young people are being assessed, detained, treated or discharged
  • Statutory safeguards extended to all children and young people in receipt of inpatient psychiatric care.


Young Carers

Barnardo's feels that the bill fails to take into account the needs of children and young people whose parents are subject to compulsion. As the bill stands, such children and young people will either have no rights at all in regard to their parent or carer, or a potentially highly inappropriate range of rights where they meet the definition of 'carer' employed in the bill.

Children and young people who do not provide 'a substantial amount of care on a regular basis', or who do provide such care yet are under 16 will have no right to information about or input into their parents experience of treatment under this bill. In sharp contrast to this, young people over 16 providing 'a substantial amount of care on a regular basis' will have a wide range of rights, the exercise of which might do irreparable damage to an otherwise positive parent/child relationship.

Barnardo's would like the bill to include a right to information for all children and young people whose parent or carer is subject to compulsory treatment. These children and young people should be entitled to basic information about the nature of the mental health problem being experienced by their parent or carer, the role of statutory services in supporting people with mental health problems, opportunities to input into the care and discharge planning process and any support that is available to them in coming to terms with the experiences of their family.

Clearly, such a right can and should be subject to an assessment of specific family circumstances, including age and development of the child concerned and the nature of the family network, but the fundamental principle should be one of entitlement to information.

Barnardo's is concerned that the definition of carer employed in the bill may lead some young carers to become involved in their parent or carers assessment, treatment and discharge in a way which is profoundly damaging to their family relationships and thus to their own experience of being cared for. We would like to see a more careful consideration of any safeguards which may be necessary to ensure that the carers rights set out in the bill are not exercised in a manner which causes harm to vulnerable young people eager to provide their parent or carer with support.

Additionally, it is essential that families where parental mental health is an issue are able to access the widest possible range of support. In order to achieve this aim, the bill should acknowledge the new duty under Clause 11 of the Children Bill 2004, and stipulate that where appropriate, practitioners engaged in assessing or treating adult patients should request assessments under s17 of the Children Act 1989, or any other legislative provision linked to accessing support for vulnerable children and young people.

Barnardo's would like to see

  • A right for age appropriate information for all children and young people whose parent or carer is subject to compulsory treatment
  • Further consideration of family safeguards needed where a young person meets the definition of 'carer' set out in the bill
  • A clear link between the bill and holistic child focused assessments under the Children Act, Children Bill etc, in order to ensure that the needs of children and young people are not overlooked where their parent or carer has mental health support needs.


Nancy Kelley

Principal Policy Officer

020 84987734

nancy.kelley@barnardos.org.uk



 
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