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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