DMH 157 National Mental Health Partnership
Memorandum from the NATIONAL MENTAL
HEALTH PARTNERSHIP
We welcome the opportunity to comment
on the proposals for the new legal framework set out in the draft
Bill and on the other consultation issues raised.
General
These comments are based on views from
a wide range of staff including doctors, other mental health professionals,
union representatives and Mental Health Act Administrators.
Social Service colleagues have also contributed to the debate.
There are concerns from these groups
on specific aspects of the Bill which require clarity. These
include:
- The definition of mental disorder
- Criteria for compulsion considered
too broad
- Loss of the 'independent' view of
the Approved Social Worker
- Funding and organisation of Mental
Health Tribunals to meet the new 28 day deadline, including the
implications for senior medical staff time and the impact on the
provision of day to day services
- The implications for community staff
of Community Treatment Orders, including resources
- The likelihood of increased admission
rates under compulsion and the impact of this on patient care
and resources
- Funding and training of advocates
Psychiatrists will also be making separate
and strong recommendations via the Royal College of Psychiatrists
about their specific professional concerns.
The following comments are offered on
specific points:
Scrutinising the proper application of
the Act
The role suggested for the new specialist
arm of the healthcare inspectorate is broadly welcomed although
due consideration needs to be given to the particular nature of
activities currently carried out by the Mental Health Act Commission
to ensure these are not lost in the new system.
The replacement of the Approved Social
Worker (ASW) by the Approved Mental Health Professional needs
consideration in respect of the potential loss of independent
scrutiny that the ASW role currently gives. It will be important
to maintain the number of ASWs in the interim and training of
approved mental health practitioners should be considered at an
early stage in preparation for the implementation of the legislation.
Protecting children with serious mental
disorders
The clarification given in the Bill
in respect of 16 and 17 year olds is welcomed and the recognition
of the rights of these young people to have a greater say in their
care is a positive step. Proposals to extend parental authority
in respect of children who are refusing treatment also seem appropriate.
There is a view that the new legislation
could increase the work of Mental Health Tribunals in relation
to young people and this would obviously have implications for
the training of people involved in respect of young people's needs
and rights.
Opportunity could be taken within the
Act to create specific duties in relation to service provision
and procedures for children and adolescents to ensure appropriate
care and treatment of young people.
Respecting the legal rights of patients
and health care workers
It is agreed that the current necessity
requiring a patient under compulsory power to take additional
steps prior to making a legal complaint against a health care
worker is not appropriate. The future requirement for health
care professionals to be able to defend their decision-making
is agreed as fair and equitable.
Focusing on individual needs, removing
exclusions
Health care professionals have concerns
with regard to the removal of the exclusion under Section 1(3)
of the 1983 Act. It is felt that it would be better to interpret
this section clearly in the Code of Practice for the new Act than
to remove it due to previous misunderstanding. Separate Codes
of Practice for England and Wales will cause problems with cross
border services if the Codes are significantly different.
Sharing information to improve patient
care
The proposals requiring agencies to
share information on patients to improve patient care and minimise
risks is welcomed and supported. There will need to be very
clear protocols, however, to ensure appropriateness of information
sharing and to define the involvement of patients in the process.
Better care for prisoner patients
Any improvement in services for prisoner
patients would be welcomed.
The need to ensure safeguards as outlined
in the consultation document is supported, as it would be inappropriate
for the provisions of the Act to deny prisoners transfer to an
NHS hospital when required or an inferior level of care within
the prison system.
Patients' correspondence
In general these proposals are supported
but would need to incorporate a right of appeal and would need
to include clear criteria for the exercise of these powers, taking
into account the provisions of the 1998 Human Rights Act.
Mental Health Tribunals - single member
sittings
Interpretation of 'simple issues of
fact' has been raised as an issue with regard to single member
sittings, although it is recognised that this is a pragmatic response
to potential workload issues. In general this proposal is supported
but would need close scrutiny to ensure there is no prejudicial
decision-making.
Detention
It is not clear whether detention in
hospital counts as treatment. The proposal is that somebody cannot
be 'sectioned' unless the "appropriate treatment is available".
The implication of this is that people with personality disorders
who are untreatable may not be detained. 'Medical' treatment may
not be the most relevant - 'clinical' treatment might be more
appropriate.
Summary
A number of concerns are raised regarding
specific proposals contained within the Mental Health Bill and
clarification is needed on a range of issues which are not yet
outlined in detail. The need for a Code of Practice well in
advance of the implementation date is definitely a requirement.
The Partnership welcomes the opportunity
to improve the delivery of treatment to our patients whilst safeguarding
both individuals and members of the public. It is recognised,
however, that there will be considerable implications in terms
of overall cost, training and operational implementation. Without
careful thought in advance of implementation of the proposed legislation
to all of these matters, the situation for people receiving and
providing care will deteriorate, which is clearly not the intention
of the proposals.
We thank you for the opportunity to
comment on these proposals.
October 2004
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