DMH 187 Sefton Recovery Group
Committee Office Scrutiny Unit
House of Commons
London
SW1A OPW
30.10.04
Dear Richard Dawson,
Re: Draft Mental Health Bill
We are writing to you to express our emerging
concerns about the Draft Mental Health Bill.
1. A right to services when they need them?
If the government were serious about public safety
and people's health, surely they would
do more to ensure that people got the care and treatment
they need when they need it.
People often recognise they are reaching crisis point
and seek help immediately to avert it, but they
do not receive that help.
2. Compulsion should be the last resort.
The purpose of the MH legislation such as this Bill,
is to force people to have treatment
(usually hospital treatment) against their will
because doctors believe it is necessary for the
protection of other people.
Under current law, a patient may be kept 6 months
and often much longer.
The proposed new law makes compulsion more likely
to happen than under the current law.
The new provisions would allow compulsory assessment
and treatment to be carried out in the
community. And taken together, they increase the
prospects for any individual person of coming
under compulsory treatment powers.
People who are in mental distress should only be
put under compulsion when
they are truly in a crisis, in danger, and when they
have lost the ability to make choices for the
themselves. It is an offence against human rights
for a person to have treatment forced upon them when they do not
want it and are able to make a choice. No one can force you to
have chemotherapy if you have
cancer ( even if it may save your life).Why are people
with mental health problems different?
3. Dangerousness and compulsion
More than under current law, the Draft Mental Health
Bill is based on the notion that people with
mental health problems present a risk to others.
It is designed to ensure that a person, particularly
with a personality disorder, can be forcibly admitted
to hospital, even though the treatment or
therapy offered might not have a beneficial effect
on their health. We object to these powers because:
they reinforce the prejudice that all people with
mental health problems are dangerous and as, a
result, stigmatise all service users they will drive
vulnerable people away from seeking help when they need it they
are unnecessary.
People working in clinical mental health care, can
, and do, take action under
existing law to deal with the situation once they
are aware of a genuine risk of this kind
they do not deal with a more significant problem:
the denial of help to some perpetrators of violence
who are refused help prior to the crisis due to lack
of resources
they are discriminatory. There is no preventive detention
of many people who put others at risk, such
as dangerous drivers or people who abuse their partners,
even if risks of offending or repeat offending
is likely.
4. Compulsion in the community
Under this Bill, the clinical supervisor can decide
to put a patient under compulsion in the community
rather than in hospital. Conditions can be imposed
on patients in the community. For instance, such a
patient could be required to take particular medication,
to stop taking particular drugs, to live at a
certain place and to attend a clinic on a weekly
basis.
If you refuse to attend a clinic on a weekly basis.
If you refuse to comply you will most likely be
taken to hospital to be given a depot injection or
other treatment.
Once a person is on a community order, it could be
quite difficult to be discharged from it. It will be
harder for a patient to get a change in treatment
regime if the psychiatrist disagrees.
If people are in a crisis where compulsion is the
only option for them, they need to be in hospital
where they will be safe, and where there will be
medical and nursing staff to help, for instance, to
monitor the effects of medication and treat adverse
reactions quickly.
Compulsion in the home is disruptive and can interfere
with people's domestic lives, denying
them the human right to privacy and family life.
Community nurses and psychiatrists do not want or
need to police their clients in this way.
It will damage trust in their relationships with
their clients.
5. Independent Mental Health Advocates and nominated
persons
We believe that if a person is in crisis and put
into hospital, several things need to happen right
at the start. They need an independent mental health
advocate who can help to explain what is
happening, to negotiate with the medical team and
possibly get agreement to the course of action that
is best for the patient.
Nominated persons: Such a person should be someone
trusted by the person and who knows them
well. It may be a carer, a friend , a member of the
family or advocate.
They need that person to be able to have a say in
what will happen, including a right to object to the
patient being put under compulsion.
Under the proposed new law an informal carer (such
as a family member giving substantial care)
will be consulted during the examination stage. This
is a period of up to 5 days in which doctors
decide whether to go ahead with compulsory assessment.
The person can be kept in hospital
during the examination stage. But the consultation
on examination cannot be with a paid carer, or
even a volunteer who is working with a voluntary
organisation, no matter how well they know,
understand and are trusted by the patient.
The nominated person (chosen by the patient) is not
appointed unless, and until, the formal assessment
stage is reached. The current law allows the nearest
relative to take steps to discharge a patient
under compulsion. Under the Draft Mental Health Bill
this provision will disappear.
6. Advanced agreements
People tell us that one of the most helpful ways
to give a person some control over
what happens to him or her in a crisis is to participate
fully in treatment decisions and , in particular,
decide in advance what should happen in a crisis.
This can be achieved with an advance directive,
which is a statement of wishes and instructions for
what should and should not happen, at a time
when the person is not well enough to express their
wishes and make decisions for themselves.
In particular, it would include what treatment should
and should not be given.
Legally, a statement of the treatment that should
not be given must be followed in most
circumstances. But this right will be taken away
under the Draft Mental Health Bill once a person
is put under compulsion.
An important study has shown that use of advance
decision making by established service
users, in cooperation with the clinical team, cut
compulsory admissions for patients with severe
mental illness over a 2 year period.
7. A right to aftercare
Many people who are detained in hospital could be
given leave or discharged, if suitable
social care arrangements were in place. Good clinical
practice arrangements were in place.
Good clinical practice includes securing care services
to support discharge from hospital as soon as
possible.
The Draft Mental Health Bill allows for a further
compulsory hospital treatment order to be made in
some circumstances when care service provision is
not ready. This will help disguise the lack of
services that prevent further admissions. It will
also result in unjustifiable compulsory detention just because
services are not being provided.
Under the present law, there is a right to free aftercare
services for people that have been in hospital
under compulsory powers. This includes housing, as
well as community care services.
Someone trying to rebuild their life may need several
months or even a year or two in special,
supported living arrangements before moving on to
independent accommodation. Under the Bill, the
right to free aftercare is restricted to just six
weeks.
The accommodation that would be covered by the new
arrangements is further limited. Six weeks is a negligible period
of time for the type of adjustment that many long term inpatients
must make on discharge. It is an arbitrary period and takes important
judgements away from service users and those planning their social
care.
These proposals run contrary to the good practice
that the Government claims the Draft
Mental Health Bill supports: continuous, holistic
care designed to prevent admissions to
hospital.
8.The tribunal system
At present a person can be discharged from compulsion
by the Responsible Medical Officer
(clinician in charge) or by their nearest relative
or by the Mental Health Tribunal. Under the
proposed system, the new Mental Health Tribunal will
have greater say in when and whether a
person can be discharged We are aware that, at present,
there can be real delays with getting a
hearing at tribunal. We think the Committee should
be aware of this and of the distress this
causes to patients.
9.ECT
The proposed Bill is much better in part than the
current law on ECT. It will not be possible to give ECT to
a person with capacity to consent unless they do
consent.
However the new law does allow ECT to be given against
a person's consent in an emergency.
We believe ECT must never be given to a person who
has the capacity to make his or her own decisions about this controversial
treatment.
10. Police Powers
The police will have extra powers under this Bill
to enter private premises without a warrant
in an emergency where it is believed there is someone
in urgent need of treatment. We believe this
is an unnecessary extension to police powers. Police
will retain the right to take people to a place of
safety and this will continue to include police cells.
Without doubt the Draft Mental Health Bill flies
in the face of recent government policy on social inclusion; anti-
stigma and discrimination, choosing health, the expert patient
programme and
'Recovery; the over pinning vision for the
future of Mental Health Services'
National Institute for Mental Health in England;
NIMHE strategic objective 2003-06
We feel the Draft Mental Health Bill would be
enormously improved if:
1.The Scrutiny committee review the evidence for
Recovery (oriented services and practices are well advanced in
the US and New Zealand) and how Recovery research and practice
must change the paradigm for our field ; including the role of
people with direct experience of mental illness services, service
providers (Expert by Experience governed services), policy makers,
paid and unpaid workers; family, friends and community; and implications
for ongoing development of Recovery oriented systems;
Allott, P, NIMHE Fellow for Recovery et al 'Discovering
Hope For Recovery From A British Perspective: A Review Of A Selection
Of Recovery Literature, Implications For Practice And Systems
Change.
(Copy attached).
In the NIMHE statement on Recovery; Recovery is defined
to include the following meanings:
A state of wellness (eg. following an episode of
depression)
Achievement of a quality of life acceptable to the
person (eg. following an episode of psychosis)
A process or period of Recovering (eg. following
trauma)
Guiding principles which form the basis for the development
of the Recovery process include:
The user of services decides if and when to begin
the recovery process and directs it; therefore service user direction
is essential throughout the process.
The mental illness system must be aware of its tendency
to promote service user dependency
Recovery from mental illness is most effective when
a healing holistic approach is considered
Clinicians and practitioners initial emphasis on
'hope' and the ability to develop trusting relationships influences
the recovery of users of services
People with direct experience of mental illness services
should have the choice of developing a recovery self management
or wellness recovery action plan. This plan focuses on wellness,
the treatments and supports that will facilitate recovery and
the resources that will support the recovery process
Community involvement as defined by the user of service
is central to the recovery process and all
It is argued we do not have mental health services
in this country we have 'mental illness' services with a total
emphasis upon illness, vulnerabilities, risk and coercion; rather
than wellness; individual strengths; potential and self agency.
Additionally the work of NIMHE on values in mental
health care and what is of value to people is guided by three
principles of values - based practice:
'Recognition of the role of values alongside evidence
in all areas of mental health policy and practice
Commitment to raising awareness of the values involved
in different contexts, the role/s they play and their impact on
practice in mental health
Respect for diversity of values and will support
ways of working with such diversity that makes the principle of
self agency a unifying focus for practice.
Respect for diversity in mental health is also
Dynamic - it is open and responsive to change
Reflective - it combines self- management with positive
self - regard
Balanced - it emphasizes positive as well as negative
values
Relational - it puts positive working relationships
supported by good communication skills at the heart of practice'
Ref: Emerging best practices in Mental Health Recovery:
Poster and companion PDF file:
Approved by NIMHE 2004: Principal Editor: Allott,
P et al.
2. We must be cautious of pandering to the myths
of the gutter press 'all people with mental illness present a
risk to the public' and invest resources in Recovery and self
management approaches to mental illness which give hope for a
future, and build on the strengths, self responsibility, self
agency; human rights and resilience of people to self manage their
condition across shared care services. This cannot be achieved
without the support of mental health services, friends, family
and independent mental health advocates; at each and every stage
of the Recovery journey.
WRAP presents a system developed and used successfully
by people with a variety of emotional (and physical) symptoms.
It has helped them to use self management skills more easily to
monitor their symptoms, decrease the severity and frequency of
symptoms, and improve the quality of their lives. Through developing
activities for everyday well being; tracking triggering events
and early warning signs; preparing
personal responses if symptoms increase and creating
a plan for supporters to care for you if necessary.
The enthusiasm for this program continues to be overwhelmingly
positive. People across the world
are reporting that by developing and using this simple
planning process, they are achieving ;
in collaboration with supporters ; family, friends
and mental health professionals; levels of wellness
that they had never dared dream of.
3. Further we feel attention needs to be given to
the 'distribution of wealth' within mental illness services; with
a disproportionate amount of total spend on specialist mental
illness trusts; to the detriment of; voluntary (some) and
expert by experience governed services and importantly independent
mental health advocacy services.
4. The proposed new law makes compulsion more likely
to happen than under the current law. Compulsion in the home is
disruptive and can interfere with people's domestic lives, denying
them the human right to privacy and family life; and denying their
children; dependents; family and friends the human right to privacy
and family life.
To scapegoat the one in four people in this country
who will at some point in their lives, experience mental distress
(a quarter of the population) will not lead us toward the Recovery
of individuals, organizations and communities; inclusion, human
rights, expert patients and choosing health. Further there are
enough powers within the 1983 mental health act. There is no need
for an extension of statutory / police powers.
Further seemingly there is almost an inverse
correlation between 'as some may say' lack of competence of the
specialist mental illness trust's and levels of coercion for the
recipients of that very same system.
What we need is support proportionate to the needs
of individuals; including a decent, safe place to live; and drug
treatments free from hideous side effects; and staff (and services)
who are measured on their level of helpfulness and not just upon
'credentials'.
Currently there is a gap between the vision for the
Future of mental health services and our reality. The whole idea
of a vision is to pull us into the future. Implications for a
Recovery vision at a systems level will require belief in and
strong commitment to Recovery and the capacity to support Recovery
orientated ways of working within an environment (human and financial)
which enables Recovery.
5. With support (from the outset and throughout)
from the Fellow for Recovery NIMHE 02 to date; Sefton Recovery
Group in successful cross platform collaboration with Southport
College of Further Education and Seaforth Adult Education Centre
have provided Wellness Toolbox sessions as part of our developing
borough wide WRAP program. We have and continue to educate our
local specialist mental health trust; PCT and community groups
in the Recovery of individuals, organizations and communities;
in 2003 we gained local agreement WRAP run alongside Effective
Care Co-ordination. Recently our Local Implementation team signed
up to Recovery the vision for the future of mental health services
and
we are now working to gain agreement for a total
Recovery focus through our Local Strategic Partnership.
In concluding, public opinion shapes government policy.
We feel you would be receiving many more letters of the same;
if the 1 in 4 people (their family and friends) who may directly
be affected by these proposals were aware of this Draft Mental
Health Bill. We feel this Bill is nothing more or less than a
knee jerk reaction to the 'gutter press' as well as others .Additionally
this is clearly the backdoor in as far as treating people ; with
a deemed mental illness on the 'cheap' and sadly 'nasty'.
Yours sincerely,
Name: Karen Colligan for
and on behalf of Sefton Recovery Group
Address: Sefton Recovery
Group c/o First Floor, Burlington House, Crosby Road North,
Waterloo, Liverpool; L22OQB
E Mail: Recovemast@aol.com
Telephone Number: 0151-920-3356
Mobile: 07736-958526
Sefton Recovery Group have over 300 members
from across Sefton who have self selected to join our network
Additional, background papers were also supplied
- but not circulated owing to the number of pages involved. These
are available to members; please ask your Committee Assistant
for copies if required.
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