DMH 328 Unison
UNISON HEALTH SUBMISSION TO THE DRAFT MENTAL
HEALTH BILL 2004
1. Introduction: -
1.1 UNISON is the largest trade union in the UK,
with 1.3 million members. We have 450,000 members working within
the health service and across the whole range of Mental Health
Care provision. We have been instrumental in helping to develop
health policy and we are pleased that the Government have listened
to the concerns expressed in our earlier evidence on this issue.
1.2 We have sought to work in partnership with a
number of other organisations in sharing views and concerns relating
to the current proposals. UNISON has had information on the bill
available on our web site, we have worked with a number of senior
mental health nursing practitioners and mental health social worker
within UNISON to formulate this response. We will continue our
consultative work, throughout the political process to ensure
that all of our member's views can be fully taken into account
in developing a comprehensive response across our full membership.
It would be our intension to submit further evidence and information
during this time, as there has not been sufficient time over this
period to ensure that our initial submission comprehensively reflects
the views of our whole organisation and across our multidisciplinary
membership. It is our intension to submit further evidence on
the role of approved social workers, and the civil rights of individuals.
1.3 In the main this submission currently reflects
the views of our nursing membership, we would wish to consult
more extensively within our health and social care services to
ensure that the Mental Health Bill becomes an effective bill capable
of delivering comprehensive care across the health and social
care spectrum, in addition that it maintains attains the principal
of patient centred care and where appropriate offers patient choice.
1.4.1 Mental Health organisations have over the last
24 months come under the most public scrutiny from the media and
subsequently public. We are concerned that some of the sensational
media has in some ways helped to stereotype the perception of
Mental Health Service users being violent when in effect this
is far from the truth. We have concerns that the effect of this
may deter some individuals from seeking assistance when needed;
the result of this could be the presentation of a more critical
episode than was necessary.
1.5 As a member of the Mental Health Alliance, we
support many of the recommendations outlined in the joint submission.
2. The Government's Strategy for Mental Health
2.1 We recognise and value the additional funding,
which is being given to Mental Health Services, in addition we
are supportive of new initiatives such as assertive out reach
services, home treatment and early intervention teams. However
we are concerned that the targets expected by NHS organisations
in achieving these objectives, have on occasions been at the expense
of other aspects of the day-to-day service. Whilst we recognise
the need to achieve change, we firmly believe that this should
not be at the expense of other aspects of service provision we
will only achieve Mental Health Services fit for the 21st
Century when change is an organic process. The new initiatives
will help to achieve this, however all aspects of Mental Health
currently need to be a priority.
3. How has reform of the legislation been developed?
3.1 We want to recognise the partnership approach
that Government has taken to develop this package, we acknowledge
that the road has been long and our journey still continues, however
patient involvement is fundamental to achieving new legislation
- as it has to work for them. We will continue to work with all
parties and stakeholders to ensure that UNISON's views and values
of services with Mental Health are taken forward in this process.
4. The Size of the problem
4.1 Mental Health problems are more common than asthma.
Up to one in six people suffer from them over the course of their
lifetime, while 630,000 people have severe mental health problems
at any one time from schizophrenia to deep depression. Beyond
this, mental health has a far wider impact on families: there
are over 1.5 million carers supporting people with mental health
problems. People do not experience mental health problems in
isolation; in particular severe mental illness is frequently linked
to poverty, discrimination and other complex needs. Within this
group are also health workers, who also suffer from depression,
which often goes unrecognised.
5. Is the definition of Mental Disorder appropriate
and unambiguous?
5.1 We believe that there needs to be a broad definition
of mental disorder and therefore welcome this approach, however
we are concerned that the act may have a negative impact on individuals
with learning disabilities and believe that an option may be to
consider clear boundaries and possible exclusions. We would welcome
the opportunity to look at other examples, which may help to protect
this often vulnerable group.
5.2 We support the MHA recommendation of on the definition
of mental disorder 1C and 2.
6. Are the conditions for the treatment and care
under compulsion sufficiently stringent?
6.1 Whilst we welcome many aspects of the new bill,
we would ask that the Government give further consideration to
some aspects of the Scottish bill. Whilst we support the need
for English legislation, we have some concerns that a lack of
continuity in its approach may not be in the public's interest.
7. Are the provisions for the assessment and
treatment in the community adequate and sufficient?
7.1 We believe that there is merit in further work
being undertaken looking at this aspect of care. It is a new
concept and its important that it has the full support of service
users. It is our view that for some patients this may be the
best option, especially for those with children for whom separation
could have a detrimental effect on their condition and relationship.
However we would wish to give further consideration to this aspect,
we do not believe that there has been sufficient time to currently
do this and would welcome the opportunity to discuss this further
with Government and Policy advisors.
8. Does the draft bill achieve the right balance
between protecting the personal and human rights of the mentally
ill v's public and personal safety?
8.1 Clearly public protection is vital
and we would support many aspects contained within the bill.
However there is a difficult balance to be stuck to ensure that
the introduction of such a clause does not inadvertently continue
the negative stereotype those with a mental health illness.
8.2 We would again welcome the opportunity to discuss
this further, we believe that the bill goes along way to achieving
this goal but needs some safe guards to also protect those with
mental health illness.
8.3 There is not doubt that for high risk offenders
the judicial system may be the most appropriate, however for others
it will not, this coupled with issues within the prison system
regarding care of mental health patients means that the bill needs
to effectively achieve this balance, currently we are concerned
that it may not.
9. Approved Mental Health Professional
9.1 We will submit further evidence regarding this
role, we welcome the further amendments, which have taken into
account earlier concerns expressed by UNISON. However we recognise
the importance of the continued role that approved social workers
will play. Some of our nursing members expressed concern that
such a role could lead to a conflict of interests and effect detrimentally
their therapeutic relationship. Whilst others recognised that
this offered advance practise for many nurses within Mental Health
settings. We believe that this accurately reflects many of the
fears of Mental Health nurses, we would again welcome the opportunity
to have further discussions with Government regarding this aspect
of the bill.
10. Is the proposed institutional framework appropriate
and sufficient for the enforcement of measures contained in the
draft bill?
10.1 UNISON broadly welcomes many aspects
of the bill, we do also however support the Mental Health Alliance's
recommendation on the composition of tribunals.
10.2 We also welcome the provision for advocates,
the ability to appoint a nominated person, the single assessment
process for civil patients, the ability to appoint a nominated
person, the improvements to treatment safeguards for patients
undergoing ECT, the special provisions for children and young
people, the enhanced powers in the criminal courts to acquire
mental health reports and the duty to consult the patient where
appropriate.
11. Are the safeguards in respect
of particularly vulnerable groups, for example children sufficient?
11.1 We genuinely welcome the revisions to the draft
bill, in addition welcome the publication of the children's national
service framework and every child matters. Currently we believe
that there is insufficient environments to care for children will
a mental illness in 2002/03, 213 under 18's were placed on an
adult mental health ward. We believe that urgent work needs to
be done to tackle the specific needs of children with mental health
illness, in addition the support that children who are caring
for parents will a mental illness need. We would ask that Government
prioritise this work and try to implement their vision for children
as soon as possible.
12. Are there enough safeguards against misuse
of aggressive procedures such as ECT and psychosurgery?
12.1 We feel that the safeguards surrounding psychosurgery
are sufficiently covered in the act.
12.2 Our concerns surrounding ECT are sufficient
covered by the recommendations outlined by the MHA. We support
the need to obtain informed consent from service users with capacity,
we firmly believe that this builds on the change that the Government
have sought to improve on consent following the public out cry
of the inquiries in to Bristol and Alderhey.
12.3 We also strongly support the emergency criteria
outlined in the MHA for ECT that it should be restricted to preserving
life - where an individual does not have the capacity to consent.
12.4 We also support the involvement of the advocate
where this aspect of treatment is being considered.
13. Is the balance struck between what has been
included on the face of the draft bill and what goes into regulations
and the code of practices right?
13.1 We would recommend that there is a need to review
the code of practice that it needs to be able to be organic and
respond to changing needs, however we believe that where this
is necessary it should be subject to a consultative process.
14. In relation to questions 8 and 9 asked by
the scrutiny committee we would wish to submit further evidence
during the parliamentary process.
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