DMH 242 Alzheimer's Society
Memorandum
| To: | Joint Committee on the Draft Mental Health Bill
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| From: | Alzheimer's Society |
| Date: | 21 October 2004 |
DRAFT MENTAL HEALTH BILL
Introduction
The Alzheimer's Society is the UK's leading care and research
charity for people with dementia, their families and carers.
Dementia affects over 750,000 people in the UK alone. The Alzheimer's
Society has over 25,000 members and works through a network of
over 250 branches and support groups. It provides information
and support for people with any form of dementia and their carers
through its publications, helplines, website and local network.
It advises professionals, runs quality care services and campaigns
for improved health and social care and greater public understanding
of dementia. The Society funds an innovative programme of biomedical
and social research in the areas of cause, cure and care.
The Society has concerns about the proposed Mental Health Bill
that relate to the lack of safeguards for people with dementia
who are informally detained. We do not believe the provisions
of the Mental Capacity Bill are sufficient to close the gaps left
by the Mental Health Bill.
Are people with dementia affected by the Bill?
There are thousands of people with dementia detained informally
in care homes and in hospital. In many cases people with dementia
are detained informally because they do not have the capacity
to give consent, but do not resist treatment or detention so are
not sectioned under the Mental Health Act.
There are also a number of people with dementia are detained against
their will without being sectioned. These include people who are
in locked wards and care homes.
There are also a small but significant number of people with dementia
who lack capacity and are detained compulsorily. The review of
research relating to the Mental Health Act (1983) found that of
people over 65 who are sectioned, up to 48 per cent had a diagnosis
of dementia.
All groups require adequate safeguards that protect them from
abuse and bad practice.
Lack for safeguards for those detained informally
The Mental Health Bill does not provide safeguards for people
with dementia detained informally. As the Bill stands they have
no right to assessment or a care plan, and no right to ask for
a review of treatment or to challenge detention. This lack of
protection was highlighted by the recent ruling on the Bournewood
case which concluded that the informal detention of HL was a breach
of his human rights.
People with dementia are particularly vulnerable to abuse. This
could include physical, psychological, financial or sexual abuse
and neglect. In addition, the care provided to people with dementia
is frequently of a poor standard, often due to the lack of staff
trained in caring for people with dementia. The Society estimates
that, even though three quarters of people in care homes have
some form of dementia, only 10 per cent of care home staff are
trained in working with people with dementia. The inadequate care
experienced by people with dementia highlights the importance
of adequate safeguards and the right to contest poor care practices.
Of particular concern to the Alzheimer's Society is the frequent
overprescription of neuroleptic drugs experienced by people with
dementia. These drugs are often used to deal with behavioural
symptoms of dementia, rather than attempting to investigate and
understand the cause of the behaviour. They are often prescribed
over long periods of time with no review of their use. If the
Bill provided the same kinds of safeguards to people detained
informally as for those who are sectioned, people with dementia
would be entitled to have their treatment reviewed. This would
help to guard against unacceptable practices such as overuse of
neuroleptics.
The safeguards contained in the Draft Mental Health Bill 2002
for people detained informally were helpful, but whether a person
was protected by them depended on setting rather than the needs
of the individual. The safeguards did not apply to people with
dementia detained informally within a residential home. While
it may appear that residents in nursing homes are more likely
to have high needs and require protection from safeguards, high
proportions of older people living in residential homes also have
dementia and therefore require the protection of these types of
safeguards.
The Society believes that all people with dementia should have
the right to a care plan and a review of that care plan within
a specified period of time. We know that while this is available
to some people, there are many whose care is not properly planned
or reviewed and so does not meet their needs. However, those people
with dementia who are detained informally within a care home,
and have not appointed an LPA, are a particularly vulnerable group
who are often subject to abuse and neglect. For this reason their
rights need to be protected by the same kinds of safeguards available
to those who have been compulsorily detained.
The Mental Capacity Bill
The Alzheimer's Society does not share the Government's confidence
that the Mental Capacity Bill will provide adequate protection
for people with dementia detained informally. While we welcome
many aspects of the Mental Capacity Bill, its provisions do not
match the safeguards provided by the Draft Mental Health Bill
2002. As the Mental Capacity Bill stands, it will not allow patients
detained informally the right to a tribunal, statutory care plan
or access to an advocate as the Draft Mental Health Bill 2002
would have. The independent consultees included in the Mental
Capacity Bill are likely to have a much more limited role than
an advocate and will only be available in a very limited number
of circumstances. These deficiencies make it more likely that
people with dementia are left in care homes or hospital without
properly planned and reviewed treatment and care and with no right
to appeal against poor care or abusive treatment.
However, we believe it is necessary to have a mental capacity
framework, provided by the Mental Capacity Bill, in place before
the Mental Health Bill is implemented. The Mental Capacity Bill's
general principles which include assuming that a person has capacity,
a requirement to act in the person without capacity's best interests
and attempting to maximise decision making, provide the basis
upon which the Mental Health Bill can operate in terms of people
who may not have capacity.
The Alzheimer's Society believes the government needs to consider
the gap in the protection of vulnerable groups created by the
inadequacies of the two bills and work to remove the disparity
in the safeguards provided to people detained formally and informally.
We would welcome clarification on whether decisions made by the
nominated person, as set out in the Mental Health Bill, will override
decisions contained within an advance directive, as set out by
the Mental Capacity Bill, should an individual be compulsorily
detained. This needs to be made clear if the legislation is to
work effectively.
Aftercare
The Society disagrees with the reduction of free, integrated health
and social care services for people who have been discharged from
compulsory hospital treatment to just six weeks. This period of
time will be inadequate for many people with dementia leaving
hospital following compulsory treatment. These individuals are
likely to have a high level of need and will require intensive
support from health and social services. This support is a health
need and should not therefore be means tested and should be available
for as long as is required by the individual.
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