DMH 226 Memorandum from Malcolm Turner,
Chair Peterborough and Fenland Mind.
1 Introduction
1.1 Peterborough and Fenland Mind provides
a range of mental health services across Peterborough City, Fenland
DC and Cambridgeshire C.C. User involvement is central to our
mode of operation and we are therefore in a position to submit
this evidence to the joint committee about user concerns regarding
some of the current content of the Mental Health Bill.
1.2 The subjects that concern us are:-
- A right to access services
- Compulsion should be avoided if possible
- Advocacy
- Advance directives
- Aftercare and support services that are socially
inclusive
- Tribunals
- Police powers
2 Access to Services
2.1 A frequent concern expressed to us by
service users is that they often have difficulty in accessing
services when they are needed. People often know when they are
feeling unwell and in the absence of community based services
seek admission or support from ward based staff. This support
when not available then results in people continuing to get unwell
to the stage where crisis point is reached they are admitted compulsorily.
This is not helpful to people and is a poor use of resources.
2.2 The Care Programme Approach (CPA) has
been in place since 1991 but in many places is still not effective.
CPA could be a powerful tool in providing person centred care
that would improve outcomes for people, their carers and for staff.
2.3 Poor discharge arrangements and lack of
post discharge support does add to the revolving door syndrome.
3 Compulsion should be a last resort.
3.1 For many people hospital admission is
a very negative experience compulsion aggravates this negativity.
These proposals will increase the numbers of people subject
to compulsion. The accompanying process of tribunals etc will
divert resources from services into bureaucracy.
3.2 People with mental health problems suffer
discrimination more than any other group. Compulsion to receive
treatment when a person has mental capacity increases this level
of discrimination and further endorses public perceptions of dangerousness.
3.3 Many people have poor experiences of the
mental health service and avoid contact if they can. If compulsion
becomes easier they will again not want engagement.
3.4 Such people may often find it easier to
engage with voluntary sector services. The voluntary sector though
is usually under funded and finds difficulty in getting positive
support from clinical services.
3.5 People on a section already have difficulty
in getting properly discharged from hospital. If they are subject
to a community compulsion order how readily will they be discharged
from the order?
3.6 To what extent will being on a community
order prevent people from obtaining accommodation, employment,
bank account etc?
3.7 Compulsion is not something that affects
a person in isolation. It impacts on the whole of their life,
family, friends, employment, and accommodation. Viewing compulsion
from a clinical perspective alone may (and often does) have a
devastating effect on a persons life which for some is never recovered.
4 Advocacy
4.1 Advocacy services are currently under
provided and are limited in scope. The proposals in the bill
are broadly welcomed but access to an advocate should be made
available at the examination stage.
4.2 As above a paid carer or volunteer should
be available if the person so desires. It should also be recognised
that relatives do not always willing or able to represent the
clients best interest.
4.3 In current practice there are often tensions
between advocates and clinical staff with the latter being unwilling
to co-operate and to accept the involvement of advocates.
5 Advance Directives
5.1 As outlined in 2.1 above people know from
experience what works and what doesn't when they are or are becoming
ill. This may extend beyond treatment and may include arrangements
for finance, employment, pets etc. These may be of real concern
to a patient where compulsion is being considered and their satisfactory
resolution may help reduce the crisis. As individuals we are
usually happier when we feel in control of any situation advance
directives offer patients some of this control.
5.2 Advance directives are increasingly recognised
in other spheres and disability groups. There is an opportunity
for them to be enshrined in this piece of legislation.
6 Aftercare services
6.1 There is a need to ensure that people
receive necessary support and treatment after discharge. Current
local discharge arrangements are inadequate, there is limited
supported accommodation, CMHTs work from 9 - 5 Mon to Fri. Vocational
support and employment opportunities are also limited.
6.2 Given the paucity of limited community
based services it is inevitable that people who have been admitted
under compulsion remain in hospital for longer than is necessary.
This cannot be in any one's interest nor sit easily with civil
liberty.
6.3 The Office of the Deputy Prime Minister
recently published a report about social exclusion and mental
health. The new bill should take this as its underlying theme.
Treatment and compulsion should all be geared to helping people
remain in the community.
6.4 Too often at present people remain within
the mental health system for so long that they lose the social
and living skills. Inactivity on the wards creates dependency.
Maintaining a persons skills and independence while on the wards
would be a more effective approach.
7 Tribunals
7.1 The existing system of tribunals is time
and resource expensive. People often have difficulty in understanding
the system and there are long delays in getting a hearing.
7.2 The present levels of advocacy services
is inadequate and patients face delays in seeking advice.
7.3 The bills proposals will make this process
even more complex and also is weighted toward the system rather
than to the patient. People will remain in hospital for longer
than is necessary.
7.4 Most other parts of the NHS are trying
hard to reduce the length of time people stay in hospital and
there are rules and penalties for delayed discharges. This has
led to a number of initiatives that provide for community based
support services. Why should this not also be the case for the
Mental Health part of the NHS?
8 The Police
8.1 The police at present do have some difficulty
in operating within the present system. At a recent local incident
the police delayed becoming involved because a) they were not
aware that the person was on a section but on home leave and b)
were unsure that the location of the incident was in a public
place.
8.2 It does not seem to be necessary to extend
police powers but rather to improve joint training so as to improve
police awareness of mental health issues..
Malcolm Turner
Chair, Peterborough and Fenland Mind
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