DMH 251 Memoranda from Mind - Basildon
Memorandum of Evidence to the Joint Committee on the
Draft Mental Health Bill from Basildon Association for Mental
Health (Mind)
1. Introduction
1.1. I am secretary of the above association
and have been instructed by our Executive Committee to write to
the Joint Committee expressing our concerns about the proposed
provisions in the Draft Mental Health Bill. These are summarised
below. We wish this memorandum to be treated as evidence.
1.2. We are particularly concerned about
the following aspects of the Draft Bill.
i)
The basic right to services is not stated as a prime aim
of the Bill.
ii)
There is an increased use of compulsion.
iii)
The forced admission of patients not necessarily for their
own benefit.
iv)
Compulsion in the community where hospital treatment would
be more effective.
v)
Changes in procedures leading to compulsory treatment particularly
in relation to loss of early support from family, friends, carers
and advocates.
vi)
Removal of legal status of advance directives under new
proposals.
vii)
The restriction in availability of free housing and community
care post compulsory hospital care.
viii)
The proposed increased powers of the Mental Health Tribunals
will actually cause considerable delays in the discharge of patients
who are being treated compulsorily.
ix)
The new powers for Electroconvulsive Treatment to be given
without consent in an emergency.
x)
The new powers to be given to police to enter private premises
without a warrant.
2. Subject:
Lack of stated basic patient right to mental health services
2.1 If the government was serious about public safety and patients'
health they should do more to ensure that people get the care
and treatment they need when they need it.
2.2. This aim should be clearly stated in the Bill and should
be the primary aim of the Bill.
3. Subject:
The whole thrust of the Bill is towards the increased use of compulsion.
3.1. The Bill gives increased powers
to new Mental Health Tribunals when existing procedures work reasonably
well.
3.2. The areas of the Bill relating
to the new provisions should be reviewed in consultation with
representatives of mental health professionals and relevant voluntary
bodies representing service users.
2.
4. Subject: The particular emphasis in the Bill on the forcible
admission to hospital of people with mental health problems even
though the treatment or therapy offered might have no beneficial
effect on their health.
4.1 We feel that this emphasis has the effect of reinforcing public
prejudice against people with mental health problems; that it
will drive vulnerable people away from seeking help when they
need it; they are unnecessary as people working in clinical health
care currently can, and do, take action under exiting law to deal
with the situation once they are aware of a genuine risk of this
kind; and, lastly, powers sought do not address a more significant
problem: the denial of help to some perpetrators of violence who
are refused help prior to the crisis due to the lack of resources.
4.2. As in 3.2 above the relevant clauses should be reviewed in
consultation with representative of the people actually dealing
with such cases with a view to achieving a sensible workable legal
framework - that is one not driven by prejudice against the mentally
ill.
5. Subject: Compulsion in the community where hospital treatment
would be more effective.
5.1 Under this Bill patients may be put under compulsion in the
community rather than in hospital. Patients could be required
to take certain drugs, to stay in a certain place and to attend
certain clinics. It appears that once a patient is on such an
order it would be difficult to be discharged from it. Additionally,
it would be difficult to get a change of treatment regime if the
psychiatrist disagreed. Basildon Mind feel that if in a crisis
situation where compulsion is the only option people need to be
in hospital where there will be medical and nursing staff to monitor
the effect of medication and treat adverse reactions. 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.
5.2 The relevant clause should be amended or deleted to remove
this power.
6.Subject: Changes in procedure in relation to use of advocates
and nominated persons in proceedings leading to possible compulsory
treatment.
6.1 Basildon Mind believes that as soon as a person is deemed
to be in crisis and is put in hospital that person needs a friend
or advocate to explain what is happening, to negotiate with the
medical team and, if possible, get agreement to the course of
action that is best for the patient. Such a person should be someone
who is trusted by the patient and who knows them well. Under the
new Draft Bill such a nomination does not take place until the
later formal assessment stage of the procedure. Also, under the
new Bill, the right of the nearest relative to seek to have the
patient discharged while under compulsion will be lost. We feel
that it is essential the current right of a patient to have the
early support of family, friends, carers and advocates is essential.
We also feel the loss of the right for relatives to seek the release
of a patient is a retrograde step if the aim is improving the
care available to patients.
6.2 We feel that the relevant clause in the Draft Bill should
b deleted or amended
3.
7.Subject: The removal of the legal status of advance directives
under the new proposals.
7.1 Basildon Mind has always felt that the existing right of patients
to make advance directives as to their care in the event of their
being unable to express these wishes in time of crisis is an extremely
valuable one. Indeed, a recent study has shown that use of advance
directives in cooperation with the clinical team has cut compulsory
admissions over a two-year period. Under the new Draft Bill this
right will be lost when a person is put under compulsion. Basildon
Mind feels that the loss of this option will adversely affect
the rights of patients and will have deleterious clinical effects.
7.2 The Bill should contain clauses that will maintain the status
quo.
8. Subject: The proposed restriction in the availability of housing
and community care post compulsory hospital care.
8.1 We at Basildon Mind are seriously concerned at the proposed
powers under the Draft Bill for the extension of compulsory hospital
detention if suitable care service provision is not available.
We feel that this will disguise the lack of services which support
recovery and prevent further admissions. It will result in unjustifiable
continuation of compulsory detention just because services have
not been provided. Furthermore, the Bill restricts the right of
community care and housing after discharge to just six weeks.
In our view six weeks is a negligible period in which to allow
patients to adjust to life outside hospital particularly for those
patients who have been discharged after long-term hospital stays.
These proposals seem to run contrary to the Government's claim
that the Draft Mental Health Bill supports continuous, holistic
care designed to prevent admissions to hospital.
8.2. Basildon Mind feels that the relevant clauses in the Bill
should be amended or deleted.
9. Subject: The proposed increased powers of the new Mental Health
Tribunals will actually cause considerable delays in the discharge
of patients after compulsory treatment.
9.1 Under the present legislation a patient can be discharged
from compulsion by the Responsible Medical Officer, or by the
patient's nearest relative or by the Mental Health Review Tribunal.
Under the proposed legislation the Tribunal will have increased
powers in this area. We foresee that considerable delays will
occur under the new arrangements, as even now it is sometimes
difficult to arrange a hearing at a Tribunal. We feel the new
arrangements could add greatly to distress to patients while they
await discharge.
9.2 The relevant clauses in the Bill should be reviewed.
4.
10. Subject: The new powers under which Electroconvulsive Treatment
can be given without consent in an emergency.
10.1 While Basildon Mind does agree that the proposed Bill is
much better than the current law on Electroconvulsive Therapy
we are concerned that the new powers to give ECT to patients without
their consent in an emergency are excessive. We do not believe
that ECT should ever be given to patients without their consent.
10.2 The relevant clauses should be amended.
11. Subject: The new powers to be given to police to enter private
premises without a warrant.
11.1 We feel that there are sufficient existing powers available
to the police to deal with situations where they believe people
in private premises are in urgent need of treatment.
11.2. The relevant clause should be deleted from the Draft Bill.
Robert Currie,
Secretary, Basildon Association for Mental Health (Mind)
440-442 Whitmore Way,
Basildon,
Essex
SS14 2EZ
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