DMH 225 SOUTH EAST ADVOCACY PROJECTS SEAP
28 October 2004
Re: Mental Health Bill 2004
Mental Health Advocacy, My Choice, Xpress
Advocacy Service and ICAS are all projects working to the executive
committee of SEAP (South East Advocacy Projects), a registered
charity No1080679. SEAP provides advocacy and related services
to a wide range of client groups across the South East including:
- Adults with mental health issues
- Children and young people who are
Looked After, left care, have a physical or learning disability
or who have a mental health difficulty
- Adults with learning difficulties
- Anyone
wishing to make a complaint about their NHS healthcare
Due to the time constraints regarding
the consultation period of the Bill we have been limited to responding
jointly on the following themes;
Definition
The definition of mental disorder -
'an impairment of or a disturbance on the functioning of the mind
or brain resulting from any disability or disorder of the mind
or brain.'
The definition needs to be set against
the conditions for compulsion. The conditions include the treatment
of the 'dangerous patient'; the distinction between the adult/young
person's, 'dangerous patient' and
' best interest' may be lost by the
general public. Because of the definition being so broad and the
widening of treatment being both hospital and community based
more young people could fall within the scope of compulsion under
this bill.
Consent to treatment
For 16 -17 year olds the Bill gives
the same rights as to adults they can consent and also refuse
treatment as adults.
Under 16 years a child or young person
can only be treated if parental consent is given, this can also
be obtained from any one who holds parental responsibility for
the maximum of 28 days, thereon after treatment can only be authorised
by a Mental Health Tribunal. Disputes between parents and children
regarding consent be should the Tribunals responsibility to resolve
this should help to eliminate all forms of abusive form parents
and act as another safeguard.
YOUNG PEOPLE
Under 16's have Children / young people
have the right to refuse physical treatment - Gillick there is
no reference to this = level of understanding and consequences.
Children Act give the right of assessment regarding social need
therefore this should be taken into consideration when assessing
children and young people. If Children and young people are detained
under the MH Act what happens to their education?
All professionals working with children
/ young people must be subject to CRB checks and should be children
/ young people specialist this should also include the specialist
advocate
Where children and young people have
special requirements eg, language needs, learning disabilities,
or physical disabilities; professionals should have access to
specialist skills /tools
Where the MHT is refusing children /
young peoples wishes, there must be a rationale for the decision
that is acceptable to the patient.
Concerns that young people will feel
deterred from seeking help re:- depression, suicide, bullying
and sexuality; they may feel due to the breath of he definition
they will be held under the new Act and forced to take medication
and could be detained indefinitely.
Presently although there are no dictates surrounding
advocacy provision, it is seen as good practise, therefore many
advocacy services are presently being supported by statutory funders.
Within the advocacy advisement in the new bill there are allocations
for 140 full time advocacy positions, but the funding will not
be ring fenced. The possible outcome of this is that statutory
funders will only see the importance of funding advocacy provision
as outlined under the new bill. The new bill indicates that advocacy
should be provided for those seen as most vulnerable, these being
sectioned patients and their carers. Presently a very large proportion
of our work is with voluntary / informal patients and those being
supported in the community. If we were to lose funding for our
support of those individuals it would be a terrible loss for the
advocacy providers as well as the individuals we serve. We see
this as an unwitting side effect of the present draft bill.
We understand that the study undertaken by Di Barnes
at the University of Bristol and sponsored by the Dept of Health
was foundational in drafting the recommendations for advocacy
within the bill. South East Advocacy Projects consists of four
individual specialist advocacy services, and is a major advocacy
provider within the South East.
Over a year ago we took the time to attempt to comment
on the study and were told that comments were not being accepted
at that time. A major concern for us around the study is that
it presents one view and is not representative of the views or
practise of all advocacy providers.
Because advocacy is by its very nature a user led
and empowered process and service, it will obviously differ greatly
in its practise and implementation dependant upon clientele and
their needs and wishes.
To formulate advocacy provision definitively we see
as being quite problematic. We as a service see all our clients
whether sectioned or informal as being equally vulnerable and
any precepts that limit our service provision to this very vulnerable
group of people would be quite tragic. We would urge you as
policymakers to take another look at this section and possibly
to consider consultation with a wider cross section of advocacy
providers and service users.
We also would ask that you consider ring fencing
the financing allocated for the provision of advocacy services.
Children and young people will have the right to
an authorised Nominated person of their choice providing the person
is suitable, they will also have the right to a specialist advocate
and to challenge their treatment through the Mental Health Tribunal
in the first 28 days, only once this seems extremely restrictive
It seems that the advocate and or the Nominated person was appointed
at the initial stage.
We also see it as a conflict of interest for Specialist
Mental Health Act advocates to be acting as supports for both
service users and their nominated persons. We do not deny that
nominated persons may well need advocacy support but we do feel
that it should clearly be a separate support.
- APPROVED MENTAL HEALTH ACT PRACTITIONER
The loss of the Approved Social Worker role will
have a major impact on those individuals experiencing mental health
difficulties, as well as people with learning difficulties, children
and young people. It could potentially mean a totally medical
assessment team and seems at odds with the accepted good practise
of a medical/ social balanced approach to care.
We as an organisation are very pleased at the elements
of the bill that address patient choice and allow for more support
within a community setting but would like to voice our concerns
over the above issues in the present draft.
Yours Sincerely
Ros Starling - County Manager Xpress Advocacy Service
Trudi Allen - County Manager My Choice Advocacy
Service
Annie Flores- County Manager Mental Health Advocacy
Service
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