DMH 100 Memorandum from the Welsh Nursing
and Midwifery Committee
Memorandum
from the Welsh Nursing and Midwifery Committee
PWYLLGOR
NYRSUS A BYDWRAGEDD CYMRU
Thank you for the opportunity to
comment on the revised draft Mental Health Bill. This response
will largely address itself to the broad issues relating to nursing
workforce planning, and the practicalities of implementing the
Bill, if enacted in Wales. We would bring to the Scrutiny Committee's
attention the responses from the Welsh nursing advisory groups
on Adult Mental Health Nursing, Child and Adolescent Mental Health
Nursing and Learning Disabilities Nursing.
1. About the Welsh
Nursing and Midwifery Committee (WNMC).
The WNMC is the statutory independent
advisory committee to the Welsh Assembly Government on professional
issues relating to Nursing, Midwifery and Health Visiting practice.
The scope of the WNMC includes advice relating to workforce planning,
the contribution of these professions to service delivery and
the professional development required to deliver an effective
health service.
2. Summary of this
response.
The WNMC acknowledges the efforts
made to update Mental Health Act legislation, and the responses
to the initial consultation to the 2002 draft. Nevertheless areas
of concern remain in relation to:
- The capacity of mental
health services in Wales to deliver the requirements of the Act,
and the effect this will have on assessment and treatment services.
- The lack of detail
regarding the 'yet to be drafted' regulations and Code of Practice.
- A focus on compulsion
rather than entitlements to assessment and treatment.
- The removal of the
need for two agencies to be represented in the 'initial examination
process'.
- The removal of some
existing rights for carers.
- The possibility that
groups currently excluded from Mental Health Act provisions will
be included under the current Bill, if enacted.
- The erosion of some
rights and protections available under the current Act.
3. Welsh Policy and
Resources to Implement the Act in Wales.
The WNMC is concerned that the Westminster
Government has tasked the Department of Health (DoH), which has
no responsibility for the NHS in Wales, with developing this Bill.
This is not to suggest that colleagues in the DoH would discriminate
against Wales, but to recognise that there are no systems in place
to enable the DoH to take into account the circumstances and resources
of Mental Health Services in Wales. These systems reside within
the National Assembly for Wales.
The Commission for Health Improvement
has raised concerns about the level of development of mental health
services in Wales: ten years behind England in the implementation
of the Care Programme Approach, and still largely reliant on Victorian
institutions as the 'hub' of care delivery. Very few resources
have been released to support the Welsh Adult Mental Health and
Child and Adolescent Mental Health Strategies and there are no
published plans from the Welsh Assembly Government to do so. The
Adult Mental Health National Service Framework has hardly been
implemented, and there are acute shortages of psychiatrists, mental
health nurses, and other key mental health professionals in Wales.
It is the view of the WNMC that the
calculations given in the Bill regarding the increased workforce
that will be required to implement the Bill are over-optimistic,
and fail to take into account the situation in Wales. Issues of
rurality are an important issue; NHS trusts serving rural communities
are finding it increasingly difficult to recruit appropriately
qualified and experienced mental health professionals. The implementation
of this Bill in Wales will require resources to be reinvested
into managing legal processes, and away from assessment and treatment
services.
The WNMC keenly awaits the proposals
from the National Assembly for Wales of the development of the
Code of Practice under the Act. As the implementation of the Act
depends on the availability of the Code of Practice, we would
also like to know the implications of the Code being available
in England or Wales before the other country's Code is ready.
4. The Effect of the
Act on the Role of Nurses
In general, nurses have more contact
with their patients than any other mental health professional.
The therapeutic relationship between nurses and their patients
is at the heart of clinical practice, and relies on collaboration
rather than compulsion. The WNMC believes that the most effective
way of working with patients is to offer early engagement and
treatment, often at the point where the patient is actively seeking
help. The WNMC is concerned that the adoption of the role of the
Approved Mental Health Professional (AMHP) by nurses may jeopardise
this therapeutic relationship. The WNMC supports a multi-disciplinary
approach to decision making, however there is not yet enough detail
available from the Welsh Assembly Government regarding how the
role of AMHP will be developed to comment further on this. Of
particular concern is the impact on Services created by the removal
of Mental Health Nurses from their therapeutic role for training
as AMHPs.
The WNMC recognises, and welcomes,
the requirement in the Bill for a non-medical view to be considered
in the initial examination process. We also recognise that the
training and approval of the AMHP by Local Authorities is an attempt
to retain the independence of the AMHP currently held by the Approved
Social Worker. Nevertheless, the WNMC views the possibility that
under the new Act that both the medical staff and the AMHP undertaking
the initial assessment may be employed by the same organisation,
as an erosion of the protections provided by the present Act.
5. The Basic Principles
of the Bill
The WNMC welcomes the review of
the existing Mental Health legislation and we believe that the
new Bill positively addresses some issues relating to patient
choice and protections that are not provided for under the 1983
Act. We also welcome the revisions and strengthening of protection
of parts of the Bill, in response to the consultation to the 2002
draft.
The WNMC would echo the concerns
raised by organisations representing patients that very often
patients seeking help in the initial stages of their mental health
difficulties fail to receive it. There is scope to incorporate
into the Bill rights to earlier treatment, which would help to
balance the focus of the Bill and would help to create a more
clinically and cost effective service.
6. Definition of Mental Disorder
The WNMC suggests that the removal
of existing exclusions contained in the new Bill is an erosion
of the public's protection, and may not be compatible with the
Human Rights Act. The removal of these exclusions effectively
broadens the grounds for compulsion. This coupled with the removal
of the 'treatability' provision in relation to mental impairment
or psychopathic disorder may lead to a significant increase in
the number of people who are made subject to formal powers. If
'treatment' continues to be construed as widely as under present
legislation, than we believe that concerns about the proposed
powers constituting a form of 'preventive detention' may be justified.
7. Remaining Areas of Concern
The WNMC is concerned that the
fact that anyone could request that somebody be examined with
a view to the use of formal powers would appear to open the door
to malicious or excessive requests and unwarranted intrusions.
The WNMC is concerned that there
remains scope in the new Bill for Tribunals to be heard by just
one person.
The WNMC view the removal of the
powers of the Hospital Managers and the 'nearest relative' to
discharge a patient to be an erosion of protections provided in
the current Act.
The WNMC is concerned about the
use of Non Resident Orders (NROs). There appears to be no evidence
from research studies that compulsion in the community improves
outcomes for patients. Of further concern is the possibility that
NROs could drive individuals away from the services that they
need.
The WNMC believe that there is still
much detail missing from the current Bill, particularly those
areas which will be the responsibility of the Welsh Assembly Government
and have not yet been drafted.
Andrew Cresswell
Acting Chairman Welsh
Nursing and Midwifery Committee October
2004
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