Questions that need Answers
- How many sections occur in this country every week?
- How many more do the Police anticipate when the new Mental Health Bill is put into practice?
- Who is being sectioned where are the figures for Age groups? Children, Adults, Older People. Gender? Race?
- Where are the places of safety in this country based and are they manned 24/7?
- How many Health Authorities use Police Cells as places of safety?
- How many people die in custody on 136 sections?
- Where are people transferred to, Prison? Psychiatric Ward? Or released?
- What are the Polices feelings about the effect on their workload when the new Bill is introduced, there must be projection figures?
- Do the police have enough manpower to sustain the extra workload?
- How many people suffer physical injuries whilst being 136 sectioned?
- How long are people detained in police custody within the 72-hour period?
- How many are detained for longer than 72 hours due to psychiatric bed shortages?
- How many people are left in the community due to shortages of beds, manpower, etc and our these figures (waiting lists) known?
- What are the top 4 reasons for a person being in such a state that they need to be sectioned? (Domestic violence victim, breakdown, bereavement)?
- Is there greater clusters of sectioning in certain areas and why should this be?
- Are the criteria for sectioning in this country the same from county to county?
- If not who decides what criteria are implemented?
- Are any 136 sections carried out by the private sector/independent sector?
- What training have they received on Mental Health Issues?
- We ask these questions, as an understanding of these issues is crucial.
- All the Public need to be made aware of the 136 sectioning powers, and know that any citizen can have these measures used against them.
This section gives the police the power to remove someone who appears to be suffering from a mental disorder in a place accessible to the public, to a place of safety.
The person appears to be in immediate need of care and control and the police officer thinks it is necessary to do so in the persons interest or for the protection of others.
Police Custody as "a Place of Safety" Examining the use of Section 136 of the Mental Health Act 1983
Members of Parliament suffering from mental illness
141 -(1) Where a member of the House of Commons is authorised to be detained on the ground (however formulated) that he is suffering from mental illness, it shall be the duty of the court, authority or person on whose order or application, and of any registered medical practitioner upon whose recommendation or certificate, the detention was authorised, and of the person in charge of the hospital or other place in which the member is authorised to be detained, to notify the Speaker of the House of Commons that the detention has been authorised.
(2) Where the Speaker receives a notification under subsection (1) above, or is notified by two members of the House of Commons that they are credibly informed that such an authorisation has been given, the Speaker shall cause the member to whom the notification relates to be visited and examined by two registered medical practitioners appointed in accordance with subsection (3) below.
(3) The registered medical practitioners to be appointed for the purposes of subsection (2) above shall be appointed by the President of the Royal College of Psychiatrists and shall be practitioners appearing to the President to have special experience in the diagnosis or treatment of mental disorders.
(4) The registered medical practitioners appointed in accordance with subsection (3) above shall report to the Speaker whether the member is suffering from mental illness and is authorised to be detained as such.
(5) If the report is to the effect that the member is suffering from mental illness and authorised to be detained as aforesaid, the Speaker shall at the expiration of six months from the date of the report, if the House is then sitting, and otherwise as soon as may be after the House next sits, again cause the member to be visited and examined by two such registered medical practitioners as aforesaid, and the registered medical practitioners shall report as aforesaid.
(6) If the second report is that the member is suffering from mental illness and authorised to be detained as mentioned in subsection (4) above, the Speaker shall forthwith lay both reports before the House of Commons, and thereupon the seat of the member shall become vacant.
(7) Any sums required for the payment of fees and expenses to registered medical practitioners acting in relating to a member of the House of Commons under this shall be defrayed out of moneys provided by Parliament.
- This section allows the police accompanied by an approved social worker and a doctor to enter locked premises to remove someone who is known to be mentally ill.
- This is done by the Approved Social Worker seeking a warrant from a magistrates court.
If there is cause to suspect that a person is suffering from a mental disorder and has been ill-treated, neglected, or not kept under proper control; or is living alone and unable to care for themselves, then a warrant may be sought from the court.
- Admission for assessment of your mental health or, assessment followed by treatment.
- It may be for up to 28 days.
- It is not renewable.
The patient suffers from a mental disorder of a nature or degree which warrants such detention and that the patient should be detained for their own health or safety or the protection of others.
- Detention can be for up to six months. After the first six month period, it is renewable for another six months. It is then renewable for periods of one year.
- It is important to remember however, that the section does not have to run its full course and you may be discharged at any time.
The mental disorder is of a nature or degree, which makes the treatment of the patient in hospital more appropriate, and it is necessary in the interests the patient's health or safety or, for the protection of others that the patient should treatment in hospital.
For a patient suffering from a psychopathic disorder or mental impairment, there is an additional condition that medical treatment is likely to alleviate or prevent a deterioration in his/her condition.
SECTION 5 (2)
- This section applies to informal patients and can enable your detention for up to 72 hours.
- Its purpose is to give time to complete a section 2 or a section 3. This means that a second opinion doctor and a ASW should be called immediately.
- Leave cannot be granted under this section.
- No rights of appeal by the patient or the nearest relative on this order.
Can be applied to a mentally disordered person already receiving treatment in hospital as an informal patient who may wish to leave the hospital before there is time to complete a section 2 or 3 assessment.
Section 17 of the act allows for a period of leave from the ward.
- The section does not apply to sections 4, 5(2), 5(4), 135, 136 as they are short term emergency assessment detention orders.
- Your consultant can grant leave of absence for patients detained under sections 2, 3 and 37.
- If you are under sections 35, 36 and 38 then you will only be granted leave if you have the permission of the court.
- If you are under sections 37/41, 47/49 and 48/49 you will only be granted leave if you have the permission of the home office.
SECTION 25- Supervised Discharge
- Supervision of the after-care of detained patients once they have been discharged into the community, to ensure they are receiving the after care provided for by s117.
- Supervision is for sixth months, renewable initially for six months and then for periods of up to one year.
SECTION 117 - Aftercare
This section ensures aftercare following discharge from hospital. A Section 117 meeting will be held to discuss and arrange various aspects of the aftercare. For example:
- Any known Risk Factors
The Act was introduced in 1983 and is intended to help doctors deal with patients who may have psychiatric disorders. Under the Act patients can be sectioned, or detained, against their will.
What does 'being sectioned' mean?
The term being sectioned refers to the use of a part of the Mental Health Act to gain legal permission to give someone compulsory assessment or treatment for a mental health problem.
Who can be sectioned under the Act?
The power to admit someone compulsorily to hospital under the Mental Health Act is applied only to people experiencing severe mental distress who are posing a danger to either themselves or to someone else, and only if they are refusing to accept help and treatment.
People with different types of defined "mental disorder" can be admitted to hospital under the Act. These include those with "severe mental impairment", "psychopathic disorder" or "mental illness".
What happens during the sectioning process?
Generally, a patient can only be sectioned if two doctors and a social worker or a close relative of the patient believe it is necessary.
One of these doctors is usually a psychiatrist. The other is often a doctor who knows the patient well.
However, in an emergency one doctor's recommendation may be sufficient.
An approved social worker also has to be involved in the assessment, and has to agree that being sectioned is the best course of action for that patient. The social worker then makes the application for a place in secure accommodation for the patient.
How long can patients be detained?
If a patient is sectioned as an emergency case, then they are said to be detained under section 4 of the Mental Health Act. This enables doctors to detain them for up to 72 hours.
If doctors believe that further assessment or treatment is necessary then the patient can be detained under section 2 of the Act.
The most common civil sections of the Act under which patients are compulsorily admitted to a hospital are:
Section 2 - admission to hospital for up to 28 days for assessment
Section 3 - admission to hospital for up to six months for treatment
Section 4 - admission on an emergency basis for up to 72 hours.
How are patients released?
The patient themselves can appeal for release to the NHS trust which is detaining them. The "nearest relative" also has a right to "order the discharge" of a patient.
However, doctors can block this by producing evidence that the patient still represents a risk to the public or himself/herself. If this happens, the relative cannot try again for another six months.
What rights does the patient have during this time?
Some treatments can be given to people detained under various sections of the Act, even without their consent. This is possible if the treatment is believed absolutely necessary to prevent the patient's condition deteriorating while they are in hospital.
How often are these powers used?
Between 1989 and 1990, 16,300 were given compulsory treatment against their will. In 2000/2001, 26,707 were formally admitted against their will, in addition to 19,570 who went voluntarily to hospital in the first instance but who were then sectioned.
Memorandum from M Telfer (DMH 416)
Memorandum from Miranda Telfer (Morland) (DMH 416)
With regards to the Draft Mental Health Bill, I see the Police Federation, are not giving oral evidence to the Scrutiny Committee.
Surely it is vital that you hear from the Police, this Bill will have huge repercussions on them, and the Public.
An increase in the use of 136 sections will be inevitable. (This is of great concern to me having been 136 sectioned. My first and thankfully only encounter to an incredibly frightening system.)
Should this Bill go through far more resources are required. For instance I am aware that
cadets In West Kent are only given an hour and a half of diversity training. This is nowhere nearly sufficient, if this Bill goes through we must have an intensive training for not only cadets but for all our bobby's on the beat.
Are the Police preparing for the rise in 136 sectioning, and is it possible to track down the figures for these sort of detentions. I believe that they are held by the Home Office. This must have been researched, so could we get the prediction figures for the next few years? As we should be prepared for the true impact of this Bill.
Miranda Telfer (Morland) bruisedUK
Memorandum from the Independent Police Complaints Commission (DMH 206)
Memorandum from the Independent Police Complaints Commission (DMH 206)
1. The Independent Police Complaints Commission (IPCC) has been established under the Police Reform Act 2002 and assumed its statutory powers on 1 April 2004 when it replaced the Police Complaints Authority (PCA). The scope, powers and duties of the Commission differ significantly from those of the PCA and, with substantially greater resources available to us, the Commissioners and staff now operate from four regional offices covering England and Wales. We have investigative powers and staff employed as investigators which are already being used in a number of significant and high-profile investigations such as into police fatal shootings and deaths in custody. In addition, the Commission is required under the Police Reform Act to secure and maintain public confidence in the system of arrangements for dealing with public complaints against police and the investigation of police misconduct.
2. Accordingly, the Commission must be alive to issues that affect general policing and from our early experience the importance of mental health as an issue affecting policing has been widely noted. To reflect this the Commission has made this topic area one of its main priorities for policy development and inter-agency liaison and this topic is likely, also, to feature in the Research and Publications programme of the Commission during its initial years. We draw your attention to the research undertaken by the PCA prior to its abolition, which had begun consistently to draw attention to the presence of those with mental health problems amongst the "at risk" groups in contact with the police service whose behaviour and needs can present some of the greatest challenges. We wish to make the following observations upon the contents of the Government's Draft Mental Health Bill.
3. IMPACT OF NEW POWERS OF COMPULSION ON POLICE CONTACT WITH THE PUBLIC
In its philosophy and specific powers, the Mental Health Bill envisages the greater use of compulsory powers in relation to patients living in the community. Conventionally, compulsion in psychiatric treatment has been restricted to institutional care and nursing staff are neither trained for nor expect to use forcible treatment methods with regard to patients living in the community. Accordingly, the police only become drawn to assist in the apprehension and forcible conveyance of those subject to powers and requiring compulsory treatment in an institutional setting. Where the threshold for admission is serious mental disorder and the person's incapacity to make appropriate health care decisions for themselves, then the removal to hospital and involvement of the police may, though often distressing for the person, nevertheless be reasonably necessary and the police involvement a necessary precaution. Where, however, a person's failure or refusal to participate in compelled treatment in the community (under a non-residential treatment order) triggers their return to hospital when they are still largely capable of making their own decisions, then we envisage it will be much more problematic for the police to become involved in support of psychiatric carers. This will be so particularly if a person in such circumstances must be forcibly removed to institutional care and physical restraint must be used to do so. The IPCC envisages complaints concerning police involvement to be likely to follow such incidents and, indeed, for these to pose a high risk of harm where the physical resistance to action is sustained and police training or resources deficient.
4. WARRANT TO TAKE OR RETAKE A PATIENT
We note that Clause 225 enables a Constable to enter premises specified in the warrant issued under this Clause, if need be by force, and remove the patient there and when they do so may be accompanied by any person who is a registered medical practitioner or an authorised person. Later in the Bill we note that under clause 227 the police presence and actions are part of a multi-disciplinary intervention, where a constable must be accompanied by at least one approved mental health professional and at least one registered medical practitioner and under clause 228 the constable must be accompanied by at least one approved mental health professional. There seems no evident logic to these variations. We would commend to the Committee this multi-disciplinary approach and the benefits of applying the principle consistently to all those interactions when the need to employ police powers brings them in contact with a patient required to be detained under mental health legislation.
5. URGENT REMOVAL TO A PLACE OF SAFETY
The provisions of clause 228 are a new provision compared to the 1983 Act providing just such a multi-disciplinary approach which we commend to the Committee. Information from an approved mental health professional triggers an intervention by a constable permitting entry to premises, forced if necessary, and the removal of the person there to a place of safety for a limited period of time (six hours). A Justice's Warrant may provide for further detention but not beyond 72 hours. It is an approach which would meet with our approval, save in relation to the comments below about the period of time for permitted detention.
6. REMOVAL TO A PLACE OF SAFETY FROM A PUBLIC PLACE
Section 136 of the Mental Health Acts 1959 and 1983 has now been reproduced in Clause 229. Under this power, the police will continue to arrest and detain for assessment in a "place of safety", very often comprising a police cell, persons found in public who appear to be disordered and require some form of care or control. The possible facilities specified as affording a "place of safety" are reproduced from the previous legislation. There is no attempt in the draft clause (it refers back to the wording of Clause 227) to limit the occasions a police station will, inappropriately, be used for the detention of a person arrested in these circumstances. The Commission recognises that, on some occasions, hospital or other premises are simply not available and a police station must, as a last resort, be used for the purposes of temporary detention. However, the draft legislation makes no attempt to limit the circumstances in which this happens only to wholly exceptional occasions. Since 1990 the Mental Health Code of Practice has strongly discouraged the use of the police station as a place of safety (as does current Home Office guidance), in the interests of the person detained and to ensure early and effective assessment. Current evidence suggests that far too often now a police station cell is the first not last resort, routinely used for this purpose.
7. If the Committee considers it necessary to retain a police station under the bill for use on rare occasions as a last resort then, at least, the Commission considers
7.1 That there should be a positive duty placed under the bill upon the relevant health authority to assess need and provide/procure adequate such facilities (for example, registered care provision) to act as intermediate care prior to assessment and a decision on residential detention, in a similar manner to which other intermediate care facilities are provided for other patients in need of healthcare;
7.2 That a period of detention of 72 hours in police station is wholly inappropriate for the purposes of the assessment needed. An assessment when a police station is used should be completed within a maximum period of 12 hours.
8. USE OF FORCE BY POLICE WHEN IN HOSPITAL OR OTHER INSTITUTIONAL SETTINGS
The Commission is aware that, from time to time, hospital or residential care staff seek the assistance of the police to deal with violent or threatening behaviour by a patient being treated in that institution. In particular, CS spray has been used in hospital settings; police officers have been required to restrain patients brought to hospital for assessment or treatment for lengthy periods as part of the admission process and police officers also become involved when moving a patient from one facility to another or even to quell a disturbance which erupts in a ward setting. The Commission regards it as generally regrettable when this occurs since the appropriate response to a person's mental health crisis is the employment of highly trained and skilled therapeutic staff who are well-informed as to the cause or causes of the person's disordered behaviour and are able to use physical restraint if this is necessary, but within the context of the person's treatment. It is often entirely inappropriate for police staff with no knowledge of a patient, who are uniformed and carry self-defence weaponry, to become engaged in these types of incidents, particularly in secure unit settings.
9. We would look to the Mental Health Bill, or to regulations made under it, more closely to regulate the management of restraint in psychiatry to ensure the human rights of patients are fully and effectively respected and police officers are not drawn into these events unnecessarily, inappropriately and possibly on occasions unlawfully.
10. In addition to improvement of the legislation there needs to be greater clarity possibly in the code of practice about application. Too often at present, when a mentally disordered offender is diverted from the criminal justice system to hospital it is the police who are called to escort the offender when the duty rests on the health service.
11. The IPCC wishes to engage fully in the debate over the reform of mental health law and would be happy to participate in the Committee's inquiry as it finds useful.
Memorandum from WISH (Women in Secure Hospitals) (DMH 265)
Joint Committee on the Draft Mental Health Bill Written Evidence
Memorandum from WISH (Women in Secure Hospitals) (DMH 265)
WHO ARE WISH
WISH is a unique national charity, working with and on behalf of women during, after and at risk of containment in high security hospitals, medium and low secure units and prison psychiatric units. WISH also supports women when leaving the system and during the complex process of re-building a new life in the community.
WISH successfully engages with women in these dire circumstances to enable women's silent voices and invisible experiences of being detained, heard and responded to by Government, service providers and commissioners in both the public and private sectors of provision. WISH have been campaigning successfully over the past 13 years for the recognition that women's needs when receiving and being detained for care and treatment for their mental distress, demands, out of necessity, to be rooted in a gender sensitive philosophy and service approach with women themselves being at the very heart of the process.
Over the past 13 years WISH has developed and published cutting edge research, policy and women centred philosophies of care that have informed and influenced new ways of approaching the delivery of care to women. Demonstrated by the fact that nationally a wide variety of services who provide care and treatment to women in this category have used WISH's work to improve their services and achieve best practice and offer a better deal to women. Finally and more importantly the core work of WISH is our ability to maintain and sustain meaningful relationships with women in all the settings where WISH operates based on a relational security model developed by WISH. WISH achieves this through regular contact with women in the system through professional support, visits, women centred advocacy, briefings, newsletters (that women themselves contribute and edit) and sponsored "Feel Good Day" events. Currently there are over 100 women who are members of WISH. Two recent consultations with women in the system (June/July August 2004) demonstrate that women benefit from, continue to want and value WISH's involvement during and after their journey through the current Mental Health system. As such WISH feel that we can claim to represent a large proportion of this small but significant group of women.
WISH do not propose to comment upon the Draft Bill paragraph by paragraph as we do not have the legal capabilities to do so but rather place before the committee WISH's views regarding areas of the bill that raise concerns and areas where we are seeking assurances that women's rights are not further eroded by proposed changes emanating from the current draft and suggested inclusions to the bill and the code of practise.
WISH are concerned that the new compulsory treatment provision will adversely effect women, currently women are detained for longer periods in Mental Health secure services than is necessary and any changes to the current act that increases this risk will be detrimental to women in this category.
Current evidence suggests that women are more likely to receive a diagnosis of border line personality disorder than men and as such would under the new "treatability" test proposed in the draft be at greater risk of being detained than under the current act. WISH are seeking assurances that this will not be the case. WISH endorse MIND's concerns here from women perspective and have real anxieties that women who experience extreme self harm will now be at risk from being detained and would by definition be more afraid of seeking help in the knowledge that this could lead to them being involuntarily detained as would other instances where women might seek help for mental distress.
WISH are concerned that there appears to be under the new Draft Bill proposal a lack of legislative "right" for people to access good quality mental health and social care services with assured standards of care. This lack will and does have an adverse effect upon women's ability to receive care and treatment based upon appropriate gender sensitive assessment. Too often in WISH's experience women have been spiralled up the secure forensic health provision due to lack of early intervention and recognition that women's life experiences can and do impact upon their mental well-being. (see "Into the Mainstream" Strategy for Women's Mental Health DOH 2002, and the Implementation Document 2003 that accompanies the strategy) for evidence and confirmation that women's mental health needs and that includes new Mental Health legislation, should as all current evidence indicates, be delivered within a gender informed framework. Women as observed time and again by WISH to not be receiving appropriate assessment, care and treatment in a mental health system that fails to have any understanding of the gender specific needs as presented by women.
WISH are concerned that the new Bill appears to make it more complex for people leaving the secure system to receive the right support and treatment during these difficult transitions. six weeks of free care is not enough and in the case of women would put them at great risk of re-call thus enforcing their sense of personal failure. It is imperative that the bill is clear and unambiguous about how after-care is managed. This is imperative for women to feel safe, secure and supported for as long as it takes.
WISH are pleased to note that Advocacy is to be recognised as essential prerequisite for strengthening the defence of patients Human Rights while being detained. WISH are concerned that at the preliminary stages before an order is made no provision has been made to include the right to an advocate. WISH urge reconsideration of this on the grounds that a woman is most vulnerable at this time and most isolated and needs independent support and advice should she want it. WISH would urge that specialist advocacy for women be promoted as recommended by "Into the Mainstream" Women's Mental Health Strategy DOH 2002.
WISH are concerned that under the new Bill women's advanced directives (that are still not fully part of the current mental health forensic service opportunities for women patients) though upheld under Mental Capacity Bill may well be denied under these new proposals, WISH seek assurances that this will not be the case.
Finally, in our submission WISH urge that both in the Revised Bill and the Code of Practice mention is made of the need to administer both the acts and the code in the knowledge of gender awareness within mental health services and how currently that awareness is now becoming part of service delivery and therefore should be an intrinsic part of both the new bill and the code. This is an opportunity to place on record how the ways in which women and men experience Mental Health distress is different in Britain to-day, all the evidence available now points to this and as such should be reflected in modern laws and codes that should be at the forefront of leading good practice and upholding the civil and human rights of both women and men rather than replicating a gender neutral law and code that makes invisible the significant and important distinctions that are experienced by women and men.
Memorandum from the Policy Study Institute (PSI) (DMH 421)
Joint Committee on the Draft Mental Health Bill Written Evidence
Memorandum from the Policy Study Institute (PSI)
Health of the Muslim Patients & Carers International Health Foundation
HEALTH ADVISORY BOARD
THE UNION OF MUSLIM ORGANISATIONS UK AND IRELAND
The UMO is the National Representative Organisation of over two million British Muslims, whose Executive Committee is democratically elected as its Annual Conferences.
To promote Unity amongst Muslims in the UK and Ireland.
To operate as a spokesman on behalf of all Muslims in the UK and Ireland on all matters relating to their religious, cultural, social, educational and economic health issues.
Institute of Policy Studies for Muslim ie leading organisations in the UK working in mental health and learning disabilities. We work to promote mental well-being for everyone and encourage improvements in the quality of life for people with mental health problems and people with learning disabilities. We seek to achieve these goals by supporting improvements in policy and services across the UK, through a range of activities including research, training and information provision.
POLICY AND SUPPORT FOR BRITISH MUSLIM RESPONSE
A majority of those surveyed (about 40%) believed there was no support from British Policy Makers for British Muslims, with an almost identical number believing there was some support albeit not very serious.
The primary reason for respondents who felt little or no support from British policy makers towards British Muslims was due to the lack of legal protection for Muslims from discrimination, similar to legislation protecting other religious communities.
Summary of key points
Summary of recommendations
1. Is the draft Mental Health Bill rooted in a set of unambiguous basic principles? Are these
principles appropriate and desirable?
2. Is the definition of Mental Disorder appropriate and unambiguous?
Are the conditions for treatment and care under compulsion sufficiently stringent?
Are the provisions for assessment and treatment in the Community adequate and sufficient?
3. Does the draft bill achieve the right balance between protecting the personal and human rights of the mentally ill on one hand, and concerns for public and personal safety on the other?
4. Are the proposals contained in the draft Mental Health Bill necessary, workable, efficient, and clear? Are there any important omissions in the Bill?
5. Is the proposed institutional framework appropriate and sufficient for the enforcement of measures contained in the draft Bill?
6. Are the safeguards against abuse adequate?
Are the safeguards in respect of particularly vulnerable groups, for example children, sufficient?
Are there enough safeguards against misuse of aggressive procedures such as ECT and psychosurgery?
7. Is the balance struck between what has been included on the face of the draft bill, and what goes into Regulations and the Code of Practices right?
8. Is the draft Mental Health Bill adequately integrated with the Mental Capacity Bill (as introduced in the House of Commons on 17 July 2004)?
9. Is the draft Mental Health Bill in full compliance with Human Rights Act?
10. What are likely to be the human and financial resource implications of the draft Bill? What will be the effect of the Bill adequately, and will sufficient resources be available to cover any costs arising from implementation of the Bill?
Additional information: Black and ethnic minorities case history. Misdiagnosis of a Muslim patient who had chest cancer for seven years. Diagnosed as mentally ill, given anti-psychiatric drug treatment instead of cancer treatment.
Appendix 2: Ethical Standards in Psychiatry and Psychiatric aspect of Muslim detainees held under the 2001 Anti-Terrorism Crime and Security Act.
Appendix 3: Census of Muslim plight and Muslim Prison.
Appendix 4: Major Anxieties of Muslims in Britain.
BRITISH MUSLIMS DEBATE THE DRAFT MENTAL HEALTH BILL
"The detention of the mentally ill in this draft is unworkable, racist and incompatible with Human Rights. Please don't let it go through".
SUMMARY OF KEY ISSUES
Reform of mental health law can only play a small part in improving patient care:
Reducing stigma and discrimination.
Enhancing awareness within society.
Ensuring an adequate and well trained workforce and
Access to a range of psychological and medical treatments
Are all far more important in improving mental health (including issues of safety).
The legal framework for non-consensual treatment for the mentally ill should:
Mirror that for the physically ill as closely as possible. There is no place, in the 21st Century, for forcing treatment which they do not want on people who retain full decision-making capacity.
Ensure the Government's intention not to increase the number of patients subject to compulsion is realised. The proposed definition of Mental Disorder is only workable if the conditions for compulsion are restricted.
Not be used solely for the control of social, or anti-social, behaviours in a health service, unless there is a health need and benefit.
Be consistent between different parts of the United Kingdom.
A Mental Health Act should not:
Have an adverse effect on voluntary patients either by making them fear using services or by limiting the services available for such patients due to an increase in resources for those subject to compulsion.
Have an adverse effect on the safeguards for compelled patients because staff requirements cannot be met.
Require practitioners to have to balance the ethical principles of their profession against compliance with the law.
A Mental Health Act should:
Be understandable to practitioners.
In relation to children and young people, involve psychiatrists and other professionals, including lawyers with expertise in working with children.
Many people, particularly in the Black African and Caribbean Muslim communities, do not believe that mainstream mental health services can offer positive help, so they delay seeking help;
They therefore are not engaging with services at an early point in the cycle when they could receive less coercive and more appropriate services, coming instead to services in crisis when they face a range of risks including over and misdiagnosis, police intervention and use of the Mental Health Act;
These aversive care pathways further influence both the nature and outcome of treatment and the willingness of communities to engage with mainstream services.
This situation is clearly unacceptable and unsustainable. Further, it constitutes an adverse and unjustifiable impact under the RR(A)A 2000 and as such there is a statutory obligation for remedial action to be taken. The main body of this document sets out the actions those responsible for and working in primary care and mental health services need to take to meet their statutory obligations and will help them to meet national targets and other standards and commitments.
SUMMARY OF KEY RECOMMENDATIONS
1. The draft Codes of Practice must be made available, alongside the draft Bill, in order to fully understand the provisions of the Bill.
2. Principles should include: non-discrimination, request for diversity, religious respect for personal autonomy, informal care where possible, reciprocity, lease restrictive alternative, patient participation and consensual care where possible, respect for religion, patient benefit,
3. The definition of mental disorder in the draft Mental Health Bill is satisfactory ONLY if combined with extremely tight conditions and limitations. Otherwise either the New Zealand or Australian definitions of mental disorder should be adopted.
4. The Bill should contain the following exclusions. Nothing in the conditions for compulsion shall be construed as implying that a person may be dealt with under this Act as suffering from mental disorder solely by reason of: cultural, political or religious beliefs of promiscuity, sexual deviancy or other immoral conduct or dependence on, or misuse of alcohol or drugs or impairment of intelligence or the commission, or threat, of illegal or disorderly acts.
5. Use of the Act should be prohibited in cases where the capacious patient willingly accepts assessment and treatment as recommended by the medical practitioner.
6. Patients who lack decision-making capacity must not be excluded from receiving treatment because they resist treatment and yet present only moderate risk to their health.
7. There should be two important additional conditions for compulsion in the draft Bill:
(a) Impaired decision-making by reason of their mental disorder.
(b) In relation to a treatment order therapeutic benefit for the patient.
8. Community Treatment Orders should be available for patients only on authorisation of the Tribunal after a period of in-patient assessment and whilst the person suffers impaired decision-making by reason of their mental disorder. Leave of absence powers enable assessment and treatment in the community during the assessment period.
9. A Tribunal should not be permitted to authorise a treatment order if it is hearing an appeal within the first 14 days of the period of assessment.
10. Compulsion should only be possible, other than in an emergency, if two doctors certify that the patient suffers from a mental disorder satisfying to conditions.
11. Clinical supervisors must be qualified to assess if a person meets the conditions for compulsion in order to be able to keep under review if the conditions continue to be met.
12. The Mental Health Tribunal should be permitted to authorise specified medical treatments only if they are agreed as necessary by both the clinical supervisor and medical expert panel member.
13. There should be no limitation of the right to discharge by the Clinical Supervisor for patients detained under civil sections. The College would also wish those rights (and associated limitations) currently available to the nearest relative to be available to the nominated person.
14. Transfer between hospitals should require consultation, other than in an emergency, but without specific time limits.
15. Medical treatment, provided it is not irreversible or hazardous, may be given under the direction of a registered medical practitioner, within the first 5 days, if it is necessary to alleviate, or prevent a deterioration, in the patient's condition.
16. Safeguards, both legal and clinical, for persons under 16 years of age must be re-evaluated.
17. Changes to the medication plan after 28 days should be authorised by a medical member of the Expert Panel, with similar requirements to consultation as specified. If a full Tribunal was to be required there is a real danger that either:
(a) Necessary changes in medication would be significantly delayed leading to prolonged suffering and increased risks or
(b) The initial treatment plans authorised would be very board giving limited or no protections to the patient.
18. It should be clear from the legislation, or Code of Practice, that one option for a care plan presented to a Tribunal would include the statement that identified treatments will only be given with the patient's consent (subject to an emergency treatment clause).
19. Electro-convulsive therapy (ECT) should only be prescribed by qualified psychiatrists. There should be no compulsory ECT in the face of the refusal of a capacitous patient. The current provision in relation to surgery for mental disorder (requiring capacitious consent) should not be extended.
20. The College believes the principles underpinning the legislation should be on the face of the Bill, as with the Mental Capacity Bill.
21. The rights, and safeguards, for patients should be the same under the Mental Capacity and the Mental Health Bills.
22. The Mental Health Act for England and Wales must meet the requirements both of Human Rights legislation and the recommendations of the Council of Europe.
23. Further research is required to assess the realistic likely impact of the proposals, on the workforce, in relation to numbers, recruitment and morale.
24. A review of the Bill's workforce and service impact in Wales should be undertaken.
25. The principles and essential provisions of mental health legislation should not differ significantly between different parts of the United Kingdom.
"For now everyone in all Muslim communities should be prepared for more raids, arrests and harassment from the authorities and this will includeBbritish, working professionals, there will be many more BPP's (British Political Prisoners) like myself and others".Woodhill Detainee Babar Ahmed (August 2004).
MAJOR ANXIETIES OF MUSLIMS IN BRITAIN
These fell into three categories:
Extremist Islamophobic agenda of various institutions
Likewise the media and organisations
A concomitant degree of misunderstanding about Islam in British society
Concerns ranged from:
Government policies and public attitudes.
Physical attacks and abuse.
Proposed ID cards.
The general public attitude of an "anti Muslim culture".
Underlying them all was fear of both physical and moral abuse.
What causes Muslim Dissatisfaction in Britain?
Respondents' reasons for feeling unhappy in Britain fell into three categories:
Antagonistic British culture.
Negative portrayal of Muslims in the media.
Lack of respect for religious values in British society.
The whole purpose of publishing the reports became clear when Ms Arzu Merali, co-author of the reports and Director of Research at the IHRC spelled out the recommendations. "There are a series of steps which the Government and those who run the country from this building need to take". She emphasised a full review of school curricula to ensure that positive images about Islam and Muslims were included.
BRITISH MUSLIMS' EXPECTATIONS OF THE GOVERNMENT
First two reports' launch at the House of Lords, London, 16 December 2004
Case of Mr J.
Misdiagnosis of a 77 year Muslim patient spent "seven" years in mental hospital and was treated with potential drugs was in fact suffering from lung cancerhe was released by chance after enquiry by Scottish Mental Welfare Commission (detail available from the commission).
Cases of misdiagnosis of BME Muslim patient very high and accepted by Health Secretary John Reid as circle of fears. Breaching an unacceptable Human Right Race Relation Act.
It is still the case, generally, that under the bill, compulsory powers will only be used if an individual is not willing to accept treatment voluntarily. There can be many reasons for not accepting treatment voluntarily, and an unwillingness to accept treatment is not necessarily a symptom of mental disorder. People who feel alienated from authority, people who feel that their cultural needs are not recognised or not respected, and people who are offered an inadequate service, may all be unwilling to accept what they are being offered. If compulsory powers are available even when people don't need in-patient treatment (and particularly when they are obligatory), it is likely that they will be used, rather than time spent in trying to build trust, appreciate difference and raise standards, so that people accept treatment voluntarily. Poor people and people from minority cultures are more likely to be affected than better off people and members of majority cultures.
REPORT ACCUSES NHS OF INSTITUTIONAL RACISM
Equitable services that are designed around and responsive to the needs and wishes of individuals, reflecting the rich diversity of modern British society, includes the NHS Plan and the Mental Health Modernisation Programme (MHMP). Since publication of the Mental Health National Service Framework (MHNSF) in 1999, with its requirement in Standard 1 for the promotion of health and social inclusion, the introduction of the Human Rights Act 1998 and the Race Relations (Amendment) Act 2000 have provided a statutory framework setting out the obligations of health and social care services in relation to equality and human rights.
CASE FOR ACTION
Concerns have been expressed over a number of years that services are not being delivered to people from Black and minority ethnic (BME) communities experiencing mental illness and distress in a way that meets these obligations.
Inside Outside: Improving Mental Health Services for Black and Minority Ethnic Communities in England was published in March 2003.
The evidence set out in Inside Outside and other research, such as that undertaken by the University of Central Lancashire and the Sainsbury Centre for Mental Health (SCMH) and the Mental Health Act Commission have shown that Black and minority ethnic people are more likely to experience:
Problems in accessing services;
Lower satisfaction with services;
Cultural and language barriers in assessments;
Lower GP involvement in care;
Inadequate community-based care;
Lower involvement of service users, family and carers;
Inadequate support for Black community initiatives;
An aversive pathway into mental health services:
Higher compulsory admission rates to hospital;
Higher involvement in legal system and forensic settings;
Higher rates of transfer to medium and high secure facilities;
Higher voluntary admission rates to hospital;
Lower satisfaction with hospital care;
Lower effectiveness of hospital treatments;
Longer stays in hospital;
Higher rates of readmission to hospital;
Less likelihood of having social care/psychological needs addressed within care
More severe and coercive treatments;
Lower access to talking treatments.
1.3 What the SCMH has termed "circles of fear" have been created so that:
Many people, particularly in the Black African and Caribbean Muslim communities, do not believe that mainstream mental health services can offer positive help, so they delay seeking help;
They therefore are not engaging with services at an early point in the cycle when they could receive less coercive and more appropriate services, coming instead to services in crisis when they face of risks including over and misdiagnosis, police intervention and use of the Mental Health Act.
There aversive care pathways further influence both the nature and outcome of treatment the willingness of communities to engage with mainstream services.
1.4 This situation is clearly unacceptable and unsustainable. Further, is constitutes an adverse and unjustifiable impact under the RR(A)A 2000 and as such there is a statutory obligation for remedy action to be taken. The main body of this document sets out the actions those responsible for and working in primary acre and mental health services need to take to meet their statutory obligations will help them to meet national targets and other standards and commitments. These actions are summarised at Annex A. The remaining annexes set out pointers for achieving improvements to some and examples of notable developments that have already taken place locally.
1.5 Successful delivery of the framework will require action by all responsible for planning, commissioning delivering and monitoring primary care and mental health services. This work should not be seen as "specialist" or separate. It is central to the modernisation of mainstream services. Implementation of this framework should help planners, commissioners and provides meet their national mental health delivery targets. It will be more difficult to meet national targets if the need of Black and minority ethnic groups unmet, given their over-representation in certain aspects of mental health services (and their under-representation in others). For example, Black and minority ethnic patients are currently over-representative both voluntary and compulsory hospital admissions, on average staying longer in hospital, and are more likely to be readmitted. Services, including those set up under the Mental Health Modernisation Progress such as early intervention, crisis services and assertive outreach teams, will need to take full account of the needs of these groups if they are to be as effective as possible in meeting their acute care targets.