Mind - the Mental Health Charity - has published the results of a nationwide survey which aimed to investigate discrimination faced by people with mental health problems.
The level of discrimination that this survey uncovered has shocked many people at Mind, and shows the extent to which stigmas and taboos surrounding mental ill-health affect every area of life including employment, housing, parenting, finances and relationships with family and friends. The findings of this survey raise deep concerns about a large section of the population which is effectively left disenfranchised, and prevented from having a 'stake-hold' in society. A common feeling amongst the vast majority of people was that of being thrown on the scrap heap as employees, as parents and as valuable members of society just because of their psychiatric histories.
Judi Clements, Mind's National Director, said:
Discrimination is the single biggest problem for mental health
policy. How can people recover and establish themselves in the
community if they are constantly refused a chance to work or
contribute to society? Despite the fact that one in four people
will have a mental health problem this year, this report
uncovers how ingrained, entrenched and debilitating attitudes
towards mental ill-health still are.
Mind plans to produce further reports on discrimination in
respect of race and mental health, an issue raised by a number
of respondents to the survey, for example one person said:
When I was in hospital, it seemed social workers brought in the
new white patients, but black patients were usually brought in
by the police and shoved in lock-up wards.
For more information on the survey contact Mind.
The NHS Executive has issued a draft of a revised version of the Mental Health Act Code of Practice. The purpose is to update the language used in the Code, and clarify guidance in areas where the existing Code may be inadequate or misunderstood. In particular, new guidance is given on the functions of Mental Health Act Managers, taking account of the recommendations of a working group set up to advise the Secretary of State for Health on these issues, and also reflected in a recent NAHAT publication.
The New Draft Code of Practice will be available through this HyperGUIDE to the Mental Health Act, by late November / early December 1996. The consultation period ends on 28 February 1997.
The Mental Health Act Commission has implemented, from 1 October 1996, a new Reporting Procedure for Issues of Special Concern. The aim is to have a clear procedure to be invoked where a matter of persistent or serious concern is noted:
The procedure is intended to cover issues such as:
The Special Procedure has been sent to all NHS Trusts, Health Authorities and Social Services Departments, from the MHAC Head Office
SANE is a charity which campaigns for the rights of relatives/carers of people of mental health service users, and argues that people with a mental illness have a right to receive treatment when necessary. The organisation's name originated from Schizophrenia - A National Emergency.
SANE has issued the following statement:
When the Mental Health Act (1983) was introduced, the concern was primarily with the need to safeguard people from being wrongly admitted to hospital or kept there when they were no longer ill. Since then the care and treatment of people with a mental illness has been revolutionised through the development of community care, and now thousands of severely ill people are living in the community.
SANE believes that the Mental Health Act (1983) requires examination and review, to provide a statutory structure for mental health which takes account of the realities of community care. It should create a better balance between the rights of patients (especially their rights to care and treatment) and those of their carers, their families and the community.
SANE is therefore consulting with lawyers, psychiatrists, other mental health professionals, general practitioners, health authorities and trusts, local authorities, the police, prison and probation services, Members of Parliament and Peers. We are also consulting voluntary organisations and individuals - users, carers and others - whose lives have been affected by mental illness. The consultation process is in the form of seminars A Balance of Rights - which will identify areas of concern, investigate ways of changing law and practice, and provide guidelines for future action.
Information about the Balance of Rights seminar on 11 November is available from the SANE Office.
NAHAT - the National Association of Health Authorities and Trusts - has just published a guide for NHS trust board directors detailing the procedures by which a trust board can ensure that its statutory powers under the Mental Health Act are fulfilled.
The forthcoming guide was referred to in a recent statement made by the Secretary of State for Health.
The guide comprises two parts: an introduction to mental health legislation for NHS board directors, and a detailed examination of the procedures for the review of detention and power to discharge as exercised by the Mental Health Act Managers.
A separate page gives more details of the Director's Guide.
The Secretary of State for Health has announced that he intends to abolish the power of the Mental Health Act Managers to end the detention of people detained under the Mental Health Act. This power is implicit in Section 23 and its abolition will mean an end to Managers' Hearings.
This cannot happen straight away, as it will require a change to the law. In fact, the government is clearly considering a complete revision of the Mental Health Act, but any new Act will not materialise before the next election. It seems that the Managers will continue to have a role for a considerable time yet. Therefore, the government plans to issue new guidance to Managers for the intervening period.
It appears that the government's thinking on how Managers should
consider whether to exercise their current power of discharge
from Section, will emerge in 2 ways:
The rest of this news item consists of:
Mental health law provides the framework that ensures that mentally disordered people get the care they need and that the public are not put at risk. It defines the circumstances in which people should be compulsorily detained in hospital or made subject to compulsory supervision in the community. The law also fulfils an essential role in safeguarding the rights of the individual not to be detained unnecessarily.
There are two routes for patients to obtain a review of compulsory detention in hospital: the Mental Health Review Tribunals and lay managers' review panels. The role of the Mental Health Review Tribunal is clearly defined in the Act but the managers' role is much less explicit.
The existence of these two completely separate systems can create confusion for patients and duplication of effort. I do not believe that a dual system is necessary or that there is a valid role for lay managers in this area. We shall legislate, when we get a suitable opportunity, to remove lay managers' powers in this respect.
In the meantime, it is important that patients, professionals and managers themselves are clear about what their role is and how they should carry it out. Subject to consultation, we shall issue new guidance on these issues in a revised Mental Health Act Code of Practice.
This guidance has been informed by the recommendations of a
working group set up to consider Mental Health Act managers'
powers to review that detention of patients. It will cover:
I am pleased that the National Association of Health Authorities and Trusts are also issuing a guide to NHS Trust directors on managers' powers to discharge detained patients which will complement the guidance we shall also be issuing.
In addition, steps must be taken to ensure that the Mental Health Review Tribunal system works as efficiently as possible. Patients should make a properly informed choice about which system to use, but may be discouraged from doing so because of avoidable delays in getting a date fixed for a Mental Health Review Tribunal hearing.
Mental Health Review Tribunals are dealing with increasing
numbers of requests for reviews (reflecting the increase in
numbers of formally detained patients). We are also taking
action:
In February 1996, Glen Grant was given five life sentences for rape. The offence occurred 4 days after he was discharged at a Mental Health Act Managers' hearing from secure facilities at Cane Hill Hospital, Surrey. Newspaper reports made much of the fact that he was discharged against medical advice, but that is virtually the definition of a discharge at a Managers' hearing: the Responsible Medical Officer is making the case for the person to remain detained in hospital.
The working group mentioned by the Secretary of State (above) is
reported to have found that:
The Glen Grant case is the only example in the public arena of a serious offence being linked to release by Mental Health Act Managers, although the Secretary of State is reported to have hinted that there may have been others.
The government has clearly acknowledged public concern about this case and feels that the Mental Health Review Tribunal system, which is formally established through the Act and Regulations, offers the best protection for the public.
The Government intends to consult on a revised Code of Practice. The draft document will be issued in October and there will be about 3 months for comments to be made.
The draft revised Code is likely to emphasise the following
matters:
HyperGUIDE hopes to have more details available here once the draft is published.