Overview

The Fife Rights Forum in partnership with Citizens Advice and Rights Fife, NHS Fife and the Scottish Legal Aid Board’s Part V Mental Health Law Project hosted a multi-disciplinary event entitled Reclaiming the Mental Health Act. The event was an opportunity for a wide range of professionals and users of mental health services in Fife to share their views on aspects of mental health legislation and to discuss commonly experienced benefits, problems and solutions. 110 delegates attended the event in Dunfermline on 22 November 2007.

Key speakers addressed commonly experienced benefits, problems and possible changes to mental health legislation and procedure to help inform the debate.

Twenty discussion groups (eleven in the morning and nine in the afternoon) with a maximum of 10 people per group took place. The break down by topics was as follows:

• Topic 1: Principles of the Mental Health Act (4 tables)
• Topic 2: Tribunal Process and Procedure (5 tables)
• Topic 3-1: Advance Statements (3 tables)
• Topic 3-2: Named Persons (2 tables)
• Topic 4-1: Community based Compulsory Treatment Orders (5 tables)
• Topic 4-2: How does mental health legislation affect young people (1 table)

Comprehensive summaries of the table discussions and the general feedback about the event are available on these web pages. Click links above and below or on left hand side of screen.

The following is an extract of the main views and findings expressed by participants.

General Feedback

“Very useful opportunity to hear different perspectives.”
“Found the day informative and thought provoking.”
“The event was well presented and provided a good overview of MHA issues.”
“Thank you for the opportunity to discuss these controversial topics!” “Enjoyed and appreciated other peoples views and opinions.”
“Excellent – event was a comfortable atmosphere for service users and was very interesting to hear the other side of the Mental Health Act.”
“It was good to have table discussions with such a wide range of individuals.”
“Extremely useful to meet and discuss in small groups with members of other disciplines.”

Topic 1: The Principles of the Mental Health (Care and Treatment) (Scotland) Act 2003

• Principles in mental health care encourage accountability by professionals and give clear expectations of what is required.
• Principles help make Act more accessible for lay people.
• Putting principles into practice can be difficult and some principles might not work due to procedures and processes within organisations.
• More discussion is needed to put principles into practice;
• There is concern regarding the current awareness of the principles.

Topic 2: Tribunal Process & Procedure

• New system more patient-centred and empowering to patient and less intimidating. As a result, more patients attend Tribunal hearings.
• Problems encountered included: short notice and the length of time of Tribunal hearings; travelling times to venues; obtaining independent psychiatric reports; the number of interim orders granted.
• Opposing views as to whether paper hearings would be an appropriate way forward where continuation of hearing is unopposed.
• Obtaining medical reports early, e.g. by day 14 of the short-term detention period not appropriate.
• Patient’s right to challenge evidence paramount, and this usually does not lead to adversarial behaviour. Role and skills of convener decisive whether proceedings are conducted in an adversarial manner.
• Tribunal process should be reviewed.
• Need for more transparency and clarity as to how tribunal members are selected, how membership is reviewed, what the rules of review are, and who carries it out.
• More training and information on the ‘softer’ aspects of the tribunal process is required (i.e. attitudes, behaviours, values).

Topic 3-1: Advance Statements

• Advance statements useful in giving practical force to the Act’s principles.
• Fact that advance statements could be overridden dissuaded service users from engaging with the process.
• Capacity to make advance statements raised questions for people from a range of disciplines.
• Process required to make advance statement creates problems for people with learning difficulties who also have mental health problems.
• Advocacy workers should be trained in helping people to draw up advance statements; or the multi-disciplinary team should identify an individual who encourages writing advance statements.
• Uncertainty as to what could be included in an advance statement.
• NHS Fife has a policy related to holding and updating of statements and advance statements could be sent in to a central storage point.

Topic 3-2: Named Persons

• The named person has a role to play to help safeguard the patient’s interests and can be a link to patient’s family, friends and the community.
• MHOs should proactively seek named persons earlier in care pathway and provide information on role of named person before it is urgent.
• There is considerable tension between protecting rights of individual and the named person’s rights to information.
• Information available about named persons appeared to be clear but blurring of the role of named persons/advocates.
• Barriers for not nominating a named person included: preference of individual not to have one; lack of awareness of powers named person has; lack of suitable friends/family to act as named person.
• The role of named person should be a planned one with an appointed individual or professional taking on the role.
• Named persons need better preparation for their role.
• Appropriately informed patients should be able to choose whether they want a named person or not.

Topic 4-1: Social Inclusion – Are community-based compulsory treatment orders a good alternative to hospital detention?

• Community-based compulsory treatment orders (CCTOs) are not ideal for everyone but treatment should be given in the community as much as possible. For CCTOs to work quality of life should be given more emphasis; there are too few services in the community for individuals. The individual’s background and home services available can make a big difference; treatment is very individual, what will work for some will not work for others.
• Multi-disciplinary working is the way forward but leadership is needed to implement such measures and to sustain multi-disciplinary working.
• A general lack of co-operation, where GPs will not speak to carer or family members was mentioned leaving carers feeling excluded with tensions building between professionals, carers and patients.

Topic 4-2: Social Inclusion - How does mental health legislation affect young people?

• Service user involvement is key to receiving appropriate care, particularly in situations where professionals, such as MHOs and CPNs work with different definitions of childhood/adulthood.
• Service users were unaware of the principles of the Act. Knowledge of these principles would allow service users to challenge their treatment.
• Good practice on engaging young people included providing soft drinks at meetings, not only tea and coffee; allowing them to hold up different coloured cards – one means “Please explain” and the other “I’d like to ask a question”. Information on the key principles of the MHA for young people needs to be produced in an accessible format.
• General awareness of mental health issues for young people has been improving, especially through school interventions.

If you would like to discuss any of the above in more detail or require any other information please contact:

Claudia Albrecht (FRF / SLAB)                                      Susan Anderson (NHS Fife)
at Citizens Advice & Rights Fife                                     Whyteman’s Brae Hospital
4 Abbey Park Place                                                      Kirkcaldy
Dunfermline,                                                                KY1 2ND
KY12 7PD                                                                    01592 643355 ext 3966
01383 749 877                                                            This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Until 31 March 2008.   New contact details will be published at www.fiferights.org/mhlf