Some pointers for a Labour policy on adult and child mental health by LSWG Committee member Dr Rob Murphy

Dr. Robert J. MurphyBA (Hons), MSc, PhD, Dip Soc Admin, CQSW,

  Dip Stress Management Training


Rob is LSWG co-ordinator on Social Work and social services for adults and children with mental health difficulties

Date:               20.7.2020

Labour Party website – ‘mental health a national priority’

Information/issues:

            800,000 children living with mental health disorders according to the Children’s Commissioner

            100,000 children denied mental health treatment each year

            4,500 fewer mental health nurses, chronic shortage of consultant psychiatrists

Proposals:

            Enhanced training bursary for nurses

            Bed cuts force children to go to non-local beds sometimes hundreds of miles from home

            Early intervention is the key to prevent or intervene in cases of abuse, neglect, trauma – i.e. Adverse Childhood Experiences (ACE)

            Extend school counselling services – to help better integrate mental health services with education and give young people somewhere to turn

            Poor mental health arises not just in schools but also in our communities, families, and online

            Poverty leads to injustices such that you are 3x more likely to develop mental health problems, and have higher rates of suicide, addictions and deaths from overdoses. Poverty results in health inequalities.

            Plan for happiness and wellbeing? – Future Generations Wellbeing Act which determines that ‘health in all policies’, ‘health equality audits of all government decisions’

The website cites LSE research which estimates the annual cost of mental ill-health at £105 billion

The website also states that research has shown that half of adults with mental health difficulties had symptoms at aged 14 yrs and yet only 8% of mental health budget is allocated for the treatment of young people.

The Labour Party is committed to tackling the issue of staff shortage crisis, through guaranteeing the rights of EU nationals working in the UK, reintroducing nurses’ bursaries, and lifting the NHS pay freeze

Review of the MHA Sir Simon Wessely DHSC 2018

A few significant conclusions:

            Increasing rate of detentions under the MHA

            Patients’ voice lost or ignored

            Services bureaucratic, uncaring, and coercive

            Over-representation of BAME people detained under MHA

            Questioning how people with learning disabilities and autism are examined/assessed

            Questioning the application of international standards of human rights

The Review noted that:

            49551 detentions under the MHA were recorded in 2017/18

            There was a 40% increase in detention from 2005/06 to 2015/16

            Black people were 4x more likely than White people to be detained under the MHA

            More Black patients, especially young Black men, were subject to Community Treatment Orders (CTO)

            Black people are 8x more likely to be subject to CTOs than White people

            For Black people as service users they experience coercion, stigma, racism, and discrimination amounting to institutionalised racism according to research carried out by Frank Keating and published in 2002 and quoted in this Review

The Review’s recommendations:

            There is a poor standard of care and support in mental health services

            The services ought to be more rights-based and reflect the 4 key principles and values of dignity, respect for persons, mutuality, and reciprocity

The Review concludes that the lack of dignity and trust inspires fear of getting worse and not better when compulsorily admitted to hospital

The new underpinning principles ought to reflect choice and autonomy such as:

            Shared decisions in care plans and treatment

            Statutory advance choice documents (ACD)

            Medication – service users’ wishes taken into account

            Patients entitled to challenge treatments

            Patients can request a second opinion (SOAD)

            Allow a patient to consent in advance to admission ie agree to become a voluntary patient at a future point which then removes the need to use the MHA

The role of the Nearest Relative is also highlighted with a recommendation that this is changed to a Nominated Person (NR)

A number of other issues are raised such as the use of police cells as a place of safety and whether the NHS ought to commission health services in police custody.

In relation to the criminal justice system the role of Magistrates’ Courts is questioned in relation to the remand for assessment of a person under Section 35 of the MHA and for treatment under Section 36 of the MHA

I raised issues which I consider important in the email and papers I circulated previously, including:

The commodification of children’s mental health which is resulting in the increased labelling of children at school has to be a priority. I can agree with the need for a counselling service in each school, but the role of learning mentors is a preventive step which is prior to counselling and a role which is of tremendous benefit for the child, their family, the teachers and the school’s academic targets. 

No one is born with ADHD, OCD, PTSD, bi-polar disorder, schizophrenia or any other psychiatric diagnosis or psychological disorder or condition. These ascriptions are applied by professional experts when a child or adult is deemed to be eligible for these relatively expensive services. Once the child or adult has crossed the threshold into the diagnostic system the door of ‘normality’ typically closes behind them, and they take on the symptomatic identity attributed to them.

I think it is ironic that the Review of the MHA should highlight the need for the implementation to reflect international standards of human rights when the 1983 MHA was itself primarily concerned with trying to establish a balance between civil liberties and compulsory treatments. Social workers as ASWs had a crucial role to play in the preservation of a person’s civil rights and liberties and prevent unwarranted detentions. The irony is that the increasing emphasis on finite and ‘available’ resources, driven by economic goals and unburdening the state and the taxpayers, has resulted in eligibility criteria which preclude, for example, the use of voluntary admission to hospital.

This Review is ironically very familiar because it repeats the dilemmas faced by those who wrote the 1983 Act and demonstrate that the fundamental issues have not changed in relation to legislating for madness in society!

So I think the Labour Party can usefully focus on the requirement for all schools to establish the role of learning mentors as a preventive mental health measure and to supplement this with a school counsellor, recognising a clear distinction in role which will be reflected in remuneration. This is one of the best means of allocating resources which will be of great benefit as a preventative mental health measure.

I also think that the Party needs to develop a strategy for tackling the evident institutional racism within the mental health system in all its features. This must include reducing the number of compulsory detentions and treatments of BAME people, as well as addressing the specific discrimination of young Black men in relation to the use of CTOs, the use of coercion, and the use of antipsychotic medication as a form of restraint and treatment.

The Party must also develop policies which focus on service users’ rights to contribute and even determine the type and quality and features of services and resources which are designed to meet their mental health needs.

I think the use of statutory Advance Choice Documents is fraught with legal, moral and professional pitfalls.

I also think the use of CTOs needs a fundamental review to establish who is using it and in what circumstances.

I also have question marks about the use of personalised budgets in mental health and I wonder how social workers are using them.

I also have fundamental questions about how the Mental Capacity Act is being used in the mental health system but also in relation to older people and people diagnosed with dementia and Alzheimers Disease.

I also think the use of the Nearest Relative has always been controversial, and I am concerned about the implications of changing this role to a Nominated Person role.   

The role of the police in the use of mental health legislation has always been fraught and more has to be done about ensuring that anyone who has to be involved in a potential suicide, domestic violence, and use of compulsory admissions to hospital for treatment or assessments of people in the community and the use of police cells as a place of safety have to be evaluated and effective and constructive policies developed.

I would like to see more evaluation of the use of antipsychotic medication especially in relation to its long-term use, because it has damaging effects on major organs particularly the liver, heart and brain.

I would like to see ECT banned as a method of psychiatric treatment.

I think we need to develop a clear mental health role for social workers.

I think that the Approved Mental Health Social Work role is fundamental to upholding the civil rights of people who are being assessed under the MHA, but I think this is a role that ought to have more credibility and extend more positively into a broader role in relation to children and families.

Food for thought! Where do we go from here?

Sent to Labour Shadow lead on mental health services Dr Rosena Allin-Khan May 2021

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