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The Bournewood Safeguards draft illustrative guidance is intended to be used by people exercising functions under the Bournewood provisions. The intention is that the guidance will eventually form part of the Mental Capacity Act 2005 Code of Practice (due to be issued in Spring 2007). Covering note invites comments on the draft guidance before June 2007.

DoH 22 Dec

Download Bournewood safeguards: Draft illustrative code of practice (PDF, 249K)

Download Bournewood safeguards: Draft illustrative code of practice: Covering note (PDF, 13K)

The MHAC has written an open letter to Professor Louis Appleby, the National Director for Mental Health and Director of the Inquiry, which states that, although the MHAC supports all efforts to ensure patient safety and to encourage high quality patient care, particularly where such safety is guaranteed by appropriate staffing levels and effective risk assessment, we are concerned at the report’s blurring of important legal distinctions over powers available in respect of informal and detained patients.

Read the letter (Pdf)

Avoidable Deaths: five year report of the national confidential inquiry into suicide and homicide by people with mental illness

4th Dec

Key findings and recommendations from Avoidable Deaths, the report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness at The University of Manchester.

Key findings and recommendations from the study on suicide include:

• The number of suicides by psychiatric in-patients shows a downward trend with 67 fewer deaths in 2004 than in 1997.
• Death on the ward by hanging/strangulation has fallen by 51% (27 cases) over the same period.
• Patient deaths following non-compliance with treatment has fallen from 22% (929 cases) in the previous Inquiry report to 14% (813 cases).
• Services need to do more to prevent in-patients absconding; 227 (27%) of in-patient deaths occurring whilst the patient was off the ward without permission between April 2000 and December 2004.
• Of the 1271 post-discharge suicides in the report, 192 (15%) occurred in the first week after discharge and 255 (22%) before the first follow up appointment. The transition from the ward back into the community should be carefully managed with agreed plans to address stressors that may be encountered, and mechanisms in place for patients to contact services if a crisis occurs.

Key findings and recommendations from the study on homicide include:

• 9% of all homicides in England and Wales were by people with a history of mental illness between April 2000 and December 2003.
• The number of homicide convictions by people with history of mental illness remains stable at approximately 50 per year. Homicides carried out by patients with a diagnosis of schizophrenia also remain steady at approximately 15 per year.
• Random attacks on members of the public by people with mental illness, have remained at five per year, indicating that community care has not increased the risk to the general public.
• Services should ensure that high-risk patients receive enhanced CPA (the Government’s Care Programme Approach), backed up by peer review in the most high-risk cases.

Key findings and recommendations from the study on unexplained deaths include:

• The Inquiry identified 235 deaths in this category – approximately 41 per year between March 1999 and December 2004. 17 of these (7%) were patients from ethnic minorities.
• Six in-patients died following restraint. Of these, four died within one hour of restraint.
• Services need to give greater priority to physical healthcare, particularly on in-patient units
• Services should further improve the safety of prescribing in particular avoiding potentially cardio-toxic drugs for patients with a history of heart or respiratory disease.
• Strict standards for physical restraint should be adopted and reviewed after each incident.

Click Here for more details and reports

These information booklets provide introductory information on the Mental Capacity Act. If you would like to order hard copies, please email us

The Mental Capacity Act - introductory information for people who may lack capacity or who want to plan ahead for the future. [PDF 581 kb, 50 Pages]
The Mental Capacity Act - introductory information for family friends and other unpaid carers [PDF 549 kb, 49 Pages]
The Mental Capacity Act - introductory information for people who work in health and social care. [PDF 481 kb, 62 Pages]

On 12th March 2001 the respondents, who were six nursing staff employed by the appellants at Rampton Hospital, were assaulted by a patient, Miss Rachel Agar. They brought proceedings in respect of their injuries. His Honour Judge Inglis tried a preliminary issue dealing with liability and causation. He gave judgment in the respondents' favour by a judgment dated 21 st February 2006. This is an appeal from that judgment.

Full transcript

The report will highlight medium term priorities for local CAMHS staff and managers and provide examples of good practice which can be adopted more widely.

Download report (PDF, 393K)

Download annex: Models of good practice (PDF, 296K)

Wednesday, 22 November 2006

SAMH, Scotland's leading mental health charity, is launching What's it Worth? a report in to the Social and Economic Costs of Mental Health Problems in Scotland, at the Scottish Parliament on Wednesday 22 November 2006.

SAMH commissioned the Sainsbury Centre for Mental Health to undertake an analysis of the social and economic costs of mental health problems in Scotland, following the publication of similar studies in England and Northern Ireland. The study examined not only the costs of providing health and social care services and losses to the economy, but also the personal costs of mental health problems.

Findings indicate that in 2005, the total cost of mental health problems in Scotland was £8.6 billion. This is more than the total amount spent in Scotland by the NHS on all health conditions combined, and is equivalent in monetary value to 9% of our Gross Domestic Product.

Fifty-five percent of the overall cost is attributed to the human costs of mental health problems. This means that the lion's share of these costs is actually being borne by people who have mental health problems. The report found these human costs amount to £4.7 billion: more than four times the cost of all NHS and local authority mental health services in Scotland.

SAMH believes that What's it Worth? reinforces the need for mental health promotion and prevention work to continue with added vigour, and for the barriers to mental health and well-being to be systematically dismantled.

In response to these findings, SAMH has produced an Agenda for Action for the 2007 Scottish elections, clearly stating what political commitments are needed on mental health in Scotland. Our Agenda for Action focuses on four key areas; Rights, Resilience, Recovery and Resources, and was developed through consultation with our membership: many of whom have personal experience of mental health problems.

SAMH Chief Executive, Shona Neil, said:
"This report highlights the huge cost of failing to promote mental health and well-being for everyone. The best way to reduce these costs is to:

· Build the resilience of all citizens;

· Ensure that any one of us can expect recovery if we develop a mental health problem;

· Respect the rights of people with mental health problems; and

· Commit sufficient resources to achieving all of this.

In other words, to act on the demands that SAMH is making in our Agenda for Action."

SCMH chief executive Angela Greatley said:
"The costs of mental ill health are massive. Most of them fall upon people with mental health problems and their families, many of whom live in poverty because of the prejudice and discrimination that still surround mental illness. By quantifying the cost, we can show what can be achieved if we take the issue seriously and invest in improving the lives of the people affected by it."

Key findings:

• Costs associated with mental health problems take various forms and can be analysed in various ways. What's it Worth? attempts to identify and quantify all the main costs of mental health problems in Scotland and then to combine these to give a total cost expressed as a monetary value.


• Public spending on health and social care amounts to £1.1 billion, just 12.3% of the total costs of mental health problems.


• 55% of the overall cost is attributable to the human costs of mental health problems - which means that the lion's share of these costs is being borne by people who have mental health problems.


• The cost of worklessness due to mental health problems is estimated at £915 million - making it clear that the cost of the high levels of unemployment and economic inactivity among people with mental health problems is considerable.

Click here to view What's it Worth?

Click here to view Agenda for Action

The following notes set out the main proposals of the new Mental Health Bill with a few comments on immediate matters of concern that occur to the Policy Team. What follows is not, therefore, an MHAC ‘line’ on the Bill – indeed we hope that it will stimulate discussion amongst Commissioners on the proposals.

Click Here (pdf)

s guideline makes specific recommendations on Alzheimer's disease, dementia with Lewy bodies (DLB), frontotemporal dementia, vascular dementia and mixed dementias, as well as recommendations that apply to all types of dementia. Dementia in Parkinson's disease shares a number of similarities with DLB. Although the evidence base for dementia in Parkinson's disease was not examined specifically in the context of this guideline, the recommendations for DLB may be useful when considering treatments for dementia in Parkinson's disease. NICE has also produced a clinical guideline on Parkinson's disease (available from www.nice.org.uk/CG035).

Click Here

This is an application by the Attorney General pursuant to section 36 of the Criminal Justice Act 1988 to refer to this court as unduly lenient a sentence imposed upon the offender, David Workman, on 7th July 2006 of 18 months' imprisonment. The sentence was imposed for an offence of aiding and abetting an attempted suicide to which the offender had pleaded guilty on 2nd June 2006.

Full Transcript

This guide is for carers who are concerned that the person they care for is unable to take action or make some or all decisions in relation to their finances, personal welfare or health, due to a mental disability or severe communications difficulties, such as a stroke. It provides information on:

• how the Adults with Incapacity (Scotland) Act 2000 can help;
• the purpose of guardianship and intervention orders;
• considerations to make before taking forward an application for a
• guardianship or intervention order;
• deciding what powers to apply for;
• how to make an application;
• procedures and costs;
• what to do next when you have been appointed;
• frequently asked questions ( FAQs).

Click Here

“A radical new approach is needed to the provision of prison mental health care,” John Podmore told the Sainsbury Centre for Mental Health (SCMH) today (15 nov).

Delivering the 2006 SCMH Lecture, John Podmore said: “Mental ill health can never be eradicated from our prisons. It is vital we have an effective strategy for improving the mental health of prisoners and reducing the risk of reoffending.

“Current government guidance on mental health provides the essential framework for building better services. But we need to think radically about how this can be delivered in prisons. We need creative and imaginative new solutions involving not just the NHS and prison service but voluntary bodies and social enterprises. Primary care trusts must make prison mental health care a commissioning priority.”

John Podmore, head of community prisons and transitional facilities at the Home Office and until recently governor of HMP Brixton, set out three priorities for action:

Diversion of offenders with severe mental health problems from prison to more appropriate alternatives;
Better support for prisoners with a ‘dual diagnosis’ of substance use and mental ill health; and
The need to give better care to prisoners with ‘lower level but debilitating’ mental health problems such as depression.
He added: “Prison is a fundamentally toxic environment for mental health. Courts need a greater range of options for offenders with mental health problems. We need to acknowledge that poor mental health is a major cause of social exclusion and that for prisoners this is an especial problem. Mental health services should not be an ‘add on’ to prison regimes; they should be integral to them.”

Angela Greatley, SCMH chief executive, said: “I am delighted that John Podmore is delivering the 2006 SCMH Lecture. His knowledge of what needs to be done to tackle mental ill health in prisons is so important to help us find the right approaches and the right priorities for action.

“This is an agenda that must take the highest priority for the NHS and for the criminal justice system. Today’s Lecture sets out a vision for how we might go about solving the problems we see and making the progress that is so desperately needed.”

Download Lecture Word document (61 KB)

DoH 16 Nov

This document clarifies the nature and intent of existing government policy as it relates to adults with an Autistic Spectrum Disorder (ASD). It is intended to encourage people in the social care and health field to develop local agendas for action.

Download Better services for people with an autistic spectrum disorder: A note clarifying current Government policy and describing good practice (PDF, 961K)

Download Better services for people with an autistic spectrum disorder Easy read version November 2006 (PDF, 603K)

From the Kings Fund

In recent years, several countries have introduced powers to compel certain people with mental disorders living in the community to engage with services and undergo treatment. This paper explores what happened in the first six months after community-based compulsory treatment orders were introduced in Scotland in October 2005. It looks at how many people have become subject to the orders, the pathways to being placed on an order, the impacts on mental health staff, and resource issues. It also considers what lessons emerge for England and Wales, which will soon be introducing similar arrangements.

Download (pdf)

What’s new?
IMCA service update
Health and Social Care update
In depth
Communications and Events
Consultations and responses to consultations
Jargonbox
Contact Details

Download file (pdf)

Protection for patients and the public is at the heart of the Mental Health Bill, which was published by Health Minister Rosie Winterton and Home Office minister Gerry Sutcliffe. The Bill will introduce supervised treatment in the community to ensure that patients comply with treatment when they are discharged from hospital and enable action to be taken to prevent relapse. This will benefit patients and improve public safety.

The Bill also gives new rights and extra protection to people who are unable to decide about their care and who may be unfairly deprived of their liberty. These new safeguards will affect about 5,000 people who have a serious mental disorder but up until now have not been covered by existing mental health laws. Known as the 'Bournewood provisions', they include independent checks of whether they should be detained, rights to appeal and a representative appointed to look after their rights.

It will also introduce a new simplified definition of mental disorder and remove the "treatability" test. The "treatability" test has meant that in the past, some people who needed treatment to prevent them harming themselves or others did not receive it.

Publishing the Bill, Rosie Winterton said:

"We want people to get the right treatment at the right time. We want to improve the safety of both patients and the public. This Bill will help ensure that people with serious mental health problems receive the treatment they need to protect them and others from harm. It will also strengthen patient safeguards and ensure human rights are protected.

"We are already modernising services, and the Bill is a key part of our strategy to reform and improve mental health care. It will update the law to reflect the way mental healthcare is provided in today's NHS."

Home Office minister Gerry Sutcliffe said:

"Timely treatment for mental disorder is vital in preventing harm to patients and to others. I look forward to doctors having powers to treat patients in the community to address the revolving door problem before their patients relapse and become involved in tragedies to themselves or to the public."

The Bill, which amends the 1983 Mental Health Act and the Mental Capacity Act, was contained in the Queen's Speech 2006. It was introduced on 16 November.

Mental Health Bill 2006
The Mental Health Bill 2006 amends the Mental Health Act 1983. It also introduces "Bournewood" safeguards through amending the Mental Capacity Act 2005. The Bill was introduced into Parliament on 16 November 2006.

Mental Health Bill

Explanatory Notes
Explanatory Notes were published alongside the Bill, to provide information about what the clauses in the Bill do.

Explanatory Notes

Regulatory Impact Assessment
The Regulatory Impact Assessment (RIA) sets out the options for achieving the Government's aims, along with the benefits, risks and costs. It sets out the cost of the proposals in the Bill, and how these costs were calculated.

Regulatory Impact Assessment

Race Equality Impact Assessment
The Government has published a Race Equality Impact Assessment, and the results of consultation.

Race Equality Impact Assessment

Code of Practice and Memorandum
The draft Code of Practice provides guidance for practitioners and others who carry out duties under the Mental Health Act. The draft memorandum describes the main provisions of the Mental Health Act.

Code of Practice and Memorandum

Summary guide
The Government has published a guide to the Bill, which sets out briefly the objectives and contents of the Bill, and provides details about how to obtain further information.

Summary guide

Easy read
This document explains what the Bill does. It was written with the help of people with learning difficulties. You will need to read the full Bill if you need to get all the information. There is a list of "What the Words Mean" at the back of the paper.

Easy read

Briefing sheets
The briefing sheets have been published in order to explain the main changes to the Mental Health Act 1983 and Mental Capacity Act 2005.

Briefing sheets on key policy areas

Mental Health Act 1983 as it will be amended by the Bill
The Mental Health Act 1983 as it would look once amended by the Mental Health Bill.
(Please note: this document has been produced in order to help people understand the effect of the Bill, it should not be relied upon for any other purpose.)

Download Mental Health Act 1983 as it will be amended by the Bill (PDF, 616K)

Mental Capacity Act 2005 as it will be amended by the Bill
The Mental Capacity Act 2005 as it will be amended by the Mental Health Bill.
(Please note: this document has been produced in order to help people understand the effect of the Bill, it should not be relied upon for any other purpose.)

Download Mental Capacity Act 2005 as it will be amended by the Bill (PDF, 568K)

The incidence and impact of over-occupancy in the mental health acute sector

Findings of the Mental Health Act Commission's Bed Occupancy Survey

The report of the independent inquiry published today raises concerns about the care and treatment of John Barrett and makes recommendations for service improvements.

Anne Mackie, deputy director of public health for NHS London (the new strategic health authority for London), speaking on behalf of NHS London and South West London and St George's Mental Health NHS Trust, said:

"Both NHS London and the trust welcome the publication of the report of the independent inquiry and apologise for the failings that it highlights.

"In the last two years, a great many changes have taken place to improve the performance of the trust and the trust's forensic service, not least the appointment of Peter Houghton as the trust's new chief executive in July 2006.

"The public should be reassured that these changes have greatly improved clinical quality and safety. However, there is still much to be done and both NHS London and the trust are committed to learning everything we can from the inquiry report.

"NHS London will be overseeing the trust's response to the inquiry findings, and will be reporting direct to ministers and the national clinical director for mental health Professor Louis Appleby.

Peter Houghton, chief executive of the mental health trust, said:
"Since joining the trust I have had the opportunity to meet members of Denis Finnegan's family and to apologise to them personally. I know that they are concerned to know that improvements have been made - and will continue to be made - to safeguard the public. I have agreed with them that I will keep them informed of the progress we make.

"The inquiry report contains difficult messages for the trust. We cannot undo what has happened in the past. But I would like to make it clear to the Finnegan family and to local people that we are determined to do everything in our power to learn from the mistakes that were made.

"Since September 2004 the management structure of the forensic service has been overhauled and new managers put in place at every level. As a result our staff are now better supervised and supported than ever before, we have better ways of working, and doctors, nurses and other professionals have better systems in place for assessing and managing risk.

"But we, like the strategic health authority, recognise that more needs to be done and welcome the inquiry's recommendation of establishing a service improvement team to build on the changes already underway.

I am grateful that forensic psychiatrist Professor Tony Maden of West London Mental Health Trust has already agreed to lead such a team. Also on the team is Kevin Halpin, director of forensic services at Kent and Medway NHS and Social Care Partnership Trust; Barbara Grey, director of The Consultancy Service at South London and the Maudsley NHS Trust; and Anne Richardson, senior policy adviser at the Department of Health with responsibility for mental health and offenders.

"There are many skilled and dedicated staff working in the trust's Shaftesbury Clinic. They too are deeply sorry for what has happened. Like me, they are determined to learn from this inquiry and, with the help of the service improvement team, will ensure that the trust's services are of the highest possible standard of quality and safety."

Download the report in full - Independent inquiry into the care and treatment of John Barrett (pdf)

This guidance covers the assessment and clinical management of patients with mental illness being cared for in psychiatric inpatient or day care settings who also use or misuse alcohol and/or illicit or other drugs. It also covers organisational and management issues to help mental health services manage these patients effectively.
DoH 30 Oct

Download Dual diagnosis in mental health inpatient and day hospital settings (PDF, 657K)