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Compromise on mental health bill

Health ministers have persuaded David Blunkett, the home secretary, to water down proposals in the mental health bill that would have allowed the compulsory treatment of potentially dangerous people who had committed no crime.

guardian.co.uk 19 Aug

A revised bill will be presented to a parliamentary scrutiny committee next month providing extra safeguards for mentally ill people.

For the past two years Mr Blunkett has been calling for powers to order compulsory treatment in the community for patients who might pose a risk to others, but who were not ill enough to be sectioned to a mental health ward.

He also wanted powers to detain psychopaths who had committed no crime, even if psychiatrists thought their condition was untreatable.

The Home Office had been arguing for such measures in response to public criticism after the case of Michael Stone, a mentally ill man who killed Lyn and Megan Russell in 1996.

The proposals, included in a draft bill in October 2002, caused storms of protest from the Royal College of Psychiatrists and the Mental Health Alliance, a group of voluntary organisations.

They warned John Reid, the health secretary, that threats of compulsory treatment would drive patients away from mental health services.

Under a compromise brokered by Rosie Winterton, the health minister, according to details leaked to Health Service Journal, conditions under which an individual can be placed under a compulsory community treatment order (CTO) will include previous detention for psychiatric care and proof that they are a risk to themselves or others.

Clinicians would have to agree compulsory treatment was appropriate.

Psychiatrists who thought a patient's severe personality disorder was untreatable would not be obliged to give out a CTO. And CTOs could not be used in prisons.

But the Royal College of Psychiatrists said the amendments would not protect civil liberties, and that the mentally ill only committed 4% of murders.

The Department of Health would not comment until the draft was published.

Failure to spot mental health needs in older people leads to their eviction

Older people are being evicted from sheltered housing because their needs are inadequately assessed, a consortium of sheltered housing schemes has warned

communitycare.co.uk 19 Aug

Some older people are ending up in council emergency accommodation, including B&Bs, after being evicted from sheltered housing for antisocial behaviour, the Emerging Role of Sheltered Housing (Erosh) told the National Sheltered Housing Conference in Harrogate last week.

Only when in emergency accommodation will social services assess their needs and identify behaviour problems, for example mental health issues, and place them in psychiatric hospitals or long-term residential care, said Erosh.

The concerns follow research that examined the cases of 20 older people evicted in one month from four London sheltered housing schemes. Seven were evicted for antisocial behaviour, including abusive or violent behaviour, terrorising neighbours and playing their music and televisions too loud. Others were evicted for non payment. Some were reported as throwing their wheelchairs about and wandering naked around their housing schemes.

Erosh deputy chair Meic Phillips said wardens should alert social services of behavioural problems before evicting.
The consortium is calling for local protocols to be put in place detailing which information can be shared between health, social services and the police.

“Social services and the police often say landlords do not need to know, but if a person has a history of violence or a drug and alcohol problem the landlord needs to see whether he can manage that person,” said Phillips.

The National Wardens Association said behaviour problems in sheltered housing was a “growing problem” and access to medical history in certain cases was vital.

An Age Concern spokesperson said: “The chronic under-funding of all areas of social care for older people means many do not get the right support to meet their needs. Older people should be able to get the services they need, when they need them.”

Gloom lifts over mental health cuts

THE future of mental health services in Cambridgeshire looks brighter.

Last month there were fears that vital services run by the Cambridgeshire and Peterborough Mental Health Partnership NHS Trust could be under threat because of a budget crisis.

w3.cambridge-news.co.uk 16 Aug

However, the trust hopes to avoid cutting services in Cambridge and South Cambridgeshire if it can continue to make savings.

The future of services in East Cambridgeshire and Fenland still hangs in the balance.

Primary care trusts in Cambridge, South Cambridgeshire, Huntingdon and Peterborough have all reached an agreement with the trust, which will see them contribute funding to meet the shortfall on services in their areas.

Talks are still going on with the East Cambs and Fenland PCT.

Brian Lanman, the trust's director of finance, said: "As long as we hit the ambitious savings targets we are currently setting ourselves there should not be any major cuts to services in Cambridge and South Cambridgeshire.

"However, we are still experiencing difficulties in East Cambridgeshire and Fenland but we are still pursuing options for savings and holding discussions with the PCT about the way forward."

The trust inherited a £2.5million deficit when it was established two years ago. A £4million deficit was forecast for the end of this financial year if the current level of service was maintained.

Following an overhaul of non-clinical costs, savings of £3 million have been identified. But the trust still needs to save more than £800,000 to meet its legal requirement of a break-even budget.

In June, the trust's board approved a draft strategy including cuts in day services in Cambridge, such as the Young People's Psychiatric Service, reducing staff in adult community teams and closing wards at Fulbourn, Doddington and Wisbech.

MOVING FUNERAL OF FORMER MENTAL PATIENT

The mother of a patient found dead after disappearing from a mental health unit has spoken of her son's "moving" funeral. Daniel Heard, 26, from Crediton, was found at Hele, near Cullompton, in February, five days after he left the Cedars Unit in Exeter.

His body was released to his family only a few weeks ago after a second post-mortem examination which did not uncover any additional evidence.

After the funeral. which was held at St Matthew's Church, Cheriton Fitzpaine, which was attended by Daniel's three sisters, Jackie, 31, Maria, 28, and Jessica, 22, his body was taken to Cheriton Fitzpaine cemetery for burial.

His mother, Lynda Kelly, said: "It was quite a moving day - we saw lots of people. All his best friends were there and I learned a few more things about Dan that I hadn't known."

Last month, Mrs Kelly made an official complaint against Devon and Cornwall Police. She said police had not acted quickly enough when Daniel had gone missing

An investigation will be carried out by Dorset Police and their findings will be reported to the coroner when an inquest is held later this year.

thisisdevon.co.uk 14 Aug

Bosses to be quizzed over closure

Health bosses are to face tough questions at two public meetings about the planned closure of a mental health services unit in north Devon.
It follows a demonstration by users of the service and a call for an explanation over the proposed closure of Hyde House in Barnstaple.

Health chiefs say the closure is part of a plan to improve services for people with mental health problems.

But they also admit they are trying to save more than £4m.

'Not consulted'

Last month, users of the mental health services, and their supporters, held a silent protest outside Hyde House - one of the few rehabilitation centres in the area.

North Devon Primary Care Trust and Devon Partnerships NHS Trust bosses say the closure is to "focus resources on developing home-based services".

But protesters say they have not been consulted about the intended shutdown of the 10-bed unit, which is staffed 24 hours a day.

They fear it is the victim of cost-cutting and will not be properly replaced.

Since the protest, the Primary Care Trust has announced a nine-week consultation period into mental health services in the area.

Health managers will answer questions at public meetings in Barnstaple next Tuesday and Bideford on Wednesday about exactly how they are organising home-based care.

bbc.co.uk 13 Aug

Delivering mental health services for a diverse society

The presentation, management, and outcome of mental disorders differ between ethnic groups. The most consistent findings are that African-Caribbeans with mental health problems are disproportionately found in forensic, psychiatric, and prison populations and among compulsorily detained patients. They are more likely to receive antipsychotic medication and less likely to be offered psychotherapy. Rates of suicide are also higher among some South Asian women and young people of Caribbean origin. These disparities have several causes, but it is difficult not to consider the lack of a coordinated and effective response to them as evidence of institutional racism in mental health and allied services. In response to the disparities and the demands of service users for action, the Department of Health recently launched two policy frameworks: Inside Outside, a new strategy for England, and a consultation document, Delivering race equality: a framework for action. Unfortunately these two documents differ in their focus and emphasis

www.bmj.com 14 Aug

Full Article

That's the amount health chiefs are having to spend each year on buying private care for the city's psychiatric patients because of a shortage of NHS specialist facilities.

A 61-YEAR-old karate fan who stabbed a police officer with a pair of scissors was ordered to spend 12 weeks in a mental health clinic.

George Walker swore and hurled abuse at Judge Stanley Spence as he made the order at Reading Crown Court on Monday. Walker, of Spruce Court in Park Street, Slough, refused to stand and confirm his name and told his barrister he did not recognise the court.

A jury had convicted Walker of wounding with intent to do grievous bodily harm and one charge of attempting to wound with intent to do grievous bodily harm.

They heard how Walker was asked to leave Speedwell Enterprises in Wexham - where he was employed as a craft worker - due to bad behaviour on November 24 last year.

When he did not leave, police were called to remove Walker who then grabbed a handful of knives and scissors and stabbed PC Paul Westmoreland in the back. In a rage, Walker then flew at WPC Nicola Corani.

The court heard Walker struck a kung-fu pose as four officers surrounded him. He was struck twice with a metal baton, punched in his forehead and given a double dose of CS spray before he was brought under control.

PC Westmoreland, 22, said: "It was unbelievable how strong he was. He wasn't complying with our orders to stop struggling and biting."

WPC Corani added Walker was like 'a caged animal' in his desire to escape. "He was staring at me menacingly. He came running at me with scissors raised at shoulder level. He struck a blow and I moved across the room. I felt a thump to my chest. The scissors came towards me in a stabbing motion towards my neck," she said.

David Enoch, defending, said the defendant was 'sad lonely and distressed' when the officers arrived. "He didn't know they were coming. It must have been an enormous shock," he said. "What this rather sad person was presented with was several tooled up police-man."

Walker had denied the charges.

icberkshire.co.uk 12 Aug

Mental health boost

Plans are under way to build a new psychiatric unit in Birmingham in order to save the taxpayer more than £6 million a year.

icbirmingham.co.uk 11 Aug

That's the amount health chiefs are having to spend each year on buying private care for the city's psychiatric patients because of a shortage of NHS specialist facilities.

The £31 million secure unit will cater for up to 70 male patients, many of whom have been transferred from prison and are over-burdening the system.

Health chiefs are considering the Yardley Green Hospital site, in Bordesley Green.

High demand for psychiatric treatment means more than a third of West Midland patients are currently sent to private clinics out of the area - the nearest being Northampton.

Peter Spilsbury, director of health policy at Birmingham and Black Country Health Authority, said that psychiatric services in the Midlands were overloaded with patients.

This scheme will enable 40 patients to return to NHS care and bring back £6.2 million that is currently being spent in the independent sector.

"NHS services are at full capacity and will not be able to cope with the expected further increase in demand for medium secure care for men in prison," he said.

"If no further NHS provision is developed, new patients will have to be admitted to the independent sector, as the majority of cases are urgent."

The cost of caring for each patient through the NHS is up to £30,000 a year cheaper than sending them to be treated privately.

Health authority bosses are to hold a public consultation over the Yardley Green Hospital scheme in coming months, and an outline business case is due to be considered for approval in January.

The new psyciatric unit, including intensive care, rehabilitation suites, a therapy department and an activity centre, will cater for patients from across the Midlands.

Only two similar medium secure units for men exist in the West Midlands - the Hatherton Centre, in Stafford, and the Reaside Clinic, in Rubery, south Birmingham.

GRIFFITHS OFFERS £1 MILLION TO HELP PEOPLE WITH MENTAL HEALTH CONDITIONS BECOME ENTREPRENEURS

Bids are being sought from organisations for a share of £1 million of Government funding to help people with mental health conditions become self-employed, start a small business or social enterprise.

Health and enterprise organisations in England have until 10 September to become one of the eight to ten organisations to benefit from this latest tranche of Phoenix Fund money, designed to help encourage entrepreneurship as a means of tackling social exclusion.

gnn.co.uk 10 Aug

Nigel Griffiths said:

"A high number of people with mental health conditions aspire to work, but often feel that employers have little awareness and understanding of their situation. For some, an alternative to trying to compete directly in the job market is to become self-employed.

"This programme aims to stimulate new and innovate approaches to encourage and help sustain entrepreneurial behaviour among those affected by mental health issues."

Research shows that at any one time, around one in six people of working age suffer from poor mental health with between two and four per cent having a severe mental illness. A significant number will have had professional careers interrupted or aborted by the onset of their condition. Data suggests that up to 50 per cent of individuals with mental health conditions, even those with severe problems, can be helped to obtain paid employment. Recent research commissioned by the DTI's Small Business Service has emphasised the relevance of self-employment for some people with mental health conditions but also found few current examples of support focused on helping individuals pursue such opportunities.

Dr Andrew McCulloch, Chief Executive at The Mental Health Foundation, said:

"People with mental health problems need support to get the jobs they want. We very much welcome this new DTI initiative to help more people get back into work and would encourage those working in the field of mental health to look at putting together bids for this Phoenix funding."

Funding will be used to support schemes that offer:

* innovative approaches to encourage people to activity explore ideas for start-ups;

* practical ways of helping to take forward business ideas and develop them into business plans, including helping people access funding;

* encouragement to individuals to learn business skills

* on-going support to start-ups; and/or

* support to people already in business in circumstances where illness puts the business at risk.

Notes to Editors

1. The Phoenix Fund was established by the Secretary of State for Trade and Industry in 1999 to help promote enterprise in disadvantaged areas and groups under-represented in terms of business ownership. Some £145 million of Government money will be paid out through the fund by 2006. Further information on the Phoenix Fund can be found on the Small Business Service (SBS) website at http://www.sbs.gov.uk/phoenix.

2. A social enterprise is a business with primarily social objectives whose surpluses are principally reinvested for that purpose in the business or in the community, rather than being driven by the need to maximise profit for shareholders and owners.

3. Closing date for applications is Friday 10 September. Invitations to bid were issued in June. Bidding guidance is at http://www.sbs.gov.uk/phoenix. Funding decisions will be made in the autumn following recommendations of an independent assessment panel whose members will include representatives of mental health and business support providers. Funding will not be given to provide direct financial support, such as grants or loans, to individuals or businesses.

4. Research is from the Department for Health's National Service Framework for Mental Health (1999) and Drake, R.E., McHugo, G.J., Becker, D.R., Anthony, W.A, & Clark, R.E. (1996) `The New Hampshire Study of Supported Employment for People With Severe Mental Illness'. The report `Tackling Mental Health Issues Through Enterprise' commissioned by the SBS from MIND and Social Firms UK is available on the SBS website:www.sbs.gov.uk/analytical

Department of Trade and Industry
7th Floor
1 Victoria Street
London SW1H 0ET
Public Enquiries +44 (0)20 7215 5000
Textphone +44 (0)20 7215 6740
(for those with hearing impairment)
http://www.dti.gov.uk

Mental health 'failings' exposed

An independent review into the treatment of two psychiatric patients who killed people while under the care of mental health and social services in Birmingham has condemned the organisations for a catalogue of failings.

A report obtained by The Birmingham Post has called for a radical overhaul of mental health facilities for ethnic minority groups, better working relations between the agencies, and improved staff training.

Birmingham City Council and Birmingham and Solihull Mental Health Trust said steps had been taken to tackle the problems exposed.

The investigation, which was carried out by an independent panel of legal and health professionals, was ordered in the light of the cases of Ogilpis Hamilton and Abdul Rehman.

Hamilton, a paranoid schizophrenic possibly possessing a mild learning disability, killed Lewis Hodge with a machete at his Erdington flat on July 5, 1999, after an argument over burning rubbish. Mr Hodge was also suffering from paranoid schizophrenia and a mild learning disability, and had received treatment from the same NHS Trust as Mr Hamilton - the former North Birmingham Mental Health Trust.

Both patients were on the supervision register at the time but, despite being under the care of the same social services team, officials were not aware they were living in the same housing complex.

Rehman stabbed his wife to death with a kitchen knife in front of his two sons at the family home on February 11, 2000, during unescorted leave from Newbridge House psychiatric unit, Alum Rock, where he had been detained under the Mental Health Act.

Both Hamilton, who had a history of violence, and Rehman admitted manslaughter on the grounds of diminished responsibility. Hamilton was given life imprisonment and Rehman was sent to a secure unit.

The investigation blamed managerial in-fighting, an "ad-hoc" approach to care, poorly integrated services, and a lack of communication between agencies for a failure to provide adequate care for both patients.

Hospital bed pressures were condemned as "intolerable" and health and council bosses were accused of mental health under-funding.

The report also expressed concerns that the recent creation of a single mental health trust for Birmingham, which is required to save £8 million in three years, may lead to "further loss of focus" on "professional practices that are basic to providing safe and effective services on a day-to-day basis".

It has recommended an audit be carried out into finance and expenditure at Birmingham and Solihull Mental Health Trust, created by the merger of the North and South Birmingham mental health trusts last April.

Peter Hay, director of social care and health at Birmingham City Council, said: "The main criticisms in the report centre on a lack of joined up working between health and social care partners.

"The systems that were in place five years ago have been radically transformed. We are working towards pooling budgets with the Birmingham and Solihull Mental Health Trust to provide mental health care in the city. We are also building on our links with local communities to work towards improving services for people from ethnic minorities. The report said we should be proud of the improvements already delivered in Birmingham, but there is still more to be done."

Sue Turner, chief executive of Birmingham and Solihull Mental Health Trust, said: "We hope this review - together with the improvements we have already carried out and those we are in the process of making - will reassure the families that lessons have been learned to improve services and minimise the risk of further similar tragedies.

"Since the trust's merger with South Birmingham Mental Health Trust in April last year, leading to the formation of Birmingham and Solihull Mental Health NHS Trust, much work has been carried out to improve services. Some of the recommendations included in the review of Mr Hamilton and Mr Rehman's care and treatment had already been identified by us and action taken to improve services."

icbirmingham.co.uk 9 Aug

MENTAL HEALTH UNIT GETS THE GO-AHEAD

Concerned residents have criticised a health care company for not consulting them over plans to house mentally ill people near their homes.

thisislincolnshire.co.uk 9 Aug

Hemswell Cliff residents have spoken out against Worcester-based Craegmoore Healthcare for not giving them a chance to voice their worries over an extension to Glentworth House - a care home for people with mental health problems.

The private health care company wants to expand the facilities at the site in Dog Kennel Road so it can house more patients who suffer from conditions including paranoid schizophrenia.

A spokesman for the company said that planning permission for the development had been granted by West Lindsey District Council.

"We can confirm that the development will provide long-term sustainable care for service users with mental health problems," he said.

"It is being developed in conjunction with the appropriate local authorities and in line with Government policy, and will see the relocation of service users, currently placed across the country, in care local to their home community."

But mum-of-three Lisa Pearce of Creampoke Crescent, Hemswell Cliff, said that she had not known of the company's plans until the Echo informed her.

"It is an important issue for us and they haven't even bothered to write a letter - it's not good enough really," she said.

"I imagine that if I ever want to sell my house it would be extremely difficult with a development like this so close."

The 28-year-old, who has just moved to the area, said that security at the site was also an issue.

"I have three young children and I would want some reassurances that the patients would not be a threat and that they will be controlled," she said.

At present the home provides residential and day care support for mentally ill patients and has a sensory garden, sauna, swimming pool and relaxation therapy equipment.

Life skills and education training are also offered.

Carole Mcpherson (53), of Creampoke Crescent, said that she wanted to avoid accusations of a "not in my back yard mentality", but she does have concerns.

"Since it opened 10 years ago we've had padlocks on our gates because the patients used to wander in and out of the gardens," she said.

"They have tightened security since then, but if numbers increase I think we all want a bit of reassurance that we are not in any danger.

"I'm not sure the location is right, the patients wander down the A631 on their own and people are very concerned about it."

BEDS COULD GO IN MENTAL HEALTH CARE SHAKE-UP

The Nhs trust that runs mental health services in the Bristol area is set to cut 13 beds in a cost-cutting move to reduce its £2.5 million overdraft. Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) said the beds would be cut from the Blackberry Hill Hospital site in Fishponds and replaced with nine paid-for residential care places.

Under the re-organisation, 12 adult care beds provided at Thornbury would be moved into Blackberry Hill.

The current Oakwood House site, for patients living in South Gloucestershire, would move to Southmead Hospital.

The plans are part of the trust's attempt to recover a recurring £2.5 million debt by 2006.

Much of the debt is related to agency nursing and medical locum costs, and to sending people out of the area for services.

The trust is currently undergoing massive changes. A new facility is being built on a site on Callington Road, Bristol, and other beds are being provided throughout the city along with community care teams.

The proposals have been agreed by the region's joint health scrutiny committee and the trust is now set to talk to local people and other healthcare providers about the plans.

Fred Inman, Avon programme director for AWP, said that the move was designed to have a "minimal disruption" on services.

He said: "Over the last four months the trust has been working with the Primary Care Trusts (PCTs), partner organisations and service users to see if services could be provided more efficiently.

"We now have a range of options for change which the trust and the PCTs want to discuss with a wider group of local people.

"The options include increasing the number of high dependency beds in Bristol and South Gloucestershire, establishing a new round-the-clock crisis and home treatment team in South Gloucestershire and expanding the Avon-wide high dependency rehabilitation service from 12 to 28 beds to allow more people to be cared for closer to home."

It is hoped that clear proposals for change will be drawn up after feedback from local people and groups has been received. If appropriate, a formal consultation process would then take place later this year or early next year.

thisisbristol.co.uk 6 Aug

Mental health unit gets the go-ahead

COUNCILLORS have given planning permission for a mental health unit in Meriden, on the site of the former Penderels nursing home in Showell Lane.

Permission to knock-down the existing building and replace it with a 22-bed acute unit, housing people with a variety of symptoms from the West Midlands, was given to Castlebeck Care (Teesdale) Ltd despite opposition from Solihull Primary Care Trust.

Although the decision is subject to approval from the Deputy Prime Minister it has left many villagers feeling angry, claiming they were not aware of an initial application to change the use of the site.

Opponents to the proposal also expressed surprise that councillors granted permission to increase the size of the building on the site after three other applications to do so were turned down in the past four years.

Cllr David Bell (Con, Meriden), who spoke against the proposal, said: "It doesn't make sense to me. "I presume the support was on the basis that Castlebeck would have a case on appeal, though it wasn't mentioned at the meeting." "The residents have been fighting various proposals, and suddenly this is dumped on them citing special need.

"It seems the green belt is protected until there is a special need, even though there is greater need for nursing homes for old people in the borough."

As reported in the Solihull Times last month, Solihull Council sent letters to neighbouring properties and placed a notice on the street, but no objections were received and residents say they did not receive or see a notices informing them of the proposal.

Cllr Stuart Davis who chaired the committee last night said: "We were mindful of local feelings, but in view of the report and the applicants it was felt that this would be a good place for one of these units."

icsolihull.co.uk 6 Aug

MENTAL HEALTH RATINGS ARE QUESTIONED

MENTAL health organisations in Woking have questioned the NHS performance ratings recently published.

The North West Surrey Mental Health Partnership NHS Trust achieved two stars in the ratings.
The results, compiled by the Healthcare Commission, the NHS’s independent regulator, showed good overall performance.
Michael Andrews is branch co-ordinator of Woking Mind, which provides a range of services, including counselling, employment and training for those suffering from mental health difficulties.
He said: “Progress is being made but it is slow.
“The trust seems to be having trouble improving patient choices and information about their care and the figures do not seem to reflect that.”
The Healthcare Commission ranked the trust against seven key targets, including community outreach and hospital cleanliness and 31 performance indicators, ranging from waiting times to child protection.
The trust received two stars and rated particularly highly in areas relating to patient focus, including privacy and dignity and outpatient bookings.
Yet it “significantly underachieved” in its financial management.
Suicide rates, data quality on ethnic groups and out of catchment area treatment for adults were given a score of one in the performance ratings, labelling them poor.
According to the ratings, the trust provided more than 98 per cent of its service users with a written copy of its care plan.
Mr Andrews said several members of Woking Mind were still waiting for a care plan.
He said: “It is wrong to assume most of the service users have a copy of their care plan when I know members who have not.
“The trust also seems to have problems with communicating with voluntary services, enabling them to work together.
“If services are not working together it means people are pushed between the two and cannot get the help and support they need.
“We are talking about real people and the report does not seem to highlight real problems.
“Money spent on the survey could be better spent on helping people that need it and improving services.”
David Rainford, group facilitator for the Woking branch of the Depression Alliance, said: “Sometimes it can be difficult to find the right people to liaise with at the trust.
“Members can become quite frustrated when they are not given access to patient services which are on offer.”
Jill Jarvis, director of nursing at the North West Surrey Mental Health Partnership NHS Trust, defended the results.
She said: “We are celebrating the fact we achieved two stars by the Healthcare Commission.
“It reflects a lot of hard work and an organisation that wants to improve.
“Nearly one in three trusts had one star or less and in Surrey we have done much better when compared with national trends.
“The fact we have gone from one to two stars means we are not complacent and we are doing everything we can within financial constraints.
“The results reported were taken from the service users survey and these were opinions of the people who use our services.
“With regard to care plans, we have done comparatively well in the performance ratings but we will still be putting into place action plans to improve.
“We also work closely with many groups and would welcome the opportunity to work with others if they wish to contact us.”
For further information contact 01932 872010.

woking.co.uk 5 Aug

Plea over community treatment for mentally ill

The Irish government should establish community-based services to look after people with mental health problems rather than force them into hospitals, a watchdog said today.
The Mental Health Services Inspector Dr Teresa Carey said an individual approach to treatment needs to be taken by service providers and agencies across the country.

Dr Carey said: "The reason people end up being involuntarily detained in hospitals is that it hasn`t been possible for one reason or another to get treatment to them in time."

At the launch of the inspectorate`s first annual report, Dr Carey said, the irish government funding for the mental health area should be doubled as the sector has gone unacknowledged.

The commission`s report said the area was "seriously under-funded" as it received only €680m (£450m) or 6.8% of the health budget last year.

In the mid-1980s the funding was in the region of 12% of the health budget.

Stephen McMahon of the Irish Patients` Association said it was disturbing to hear that almost 2,000 patients had been waiting for 20 years to get treatment in the community.

Mr McMahon said: "There is a lack of information in the public about mental health."

The chairman of the Mental Health Commission, Dr John Owens, said it was "unconscionable" that around 2,400 people were being involuntarily admitted each year.

Phyllis Fitzgerald of the voluntary mental health organisation, Grow, said more effort must be made to ensure people do not return to hospital.

"They come out of hospital without being given the information they need. They come out to a family that maybe doesn`t understand how to deal with them," Ms Fitzgerald said.

Dr Carey said people with schizophrenia and severe mood disorders were the ones who tended to be involuntarily admitted and there needed to be more thorough records kept to show how many were readmitted.

The report also stated there was concern at the recent rise in suicide rates, particularly among young males.

"Developing our primary care system is critical. Young people would probably be far more comfortable going to see a general practitioner than going to see a psychiatrist," Dr Carey said.

The report showed there was a lack of services for children and adolescents and Dr Carey said young people must not be intimidated by the system.

The commission`s report described the number of beds available for young people as "wholly inadequate".

The 2001 Mental Health Act, which established the commission, also outlined examining tribunals which will be up and running later this year.

The commission said the Mental Health Tribunals would give involuntarily detained patients fundamental rights.

The tribunal will meet and review anyone who is detained in a mental hospital against their will.

The inspector also said the Criminal Law (Insanity) Bill from 2002 must be given careful treatment.

Dr Carey said any new legislation must not transform general psychiatric units into secure facilities.

u.tv 4 Aug

Website of the Mental Health Commission

Patient safety programme to safeguard mental health service users

A project to improve the safety of mental health service users by creating a safer environment on acute psychiatric wards was announced today by the National Patient Safety Agency (NPSA).

This is the first project in an extensive programme of work developed by the NPSA to ensure that services for people with mental ill-health in England and Wales are provided in the safest way possible.

Unsafe wards pose risks to both patients and staff and the NPSA is making a major contribution to work being carried out by a range of organisations involved in promoting safer mental health services. The Agency will work with frontline staff, service users and other key stakeholders in the mental health field to develop safety measures to be piloted.

To date 40 NHS Trusts in England and Wales have signed up to work with NPSA on this project.

NPSA Joint Chief Executive Sue Osborn said:

“Previous work has already identified the features and factors that optimise ward safety. The focus of our work will be to determine what prevents these features from being put in place and maintained. We will also concentrate on identifying and understanding systems that exist on acute psychiatric wards and how these can be managed to improve safety. “

“The factors that make a ward safe are often the same as those which make a ward therapeutic. If we find solutions to the problems of ward safety we will also improve the quality of the whole experience of in-patient psychiatric care for both patients and staff.”

Factors that contribute to an unsafe ward environment, which will be considered as part of the project, are:

Lack of social and therapeutic activity for service users
High turnover of staff
Poor physical environment
Bed pressures
Lack of staff leadership
The issue was identified as a priority for action when a breakdown of data from the pilot phase of the NPSA’s National Reporting and Learning System (NRLS) showed a high number of mental health patient safety incidents related to in-patient wards.

Consultant Psychiatrist Professor Paul Lelliott, NPSA’s Clinical Specialty Advisor for mental health and Chair of its Mental Health External Reference Group said:

“The NPSA is able to give a unique focus to improving the experience of many service users of acute inpatient care. By focusing on the causes rather than the symptoms, the project will, in partnership with both service users and front line practitioners, be able to address many of the issues that have led to unsafe environments for both groups.

“By collaborating with other national projects that will have an impact on the future of acute psychiatric inpatient care the NPSA is able to ensure that patient safety is at the heart of this important work.”

The NPSA mental health programme is also working on or involved in a number of other patient safety issues. These include:

Developing safe practice in relation to the management of violence and aggression. A small but significant number of mental health service users have died following restraint either in a police cell or psychiatric hospital. The National Institute for Mental Health England (NIMHE) has published draft guidance for consultation. The NPSA is supporting this work through the joint appointment of a project manager to oversee the implementation of the guidance and the development of an accredited national training programme for the safe management of violence and aggression.
The safe application of cardio pulmonary resuscitation (CPR) and safe medication practice. This work has arisen from the findings of the inquiry into the death of David Bennett, the mental health service user who died in 1999 after being restrained in the Norvic Clinic in Norwich. Amongst other issues highlighted by the report the need to have well trained staff in relation to CPR and appropriate equipment readily available was recommended.
The prevention of suicide in older people. Older people may be vulnerable to the onset of clinical depression for the first time. Failure to recognise this within primary care and refer to specialist services may lead to avoidable death through suicide. The NPSA is examining the patient safety aspects of this issue.
Endorsements for the NPSA’s Mental Health Programme of Work

Malcolm Rae (OBE), Joint Lead, Acute Care Programme, National Institute of Mental Health in England (NIMHE), says:
“The launch of the NPSA’s mental health programme is timely, topical and contributes to the development of a more enlightened mental health system which aims to be service user centred and more responsive to their needs.

“Of particular note is the focus on the creation of a safer environment on acute psychiatric wards as patient and staff safety on wards are of critical importance.

“The NPSA’s approach to the management of aggression, for example, is very sound, and it is encouraging that rather than looking at ways to handle disturbed behaviour the NPSA will be using a whole systems approach to identify the causes of problems. This solution-orientated approach with an emphasis on the environment, processes and leadership will prove beneficial in the prevention of disturbed behaviour occurring in the first place.

“One of the key challenges in this work will be to equip staff with sufficient knowledge, awareness and confidence to improve the safety of patients, staff and visitors to acute wards.

“I’m also very pleased that the NPSA is focussing on older people and physical health which are areas of mental health which have been neglected in the past. The focus on the safety of older people will assist in improved assessment at an earlier stage and safer interventions. With the move to a more holistic approach to healthcare the NPSA initiative on physical health has the potential to raise awareness of the strong relationship between physical and mental healthcare and to significantly improve the unmet physical healthcare and lifestyle needs of service users.”

Simon Lawton-Smith, Senior Policy Advisor, Mental Health, the King’s Fund, says:
“The NPSA’s work on creating a safer environment in acute psychiatric wards could hardly come at a better time. The King's Fund's Inquiry into mental health in London, published in November 2003, highlighted the poor ward environment that many patients experienced, even to the extent of feeling their lives were in danger.

“Both patients and staff should expect their experience on wards to be positive and therapeutic. We don't underestimate how difficult this can be. Many patients have complex needs; there are problems with staff shortages; and the fabric and design of many wards is poor. But we have high hopes that the NPSA project will point to real solutions to these problems.”

Terry Butler, Director of Social Services for Hampshire and Joint chair of the Association of Directors of Social Services Mental Health Committee, says:
“The ADSS is delighted that the NPSA’s holistic approach reflects the way in which health and social services are coming together to deliver services.

“In many areas across the country, mental health services are provided through fully integrated teams and increasingly the commissioning of services is also integrated. It is therefore vital that the NPSA’s approach addresses safety issues across acute, primary and community settings for patients, service users and carers.

“The solutions across the NPSA’s mental health programme will impact on staff in a social care setting. ‘Transfer of care’, for example involves health and social care staff, and it is good that the NPSA has recognized the important role that social care plays in mental health care.

“We look forward to our continued involvement in the development of this programme.”

Dr Mike Shooter, President of the Royal College of Psychiatrists, says:
“The Royal College of Psychiatrists shares the NPSA's commitment to improving the safety of people with mental health problems. In particular, it welcomes and looks forward to working with the NPSA to create a safer environment on acute psychiatric wards.

“For too long psychiatric wards have been neglected as attention and resources have been focused exclusively on developments in community care. As a result, many people with the most severe forms of mental illness are cared for in old, shabby wards not suited to their needs. Also, these wards are often inadequately staffed. These factors, coupled with low morale and high turnover, make it difficult for staff to provide safe care.

“The College, through its Research Unit, has published guidelines about ward safety and co-ordinated a series of clinical audits over the past five years that have highlighted the problems. The time has now come to find answers to these problems.

“The College believes that some improvements can be achieved by changing the way in which these wards are managed. However, it is inevitable that the real improvements in safety will require financial investment to transform wards so that they meet the expectations of patients and staff.”

Chris Heginbotham, Chief Executive of the Mental Health Act Commission says:
“The Mental Health Act Commission (MHAC) supports fully the importance given by the National Patient Safety Agency (NPSA) to the development of safe, supportive and effective mental health services. People using mental health services are often very vulnerable and should be provided with services of a consistently high standard.

“The MHAC is concerned especially with people detained and treated under compulsorily. Many of these patients and service users are not able easily to demand improvements in care. Recent inquiries, such as that into the death of David Bennett, have highlighted many shortcomings in services that must be addressed, including the need to tackle discrimination and the fear that many patients have about the way they may be treated.

“The roles of the MHAC and NPSA are therefore vital in protecting the rights of patients and service users, and in ensuring that services are safe, relevant and appropriate. The MHAC welcomes the NPSA initiative and will continue to work with the NPSA and other agencies for continuous improvement in mental health services.”

Ian Hulatt Mental Health Adviser, Royal College of Nursing says:
"The RCN is happy to add its endorsement to this programme of work. We are keen to see work undertaken that identifies creative and innovative ways that may enhance the patient experience for service users and nurses alike. For too long this has been a neglected area within service development.

“Opportunities are now arising to address the environment within which individuals are cared for. We wish to see in-patient areas transformed into a positive experience for individuals with mental health difficulties, their carers and families The RCN believes this work will contribute to that process."

Phillip Chick, Director of Mental Health Services, Welsh Assembly Government says:
“The NPSA has recently developed a work programme focused upon the needs of mental health patients. As Director of Mental Health Services for the Welsh Assembly Government and a member of the NPSA Mental Health External Reference Group I am wholly supportive of this initiative. The decision to begin with a focus on the creation of a safer environment on acute psychiatric wards with future work addressing the needs of older people and the physical health care of people with a mental health problem is welcomed.

The programme is in keeping with the Welsh Mental Health Strategy and National Service Framework.

The NPSA work in mental health is vital in addressing the need for safety among some of the most vulnerable users of NHS services. People admitted to mental health inpatient facilities are frequently experiencing a crisis due to severe mental distress. In order to provide them with the care and treatment they require, wards need to be safe places where the service user’s appropriate right to privacy and dignity is upheld. The roll out of the NPSA’s first initiative should assist in making a real difference to the quality and safety of mental health ward environments.

The Welsh Assembly Government is about to undertake a priority risk review including all mental health inpatient facilities for adults of working age and older people which will include the engagement of service users through patient panels. This work and the NPSA acute ward work will complement each other and should make a positive improvement to mental health facilities in Wales.”

Notes for Editors:

For further information please contact Alison Pitts-Bland on 020 7927 9520 or Olivia Lacey on 020 7927 9363 in the NPSA’s communications team.

National Patient Safety Agency

Patients kept in dark about care

Many NHS patients say they are not involved enough in decisions about their care, a survey reveals.
The Healthcare Commission quizzed 300,000 patients and found most wanted more input into their care, especially those with a mental illness.

Of 27,000 people using mental health services, 15% said they did not have enough say in care decisions and 44% only had a say to some extent.

Nearly a fifth said their diagnosis had not been discussed with them.

Lack of information

Contrary to recommended national standards, less than half of mental health service users had access to crisis care, such as a phone number of someone in the service that they could call out of hours.

In some of the 568 English NHS trusts examined, only a quarter had access to crisis care.

Only half had been given or offered a written care plan and only half had received at least one care review in the last 12 months.

About a third had not received help with getting benefits and another third had not had received help with finding work.

Over three quarters of people using mental health services were happy with the standard of care they received, however.

This was the first survey of mental health services by the Healthcare Commission. It also looked at the ambulance service and young hospital patients for the first time and revisited adult inpatient services and primary care trusts for the second time.

The responses echoed those for mental health services.

Although most had trust and confidence in clinical staff, nearly half of adults in hospital said they would have liked to be more involved in decisions about their care and treatment.

A fifth thought they had been given too little information.

Nearly a third of people visiting GPs said they were not involved in their care as much as they wanted to be.

Confusion

Half of young patients said they wanted to be more involved in their care and about a third said they had not understood information given to them by their doctor or nurse.

A fifth of patients said they did not fully understand the ambulance crew's explanation of care and treatment.

The Healthcare Commission's chairman Professor Sir Ian Kennedy said: "While there has been a great improvement in communication between NHS staff and their patients there is still much to be done to ensure that patients understand the information they are given and can influence decisions.

"Asking patients what they think about the care and treatment they have received is an important step towards improving care for patients in hospitals and other health services."

Mental health charity Mind said the true picture was worse.

Richard Brook, chief executive of Mind, said: "It only tells part of a very mixed picture. Mind's work suggests people get even less information about their diagnosis and treatment than this survey suggests.

"Reading between the lines of this survey, mental health care remains very much a hit and miss experience in twenty-first century Britain."

It will publish a report in September revealing over a quarter of people who had been in-patients said they rarely felt safe while in hospital.

National Director for Mental Health, Louis Appleby, said: "The survey shows that most people who are under Mental Health Care are positive about the service they receive.

"It's time to recognise the excellent work of mental health staff around the country. Too often their efforts are denigrated by critics of mental health services and these criticisms are wrong."

But he added: "I'm not complacent about the less positive parts of the survey. Improving access to help for people in crisis is a priority."

A spokesman from the Sainsbury Centre for Mental Health said: "Speedy access to help in a crisis is still lacking for many people.

"Extra investment in better crisis care, without denuding the rest of the service of resources, will be needed to meet the new target of offering it to all who need it by the end of next year."

Margaret Edwards, head of strategy at the mental health charity SANE, said: "It is completely unacceptable that so many of those using mental health services are not given information critical to managing their illness, despite the fact that nearly a third of those surveyed were living alone.

"These findings, together with the recent star ratings of mental health trusts, show that in many parts of the country the NHS is still failing to provide the fundamentals of mental health care."

Liberal Democrat Shadow Health Secretary Paul Burstow, said: "These results demonstrate yet again that simply talking about choice of hospital misses the point. Some of the most vulnerable patients are not even being given a say in how they are treated."

Rethink's chief executive Cliff Prior said: "This survey confirms the findings of our own research over the past three years: the positive effects of mental health reforms have yet to be felt by everyone on the front line."

Lord Adebowale, Chief Executive of Turning Point said: "Too often people are expected to fit into services rather than having health and social care provision designed around their needs.

"It is a poor reflection on service delivery that we are still arguing that service users should be centrally involved in decisions that directly affect their lives."

Conservative Shadow Health Secretary Andrew Lansley said: "The surveys...give clear confirmation that patients want more choice in healthcare.

"We will ensure everyone has the right to make an informed choice about the NHS treatment they receive."

bbc.co.uk 4 Aug

Mentally ill man now hospitalised

A man has been detained at Ashen Hill Mental Hospital in East Sussex after wrecking his parents' home.
Nicholas Squires, 32, who suffers from paranoid schizophrenia and lives at Dawlish Close, Brighton, pleaded guilty to arson, criminal damage and affray.

At Lewes Crown Court, he was ordered to be detained indefinitely.

Defending, Jonathan Edwards said Squires had not taken his medication at the time of the offences in January and had not intended to harm his family.

Telephone call

He said that the attack had been a cry for help.

The court heard that Squires had telephoned his father, mother and sister and told them "their nightmare was about to start".

He arrived at their address in Cherry Lane, Bolney, with a can of petrol and smashed his way in and began wrecking the house, where the family barricaded themselves into the kitchen, the court was told.

Police had to use CS spray as Squires believed officers were trying to kill him and make it look like an accident, the court heard.

The court was told that he had earlier set fire to a mattress where he was staying, believing it was infested.

Squires had previous convictions for driving while unfit through drink or drugs and possession of an offensive weapon.

bbc.co.uk 4 Aug

'Psychiatric services failed me'

Many people who have used mental health services have been unhappy with the care they received, a Healthcare commission survey has revealed.
Michelle Roberts spoke with one man about the psychiatric care he received for manic depression over the last decade.

John, 45, described the experience as cold and alienating, with little support from overworked staff.

He wishes to remain anonymous because of the stigma he says is still attached to mental health problems.

John has manic depression, also known as bipolar disorder.

It is called bipolar because the symptoms swing from deep clinical depression to episodes of extreme mania, where sufferers are gripped by an uncontrollable energy and euphoria.

Over the last 10 years he has been admitted to a psychiatric unit three times, each for around three months.

These were nightmare times for John, which were not eased by the care he received.

"The environment is very cold. It's very alienating. You just get put into the system.

"The way they treat you is they know your symptoms and they know how to treat you and you are just part of the system. The system deals with you and you have little input into your care.

Left out of decision making

"You are left at the mercy of the psychiatrist who you probably only see once or twice during your stay," he said.

John said he rarely got to see the psychiatrist in person and the nurses and healthcare assistants were too busy to talk with about his care.

"They have no time to see you. They give you all 'Come back in half an hour I'm busy now'.

"They put you off because they know what you are going to say to them but they have no power to change your medication, to change your regime without the psychiatrist.

"You feel frustrated, you have the side effects of the medication and then you are having to deal with other patients that are there."

He said it was very frightening being on a ward where patients were sometimes violent and the doors were locked all the time.

"I've got manic depression and I'm having to deal with some who is schizophrenic, someone who is catatonic schizophrenic and someone who is depressive and so on.

"The people you really want to talk to are the nurses and the staff but they are not there for you."

Lack of amenities

He said the amenities were poor or non-existent.

"The food is absolutely terrible. It's all precooked. There's nothing fresh to eat. You have to rely on your friends and relatives to bring you food.

"You don't really have anywhere that's comfortable - somewhere that's nice for you to sit.

"The only privacy that you get is if you pull the curtain around your bed. You are in an open ward.

"There was only one visiting room and that was a sort of dining area which was not private. The doors were open, the nurses were in the room and other patients. It was just like a prison ward," he said.

John was also disappointed with the support he received to get his life back on track after he was discharged.

"There was no help with benefits. Having received this diagnosis and being unable to work I was entitled to benefits.

"But the nurse could not help me, the doctor could not help me, the social worker could not help me with filling in the forms.

"You are looking for a bit more from them considering how they treated you in hospital. They were completely in control of your life.

"You could not do anything without their approval and when you leave you are on your own. 'You are well, you are not sick any more, we have done our job' so to speak," he said.

John said people with mental health problems and their families needed more support to understand these illnesses.

"The doctor only has five or 10 minutes for you and that's it.

"You need to sit down with somebody who can explain to you what your illness is and how it was caused," he said.

bbc.news.co.uk 4 Aug

Critical report on patient death

A report into the death of a mentally ill man stabbed by another patient at a care home has questioned how the two men came to be in the same place.
Joseph Day, 22, was killed by Joe Janes three years ago in Folkestone, Kent.

The report, issued on Wednesday, said a risk assessment should have been conducted and criticised communication between health and social workers.

Mr Day's mother, Penny, claimed her son would still be alive if health workers had done their jobs properly.

Mr Day was stabbed on 15 July 2001 by 19-year-old Janes, a schizophrenic with a history of violence.

Janes had only arrived at Willow Lodge, a "halfway house" in Folkestone, three days earlier.

He was found guilty of manslaughter through diminished responsibility in March 2002 and ordered to be detained for an indefinite period under the Mental Health Act.

The report into Mr Day's death found there had been a lack of communication between social services and the NHS and questioned why they had not talked to each other more.

The report also questioned why the two men were being cared for in the same premises and said a risk assessment should have been carried out before Janes was placed at Willow Lodge.

It identified a chain of missed opportunities where Janes could have been prevented from being at the hostel.

Mr Day's mother, Penny, said she was still not happy after the report's publication.

She said: "I still have not got any answers as to how they could allow a dangerous person into a halfway house that was for vulnerable people."

Candy Morris, chief executive of the Kent and Medway Strategic Health Authority, said she felt "sad and sorry" about what had happened but procedures had since been tightened.

"I am really pleased that the report has finally been made public and that we are able to make clear the commitment and the determination to improve services for the future," she said.

bbc.news.co.uk 28 July

Mental health trusts appeal against falling star ratings

Two mental health trusts have appealed against the star ratings recently awarded by the Healthcare Commission.

Derbyshire Mental Health Trust and another as yet unidentified trust have said there are unhappy with their fall in the ratings.

“Our overall score has been adversely affected by inadequate information systems, which we acknowledge and already have an action plan to address,” Chief Executive of Derbyshire Mental Health Services Mike Shewan said.

The Trust met five of the seven key targets but failed to reach the required standards for the assertive outreach service and the mental health minimum data set, he said.

A Commission spokesman told Community Care that all mental health trusts needed to be better at providing information and collecting data.

“Mental health trusts are not under as much scrutiny as [better performing] acute trusts, which have become used to clinical and corporate governance,” he said

Six primary care trusts, four acute trusts and two mental health trusts have challenged their new star ratings.

“The performance of mental health trusts remains a cause for concern, with more than a third still having one star or less,” the Commission said when the ratings were published on July 21.

“The quality of the information available in these organisations, so they can monitor effectively the care of people who use mental health services, also needs improvement,” it said. However the Commission said this year’s ratings showed overall the NHS was improving.

“More trusts have been given three star and two star ratings and 93 per cent of acute trusts have no-one waiting more than nine months for in-patient treatment.”

The closing date for trusts to appeal the commission’s ratings is August 6.

www.communitycare.co.uk 30 July

Go-ahead for mental health centre

A MENTAL health centre for young people has been given the go-ahead despite fears from neighbours of a potential increase in anti-social behaviour.

Families and businesses in West End Street, off Dereham Road, complained about plans to turn former offices into a health care centre for youngsters suffering from psychotic illness.

But members of Norwich City Council's planning committee unanimously approved the proposal following a lengthy debate at City Hall.

The applicants, Norfolk Mental Healthcare Trust, will now be looking to establish the facility, which is aimed at helping people aged 14 to 35 to come to terms with mental illness and at helping to educate their parents.

At yesterday's meeting, Nicholas Bishop, team leader of the new Norwich Early Intervention Team, told the committee it would be a low-key health centre offering a non-threatening environment to provide advice, information and support.

"Early intervention is about nipping psychosis in the bud very early. It is not our approach to get people involved in institutions. We want people to continue with their every day lives."

Mr Bishop said the centre would see about 16 people per week and there would be no gathering around outside. He added there had been no anti-social behaviour problems outside the trust's facility in St Stephens.

David Bradford, member for Crome, agreed there was a need for this type of facility, which could benefit the whole community in the long run.

"I can understand the fears of residents. Potentially we are all clients. About one third of the population has mental health problems at some point in their life. Many people affected are in my ward in Norwich Prison because they have not been able to access these services at an earlier stage in their lives. We need to help people before they become criminals."

Dawn Castle-Green, member for Mancroft, said she was concerned people in her ward had not been fully consulted.

"They have a great concern about this location. The letters that were sent out did not quantify the proposed use of this building very well. It has put a sense of fear in."

Judith Lubbock, chairwoman of the committee, told objectors at the meeting there had been consultation.

"Letters did go out to immediate neighbours. The point is that you are here and you are voicing your concerns and they have been addressed."

Council officers told the committee that neighbours feared such a facility would exacerbate existing anti-social behaviour in the street.

Patricia Davies, of nearby Nelson Street, said she was disappointed that only seven nearby properties had been written to.

"I am very unhappy about this. We don't feel there was enough consultation.

"I think they ignored the issues and they did not read out the letters from the objectors. Who knows in the future what this facility will become? Eventually it could become a drug and alcohol addiction treatment centre."

www.eveningnews24.co.uk 30 July

MENTAL HEALTH ISSUES MUST BE ADDRESSED

Experts say many asylum seekers suffer mental distress due to previous traumas they have experienced such as war or imprisonment. In part it is a result of the uncertain future they are likely to face in their new countries. When arriving in the UK there is no compulsory procedure at a national level to check out their mental wellbeing.

In some areas they can be screened at induction centres and currently, 95 per cent of asylum seekers are taking up the offer.

However, in most cases, the National Asylum Support Service (NASS) makes accommodation providers responsible for arranging initial assessments when people settle into communities.

In Stoke-on-Trent, an asylum seeker nursing team offers a drop-in service at St Augustines hostel, at Cobridge.

New arrivals are scheduled for an assessment from the team and if they are found to have mental health needs, they are given a second assessment by a psychiatric nurse. The nurse can then refer the patient to the appropriate mental health service for further treatment. There are also two mental health educators focusing on the Kurdish and Afghan community in North Staffordshire.

However, current arrangements cannot guarantee that nobody slips through the net and it is often left to individuals to approach their GPs for help.

Many do not, for a variety of reasons such as language barriers and a lack of knowledge of rights.

Dave Newall, project leader for the Asylum Seeker and Refugee team at Citizens' Advice Bureau, said: "We need a system which identifies mental health issues very early on and I'm not sure that's happening. We have seen a number of people moved into Stoke-on-Trent by NASS who are already receiving treatment but there has been no hand over to mental health services here.

"So there is then a delay in support which is not good - we are talking about people who have a high level of stress."

North Staffordshire Kurdish Community Association project manager, Hashim Farraj said: "Home sickness is one of many reasons asylum seekers can feel depressed - this is a different country and very difficult when they don't speak very good English."

www.thisisstaffordshire.co.uk

Mental health cuts

MORE than £2 million worth of cuts have been earmarked for mental health services in Redbridge to help meet a funding crisis at the North East London Mental Health Trust (NELMHT).

The changes will see more community-based support for people with mental health difficulties rather than hospital-based treatment.

A meeting of Redbridge Primary Care Trust (PCT) saw a report outlining a shake-up in mental health provision designed to meet the funding gap by shifting care towards the voluntary sector and community based treatments.

With the emphasis on 'alternatives to admission', services based at Goodmayes Hospital would be among those facing the biggest changes.

Among the savings identified at the hospital are:

The closure of one of the frail elder continuing care clusters at Meadow Court with the loss of ten to 12 beds.

Closure of the acute in-patient East Forest Unit
Closure of the vocational rehabilitation unit
Closure of continuing care beds in the Martha ward.

Earlier this year a review commissioned by NELMHT urged the immediate closure of the 26 bed Martha ward which provides rehabilitation for older people.

It said: "The ward is old, in poor repair, and totally unfit for use as a modern psychiatric rehabilitation ward."

The review team, however, praised the work of the vocational rehabilitation service as 'excellent', pointing to the involvement of service users in its design and planning.

Redbridge PCT said that the measures had yet to be agreed and that consultation would take place with service users and the public before any decision was made. Director of modernisation and corporate services Jane Mehta said: "The PCT and NELMHT are in the process of reviewing the needs of mental health patients and our review is suggesting a number of areas where we may wish to change the current level and type of provision.

"There is national evidence to suggest that patient health outcomes will improve if we provide more community-based care and support people to stay out of hospital."

The task group charged with drawing up the proposals will report back to the board in October.

www.wansteadandwoodfordguardian.co.uk 30 July

Small firms warned over mental health laws

Small firms have been warned that they will soon be at risk from legal action taken by employees claiming they have been discriminated against due to mental illness.

Under legislation set to be introduced in October, staff with mental health problems will be given the same rights as those with physical disabilities.

The new rules, part of the updated Disability Discrimination Act, will affect companies employing less than 15 workers for the first time.

Until now, only medium and large firms have been required to cater for disabled staff. With previous studies showing that most small firms are not preparing for the updated Act, bosses could face damaging compensation claims in the courts from October.

As well as protecting the mentally ill, the Act also requires that employers make their premises and services accessible to disabled staff and customers. This could lead to firms paying out thousands of pounds to update their workplaces.

Russell Brown, of law firm Glaisyers, warned that the mental illness laws could prove to be costly for small businesses.

“The main fear is that a measure to protect those with severe mental illness will encourage those with less serious problems, including stress, to qualify as disabled and make claims for compensation against their employers.

“Smaller companies which have not previously had to contend with disability law could be the most severely hit.

“I’m concerned that by lowering the barrier to prospective claimants, the government will allow less honourable individuals to take advantage of the system and sue their employers without justifiable grounds,” he said.

startups.co.uk 30 July

Bush plans to screen whole US population for mental illness

A sweeping mental health initiative will be unveiled by President George W Bush in July. The plan promises to integrate mentally ill patients fully into the community by providing "services in the community, rather than institutions," according to a March 2004 progress report entitled New Freedom Initiative (www.whitehouse.gov/infocus/newfreedom/toc-2004.html). While some praise the plan's goals, others say it protects the profits of drug companies at the expense of the public.

Bush established the New Freedom Commission on Mental Health in April 2002 to conduct a "comprehensive study of the United States mental health service delivery system." The commission issued its recommendations in July 2003. Bush instructed more than 25 federal agencies to develop an implementation plan based on those recommendations.

BMJ.com

The president's commission found that "despite their prevalence, mental disorders often go undiagnosed" and recommended comprehensive mental health screening for "consumers of all ages," including preschool children. According to the commission, "Each year, young children are expelled from preschools and childcare facilities for severely disruptive behaviours and emotional disorders." Schools, wrote the commission, are in a "key position" to screen the 52 million students and 6 million adults who work at the schools.

The commission also recommended "Linkage [of screening] with treatment and supports" including "state-of-the-art treatments" using "specific medications for specific conditions." The commission commended the Texas Medication Algorithm Project (TMAP) as a "model" medication treatment plan that "illustrates an evidence-based practice that results in better consumer outcomes."

Dr Darrel Regier, director of research at the American Psychiatric Association (APA), lauded the president's initiative and the Texas project model saying, "What's nice about TMAP is that this is a logical plan based on efficacy data from clinical trials."

He said the association has called for increased funding for implementation of the overall plan.

But the Texas project, which promotes the use of newer, more expensive antidepressants and antipsychotic drugs, sparked off controversy when Allen Jones, an employee of the Pennsylvania Office of the Inspector General, revealed that key officials with influence over the medication plan in his state received money and perks from drug companies with a stake in the medication algorithm (15 May, p1153). He was sacked this week for speaking to the BMJ and the New York Times.

The Texas project started in 1995 as an alliance of individuals from the pharmaceutical industry, the University of Texas, and the mental health and corrections systems of Texas. The project was funded by a Robert Wood Johnson grant—and by several drug companies.

Mr Jones told the BMJ that the same "political/pharmaceutical alliance" that generated the Texas project was behind the recommendations of the New Freedom Commission, which, according to his whistleblower report, were "poised to consolidate the TMAP effort into a comprehensive national policy to treat mental illness with expensive, patented medications of questionable benefit and deadly side effects, and to force private insurers to pick up more of the tab" (http://psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf).

Larry D Sasich, research associate with Public Citizen in Washington, DC, told the BMJ that studies in both the United States and Great Britain suggest that "using the older drugs first makes sense. There's nothing in the labeling of the newer atypical antipsychotic drugs that suggests they are superior in efficacy to haloperidol [an older "typical" antipsychotic]. There has to be an enormous amount of unnecessary expenditures for the newer drugs."

Olanzapine (trade name Zyprexa), one of the atypical antipsychotic drugs recommended as a first line drug in the Texas algorithm, grossed $4.28bn (£2.35bn; 3.56bn) worldwide in 2003 and is Eli Lilly's top selling drug. A 2003 New York Times article by Gardiner Harris reported that 70% of olanzapine sales are paid for by government agencies, such as Medicare and Medicaid.

Eli Lilly, manufacturer of olanzapine, has multiple ties to the Bush administration. George Bush Sr was a member of Lilly's board of directors and Bush Jr appointed Lilly's chief executive officer, Sidney Taurel, to a seat on the Homeland Security Council. Lilly made $1.6m in political contributions in 2000—82% of which went to Bush and the Republican Party.

Jones points out that the companies that helped to start up the Texas project have been, and still are, big contributors to the election funds of George W Bush. In addition, some members of the New Freedom Commission have served on advisory boards for these same companies, while others have direct ties to the Texas Medication Algorithm Project.

Bush was the governor of Texas during the development of the Texas project, and, during his 2000 presidential campaign, he boasted of his support for the project and the fact that the legislation he passed expanded Medicaid coverage of psychotropic drugs.

Bush is the clear front runner when it comes to drug company contributions. According to the Center for Responsive Politics (CRP), manufacturers of drugs and health products have contributed $764 274 to the 2004 Bush campaign through their political action committees and employees—far outstripping the $149 400 given to his chief rival, John Kerry, by 26 April.

Drug companies have fared exceedingly well under the Bush administration, according to the centre's spokesperson, Steven Weiss.

The commission's recommendation for increased screening has also been questioned. Robert Whitaker, journalist and author of Mad in America, says that while increased screening "may seem defensible," it could also be seen as "fishing for customers," and that exorbitant spending on new drugs "robs from other forms of care such as job training and shelter programmes."

But Dr Graham Emslie, who helped develop the Texas project, defends screening: "There are good data showing that if you identify kids at an earlier age who are aggressive, you can intervene... and change their trajectory."

Mental Health: House of Commons written Answers 8 July Mr. Jim Cunningham: To ask the Secretary of State for Health what estimate his Department has made of the number of people with mental disorders. [182400]

Ms Rosie Winterton: The Department has not made an estimate of the number of people with mental disorders. However, the Office for National Statistics published "Psychiatric Morbidity Among Adults Living in Private Households, 2000", that describes the prevalence of a range of mental disorders in the general household population. It also describes how people with particular disorders differ from those without any disorder on a range of factors: their background and personal characteristics, including employment and accommodation, physical health, current treatment and service use. This publication is available in the Library.

Ms Buck: To ask the Secretary of State for Health if he will rank each (a) primary care trust area and (b) health authority area by the rate of detentions under the Mental Health Act 1983 in 2002–03; and how many detentions there were in each area. [182356]

Ms Rosie Winterton: Information is not available in the requested format.

Information on the number of detentions under the Mental Health Act 1983 of patients in national health service facilities by strategic health authority (SHA) and the rate of detention per 100,000 of the SHA population in England in 2002–03 is shown in the table.

	Total detentions (on admission andsubsequent to admission) in NHS facilities	Rate of detention per 100,000 of the SHA population
England	45,064	91
By SHA
North and East Yorkshire and North Lincolnshire	760	47
Bedfordshire and Hertfordshire	1,035	64
Essex	1,063	66
West Midlands South	1,105	72
Avon, Gloucestershire and Wiltshire	1,595	73
Leicestershire, Northamptonshire and Rutland	1,152	73
Kent and Medway	1,187	75
Thames Valley	1,614	77
County Durham and Tees Valley	886	78
Dorset and Somerset	938	78
Norfolk, Suffolk and Cambridgeshire	1,708	78
Trent	2,062	78
Hampshire and Isle of Wight	1,455	81
Shropshire and Staffordshire	1,271	85
Cumbria and Lancashire	1,644	86
Northumberland, Tyne and Wear	1,204	87
South Yorkshire	1,114	88
Surrey and Sussex	2,338	91
Birmingham and the Black Country	2,079	92
Cheshire and Merseyside	2,200	94
Greater Manchester	2,421	96
South West Peninsula	1,525	96
South West London	1,312	101
West Yorkshire	2,101	101
North East London	2,002	130
North West London	2,587	145
South East London	2,563	169
North Central London	2,143	176

Notes:

1. Figures exclude previous legislation (fifth schedule) and other Acts.

2. A patient may be sectioned more than once under the Korner aggregate return KP90.

3. Populations used are 2002 end of year estimates based upon the 2001 census.

Source:

Department of Health form KP90.

8 Jul 2004 : Column 807W

Adam Price: To ask the Secretary of State for Health what discussions he has had with user and provider bodies in relation to the proposed Mental Health Bill. [181571]

Ms Rosie Winterton: Formal consultation has taken place on the review of mental health legislation through the Green Paper "Reform of the Mental Health Act" 1983 (November 1999), the White Paper "Reforming the Mental Health Act" (December 2000), and the draft Mental Health Bill and consultation document published in June 2002. Throughout the review I have met with representatives of all the key user and provider bodies. Since publication of the draft Bill, I have held a series of meetings attended by individual users, voluntary organisations, health and social care professionals and national health service and local authority managers, specifically to discuss to the practical operation of policies underpinning the draft Bill.

On 26 November 2003 the Secretary of State, John Reid, announced that a revised draft Mental Health Bill will be brought forward for pre-legislative scrutiny in this session and key stakeholders will be invited to give evidence to the Parliamentary Scrutiny Committee.

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National NHS patient Survey Programme 2004

A vital step to improving hospital and other health services to ensure they are meeting the needs of patients is to ask patients about their experiences and opinions.

The Healthcare Commission is responsible for carrying out national surveys of the NHS in England. By running these surveys and publishing the results, we are able to provide important feedback about the experience patients have of their local health service.

The Healthcare Commission and Picker Institute Europe has carried out five national surveys asking patients across England about their experiences of mental health, inpatient, ambulance, paediatric and primary care services.

We will use the results as one way of assessing the performance of the NHS, and we expect individual trusts to use the results to identify how their services can be improved for patients.

Over 27,000 service users were involved in the 2004 mental health survey, providing feedback on their recent experience of mental health services. The survey included service users from 81 NHS trusts across England that are responsible for providing secondary mental health services, including combined mental health and social care trusts, and primary care trusts.

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Newsletter for Mental Health Officers in Scotland

From the Association of Directors of Social Work, the Social Work Services Inspectorate and Community Care Works. Issue 6 Summer 2004

Featuring:
Minister’s statement to Parliament calls for national and local action to ensure the protection of vulnerable adults.

Medical treatment under the Mental Health (Care and Treatment) (Scotland) Act 1984 and the Adults with Incapacity (Scotland) Act

2000 Direct payments, independent living and mental health

Opposed guardianship application

Reviewing mental health officer services to meet increasing legislative demand

A user’s view of the mental health act

Interaction between the law and codes of practice

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Reforming Mental Health Law Scottish Executive Newsletter 4 - July 2004

Welcome to the fourth edition of the Scottish Executive's newsletter, 'Reforming Mental Health Law'.

There are now less than 9 months to the implementation of the Act in April 2005 and 3 months to the introduction of the provisions allowing people to appoint a Named Person and draw up an Advance Statement.

This newsletter tells you about the work which the Scottish Executive is undertaking to implement the Act and to establish the new Mental Health Tribunal. It also includes an update on the development of the Joint Local Implementation Plans.

Full Document