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Carer detained for 'mercy kill'

A carer has been detained indefinitely under the Mental Health Act after he shot dead a terminally ill pensioner.
Ian McAuley, 57, was acting as an unofficial carer for Robert Cory in July last year when he shot him at the Northampton flat they shared.

McAuley, who admitted manslaughter on grounds of diminished responsibility, claimed he killed the 67-year-old cancer sufferer at his request.

The prosecution claimed McAuley, had an unhealthy interest in Mr Cory's estate.

Nottingham Crown Court was told Mr Cory had only weeks left to live when his body was discovered under a sheet with a gunshot wound to his head.

During interviews with the police McAuley told officers: "I helped him. It's what he wanted."

But Frances Oldham QC, prosecuting, said the victim told neighbours prior to his death he had no intention of taking his own life or being assisted by anyone else.

Sentencing McAuley on Thursday, Judge Richard Pollard, said: "This is a tragic case. It was accepted on an earlier occasion you were mentally ill at the time you killed Robert Cory and your responsibility was impaired by your mental illness."

He then sent him to a secure medical unit until doctors were certain he was no longer a risk to the public.

At the earlier hearing the court was told McAuley suffered from schizophrenia and was not in control of his actions when he killed Mr Cory.

The victim, a father of four, had been suffering from a number of cancers and was confined to a wheelchair. His illnesses had been diagnosed as terminal.

Stephen Crouch, defending, said McAuley was a "lonely and extremely polite middle-aged gentleman" who had the utmost respect for Mr Cory.

He added: "Mr McAuley has been somewhat wounded by the understanding that he committed this offence in order to inherit the flat.

"He is basically a kind man. It was a mercy killing, a mercy killing arising out of a disordered mind."

bbc.co.uk 28 Oct

Psychologist convicted of abuse

A clinical psychologist has been convicted of indecently assaulting 'vulnerable' female patients.
Reginald Kenworthy, 76, of Stocks Lane, Stalybridge, Greater Manchester, assaulted the women when he worked at Tameside General Hospital in the 1980s.

Kenworthy was head of clinical psychology at the hospital between 1972 and his retirement in 1992, specialising in hypnotherapy.

He had denied two charges of indecent assault, but will be sentenced later.

Manchester's Minshull Street Crown Court heard Kenworthy had asked women personal questions about their sex lives and used shock aversion treatment on their genitalia.

One victim, a 46-year-old woman, was referred to Kenworthy after the breakdown of her marriage.

Police say he asked her questions about her sex life, before using the shock treatment on her.
A 48-year-old woman was referred to the doctor after suffering depression and panic attacks.

Kenworthy devised a plan for her to lose weight, with penalties including locking her in a cupboard, standing in front of him in a swimming costume and also giving her shock aversion treatment.

Det Con Diane Backler, of Greater Manchester Police, said: "This is a man who abused his position at the hospital in order to take advantage of vulnerable women.

'Great distress'

"These women put their trust in Kenworthy, many of them were referred to him by their GP. They genuinely believed he was trying to help them.

"His actions have caused the victims a great deal of distress and I'm sure they will be relieved that he has finally been brought to justice."

One of victims, a 46-year-old woman from Denton, said after his conviction on Thursday that Kenworthy had "taken away part of her life".

She added: "I never believed that a man working in his position in a hospital could be so evil.

"I'm pleased that, even though a number of years have passed, he has finally been brought to justice."

bbc.co.uk 28 Oct

The Adults with Incapacity (Scotland) Act 2000: Learning From Experience

This report presents findings from a project examining the operation of Parts 2, 3 and 6 of the Act, which explored implementation, usage levels and people's experiences of using the legislations.

Full Report

The Adults with Incapacity (Scotland) Act 2000: Implementation, Monitoring and Research - Research Findings

This report presents findings from a project examining the operation of Parts 2, 3 and 6 of the Act, which explored implementation, usage levels and people's experiences of using the legislations.

Main Findings
In broad terms, the Adults with Incapacity Act is meeting its central aims to provide enhanced protection for people who may potentially benefit from the legislation and to offer more flexible and specifically appropriate means to realise this. This is recognised by users.

Uptake levels of different provisions under the Act have varied, but usage has been steady, and has consistently increased for Parts 2 and 6.

Usage levels for all Parts of the Act have differed considerably by local authority area.

When to invoke the Act was a major issue for local authorities during the consultancy.

The roles of proxies and carers are critical - as are their needs for improved support and information.

There has been insufficient understanding and consciousness of the Act amongst some key groups, such as professions with potential involvement.
Perceived barriers may be just as important as realised ones in hampering access to the Act.

The principles and the definition of incapacity, as a decision- and context-specific concept, have been enthusiastically accepted.

A number of processes may need simplification.

Actions to address the concerns identified need to include ones aimed at awareness-raising and improved information provision, alongside ones concerned with practice, policy and legislation.

Full Report

Call for smaller painkiller packs to reduce suicides

Doctors have called for a further reduction in painkiller pack sizes after research was published showing previous reductions had slashed suicide rates by a fifth.

The research, published in the British Medical Journal today, shows that suicidal deaths from paracetamol and aspirin fell by 22 percentage points in the year after pack sizes were reduced in September 1998. The reduction in suicides continued over the next two years.

Non-fatal overdoses were also reduced: by 20% for paracetamol and 39% for aspirin in three years. As a result, liver transplants and admissions to hospitals for paracetamol poisoning saw a 30% fall in the four years after the laws came into force.

But over the same period, overdoses from ibuprofen, which was not covered by the legislation, increased by 27% - although the number of deaths stayed the same.

Sue Simkin, senior researcher at the Centre for Suicide Research at Oxford University, said: "Legislation restricting pack sizes of analgesics in the United Kingdom has been beneficial. A further reduction in pack sizes could prevent more deaths.

"Other countries that have addressed this problem, such as France and Ireland, have had greater reductions in pack sizes than the United Kingdom."

She said the risk of liver poisoning from a paracetamol overdose substantially increases with the taking of more than 30 tablets for a person weighing 60kg.

"A further small reduction in pack sizes of paracetamol and salicylates would be unlikely to inconvenience users, and could have further beneficial effects in preventing deaths from self poisoning," she added.

guardian.co.uk 29 Oct

The research showed that between 1996 and 1998, there were 364 deaths as a result of paracetamol or aspirin overdose. This had fallen to 274 in the years 1999 to 2001.

Deaths by aspirin saw a 46% fall, while paracetamol-induced deaths fell less sharply, by 29%. However, paracetamol overdoses are far more common.

The legislation, which came into effect in 1998, reduced the previously unrestricted sale limit for pharmacies to 32 tablets, and for other retail outlets from 24 to 16 tablets. They must be sold in blister packs, not bottles.

The aim was to reduce household stocks of analgesic drugs. Although there is nothing to stop someone buying two packs of painkillers, doctors say people usually attempt to commit suicide on impulse and use whatever they can find in the home.

Suicide rates overall fell during the period (a 12% fall for men and a seven-point fall for women), but these reductions were outstripped by the reductions in fatal painkiller overdoses.

Separate research published in today's Economist shows that suicides and unexplained deaths fell to a rate of 84 per million last year, a rate bettered in Europe only by Greece, Italy and Portugal.

One of the most dramatic falls is among women aged 45 to 75: their suicide rate now stands at a third of the level in the sixties. Suicides among males aged 15 to 34 are down by 31 percentage points from their peak in 1998.

Full Article

Choices for women help cut suicide rate to lowest in 50 years

Britain's suicide rate has fallen to its lowest level since the Second World War and is now one of the lowest in the Western world, figures to be published today show.

Suicides and unexplained deaths dropped to a rate of 84 per million last year, lower than the United States and bettered only by Greece, Italy and Portugal in Europe.

The greatest contribution to the fall is that taking one's own life is becoming more difficult, according to The Economist magazine, which has published the figures. Suicide rates are high in countries where gun ownership is widespread, such as America, Switzerland and Norway, and among professionals who have ready access to drugs, such as doctors and vets.

Increasing choices available to women may also be a contributor to the fall in suicide, the magazine says. In Britain, one of the most dramatic falls is in suicides among women aged 45 to 75, which now stand at one-third of the level in the 1960s. "Divorce rates may have soared and tensions between family and career sharpened - but women are less desperate - not more," The Economist says.

Two of the methods favoured by women have also been made harder. Suffocation using kitchen appliances supplied with gas was ended when toxic coal gas was replaced by natural gas in the 1960s and early 1970s.

Self-poisoning using painkillers has also been made more difficult by a ban on their sale in large numbers introduced in 1998.

Separate research published in the British Medical Journal today shows that suicides from overdoses of paracetamol or aspirin dropped by nearly a quarter in the three years following the introduction of stricter controls. Pack sizes have been limited to 24 tablets, which should be presented in blister packs, not bottles.

The researchers from the department of psychiatry at the University of Oxford also found that the number of tablets taken in suicide attempts that were unsuccessful fell sharply after the ban was introduced. As a result, liver transplants for paracetamol poisoning dropped by nearly a third in the four years after the legislation was introduced.

Although customers can still buy several packs of paracetamol or aspirin, the evidence suggests that those who take overdoses do so impulsively without planning their suicide, using tablets that happen to be at hand.

Men have also found it more difficult to take their own lives. Suicides among males aged 15 to 34 are down 31 per cent from a peak in 1998. One of the methods favoured by men was fitting a hose to the car exhaust which was run into the passenger compartment.

That too has become less lethal since the introduction of catalytic converters in the 1990s which remove the toxic carbon monoxide. The Economist cites figures showing suicides and unexplained deaths from poisoning by gas have fallen from 672 men in 1996 to 265 in 2002.

Deaths from hanging and suffocation have risen in recent years, accounting for more than half of all suicides among men in 2002. But international evidence shows that when a suicide method is removed, it is not replaced and overall rates fall.

A spokeswoman for the Samaritans said: "The despairing tend not to decide to take their lives and then find a way to do it. They tend to act impulsively, using a method that is to hand. Even a small change that makes the act more difficult can save lives."

independent.co.uk 29 Oct

BMA continues to oppose assisted suicide and euthanasia

The BMA continues to oppose legislation to allow assisted suicide for patients, despite other bodies that represent doctors now taking a neutral stance.

During questioning last week by a House of Lords select committee on Lord Joffe's Assisted Dying for the Terminally Ill Bill, representatives from the BMA said that the results of "consistent and regular" debates with members meant that the position of the association, which represents 80% of British doctors, remained unchanged

Giving evidence to the same committee the previous week the Royal College of Physicians and the Royal College of General Practitioners said they did not oppose the proposed legislation and they would take a neutral position.

Dr Vivienne Nathanson, the BMA's head of science and ethics, told the committee that the BMA was in a different position to the colleges. She said, "The colleges have only discussed this issue in council meetings, whereas we have had major debates among our membership. They do not have our democratic process."

The BMA's opposition to physician assisted suicide and voluntary euthanasia was outlined to the committee by Dr Michael Wilks, chairman of the BMA's medical ethics committee. One concern was loss of trust. Dr Wilks said, "This legislation would create a different relationship between doctor and patient and, once established, could have unpredictable consequences."

He argued that the legislation could also have detrimental effects on the rights of some vulnerable patients. He said, "It is difficult to create a law that delivers a right to die without trespassing on the rights of vulnerable people who have not declared a wish to die."

Under questioning Dr Wilks acknowledged that the BMA's position would result in suffering and loss of autonomy among a small number of patients. Nevertheless he confirmed that for most BMA members the proposed legislation would be "a step too far."

Dr Wilks accepted that recent surveys, including one released last week by Medix UK ( BMJ 2004;329: 939, 23 Oct), have shown that an increasing number of doctors are supporting physician assisted suicide over voluntary euthanasia, but he said that the BMA saw "no moral difference between the two."

Dr Nathanson said a lack of good palliative care could encourage patients to consider ending their life and called for improved provision. She said, "It's a sad fact that there is insufficient investment, so not every patient who would benefit is receiving palliative care. So it would be of great concern that if good palliative care is not available then patients could be persuaded to take another option."

Despite the BMA's continuing opposition to physician assisted suicide and voluntary euthanasia Dr Wilks said that in his personal view legislation would come at some point. He said, "Some form of assisted death legislation is inevitable."

Motorbike suicide of plane pilot

A PILOT took his own life by deliberately driving his powerful motorbike into a barn wall at high speed.

Anthony John Crook, 48, died of multiple injuries, including severe burns and "unsurviva-ble" crash injuries, when he drove his BMW motorbike into the barn in Bluestone Lane, Mawdesley.

Witnesses said Mr Cook seemed to make no attempt to take the bend or slow down.

Heather Phyllis Ennis, who was driving with her husband at the time of the crash on May 26, said: "The motorcycle was perfectly upright, not leaning. He was going very fast. He hit the barn wall and went straight through."

Mr Cook's petrol tank burst into flames and the fire spread to the wrecked barn. A prize bull which was inside later had to be destroyed.

The inquest heard that Mr Cook, who worked as a commercial pilot flying out of John Lennon Airport, had been discharged from a psychiatric ward at Leigh Infirmary the day before.

He had been admitted a few days earlier following another suicide attempt and was said to be in distress over the end of his relationship.

However, Mr Cook's daughter, Lyndsey, saw him at his home in Shevington, near Wigan, just hours before the fatal crash and said that he seemed fine. He told her that he was going to Southport.

Coroner Howard McCann recorded a verdict of suicide and said: "It does look as though he has done this deliberately with the intention of taking his life."

icseftonandwestlancs.icnetwork.co.uk 28 Oct

Arsonist sectioned under Mental Health Act

A MAN who deliberately started 14 fires and burned down the restaurant where he worked has been sectioned under the Mental Health Act.
Lawrence Tilson, 20, formerly of Spencer Street, Rothwell, set fire to the Little Chef restaurant on the A6 at Desborough while working there as a waiter.
Six customers and three staff were forced to flee from the burning building on September 29, 2002.
No one was hurt in the attack, which caused thousands of pounds damage.
Tilson was also responsible for numerous other fires in Rothwell, including blazes at the Woolpack pub, the junior school in Gladstone Street and a garden shed in Cambridge Street.
Medical experts said Tilson's behaviour was a result of an impairment of intelligence and abnormal social skills.
Judge Peter Ross, who sectioned Tilson indefinitely when he appeared at Northampton Crown Court yesterday said: "I share the view of doctors that it has not been possible to identify malice in what Lawrence has done, which is one of the most frightening things about this case.
"The lack of malice gives me greater cause for concern and I take the view that there is significant risk of the defendant causing public harm."

corbytoday.co.uk 29 Oct

UK independence party accused of "shocking" discrimination against people with mental health problems

The UK independence party (Ukip) has been accused of "shocking" discrimination against people with mental health problems.

Ukip's website had stated that in order to protect itself from "extremists" people "with a record of serious mental illness" are barred from applying to become parliamentary or council candidates for the party.

After Ukip's policy was revealed in a newspaper article on October 20, Ukip took down details of its controversial rule from its website.

However, Ukip has confirmed that it is sticking to its policy, which campaigners believe is a breach of anti-discrimination law.

The party's director of communications, Mark Croucher, has confirmed that Ukip would bar anyone who "had been diagnosed with an acute psychotic illness, including schizophrenia" from representing the party.

Croucher said: "Those who suffer from a non-acute psychotic illness would be considered on their individual merits, and would be expected to show that they had successfully controlled the illness, whether by drugs or other treatments, for a considerable period of time.

"Those who had been diagnosed with an acute psychotic illness, including schizophrenia, or who had a history of failing to accept or maintain treatment, would not be accepted [as a Ukip candidate]

"The vast majority of people would recognise that while [acute] schizophrenia is controllable, you can not take a tablet and get better. As the condition is widely regarded as incurable this is a good reason to debar such people from office.

"I am not aware of any MP or someone holding political office who suffers from paranoid schizophrenia. With manic depression, for example, there's a resolution and light at the end of the tunnel.

"But for those with more severe conditions one must exercise care.

"You might get more politically correct answers from other political parties. But I stand by what I say."

The charity Rethink, which campaigns against the stigma of mental ill health, has written to UKIP demanding it changes its rules.

"UKIP's shocking policy on mental health issues beggars belief," said a furious Paul Farmer, Rethink's director of public affairs.

"Their stigmatising approach seems to be based on prejudice, ignorance and fear, not the facts about severe mental illness. It is a rule that belongs to the dark ages not the 21st century.

"People who have experienced severe mental illness have gone on to work in business, politics and public life.

"It is hardly surprising that most choose not to talk publicly about their experiences, when organisations like Ukip see fit to perpetuate the stigma of mental illness.

"We will be contacting Ukip and hope that they will reconsider their position."

Farmer said: "Contrary to what Ukip suggest, schizophrenia and manic depression are both forms of severe mental illnesses with some similar symptoms. The most basic of research would have also told them that, with the right help, people with severe mental illness can and do recover."

Ron Coleman who, since being diagnosed with schizophrenia has been a director of a company with 14 employees and now travels the world as a mental health trainer, said: "It seems to me as though Ukip is in breach of the disability discrimination act.

"It is nonsense that people diagnosed with schizophrenia do not recover.

"It's clear that UKIP know nothing about mental health."

psychminded.co.uk 29 Oct

Mother-and-baby mental health unit opens

SCOTLAND'S first mother-and-baby mental health unit will be officially opened today.
The £1.3m six-bed facility at the Southern General Hospital in Glasgow will allow mothers to stay with their babies while undergoing treatment for mental illness, including post-natal depression.
The unit, serving the west of Scotland, will be staffed by 24 health professionals including psychiatrists, mental health nurses, nursery nurses and a social worker.
Karen Robertson, a nurse consultant at the unit, said: "Although the majority of women who experience perinatal mental illness will be able to be treated in the community, it is essential that the small number of women who require in-patient care receive it in an appropriate environment.
"This will vastly improve the quality of care and treatment for these women by enabling them to continue to care for their child while they receive treatment."
The unit has been developed over the past three years, and around 60 women are expected to be admitted annually.
Bill Butler, Glasgow Anniesland Labour MSP, last year moved an amendment to the Mental Health Bill to make it a statutory obligation on health boards to provide such units.
Around 10-15% of women may suffer from depression during pregnancy or after childbirth. While most will recover, a proportion experience more serious depression and around one in 500 will develop puerperal psychosis.

theherald.co.uk 29 Oct

Report on Adults with Incapacity Act

A report of a project to monitor the Adults with Incapacity (Scotland) Act says the legislation is yielding real benefits for adults with incapacity and those who care for and about them.

The Act - the first major law reform by the Scottish Parliament - was passed in 2000 to provide a range of measures to safeguard the property, financial affairs and welfare of adults who are unable to act or make decisions themselves because of mental disorder or inability to communicate as a result of physical disability.

scotland.gov.uk 28 Oct

Deputy Justice Minister Hugh Henry said:

"One of the early successes of this legislation is that over 30,000 powers of attorney have already been registered with the Public Guardian.

"I welcome the fact that so many people are now choosing someone to manage their affairs or look after their welfare, if they become unable to do so themselves. The benefit and relative simplicity of this procedure is something we all need to promote."

The research for the report was undertaken by a partnership of Alzheimer Scotland and the Scottish Development Centre for Mental Health and included the involvement of stakeholders, in-depth research interviews, and examination of levels of use of the Act across Scotland.

The main findings were:

the Act is broadly meeting its central aims to provide enhanced and additional protection for people who may benefit from using the legislation
those who participated in the study generally welcomed having more flexible options for the management of the welfare or financial affairs of individuals
use of the Act varied between different parts of the country but usage had remained steady and was increasing each year
there needs to be greater awareness of the Act amongst professionals and bodies with a potential role to play and amongst those who could use or benefit from its provisions
the central role of lay people, acting as carers and proxies for adults with incapacity, is critical to the successful operation of the reforms
the work also uncovered processes which could benefit from simplification
Mr Henry has responded to the report in a letter to the Parliament's Justice 2 Committee which says the Executive is committed to tackling issues which may inhibit the Act's objectives being fully realised.

Much work is already in hand, such as providing advice on use of the Act in situations where, for example, someone needs to move to a care home but is not able to make this decision themselves.

Mr Henry's letter also announces two major new initiatives:

The arrangements for legal aid for proceedings under the Act, which have been a major source of concerns, are to be changed. Free legal aid will be available for welfare guardianship proceedings and also advice and assistance will be available, based on the resources of the adult with incapacity
A new National Practice Co-ordinator for adults with incapacity will start work next month
Mr Henry continued:

"This Act is one of the achievements of devolution but it is not a piece of legislation that will be set in stone and we will continue to learn from experience. The issues raised in this report need careful consideration.

"I think we should be proud that we do not regard the job as done once the legislation has been passed. We all have a responsibility to ensure that this Act works on the ground for the people who need it."

Dr Alan Jacques, Convener of Alzheimer Scotland - Action on Dementia, said:

"After 15 years of steady campaigning carried out by Alzheimer Scotland - Action on Dementia and its predecessor organisations we were delighted that this Act was the first major piece of law reform carried out by the Scottish Parliament.

"The Act is one of the most advanced pieces of legislation on incapacity in the world, and I know from my work with Alzheimer Europe that it is looked on with admiration and a little envy in many other countries.

"The Scottish Executive has very wisely taken early opportunities to review how the Act is working. There have been a few difficulties, but this is inevitable with such a complex situation. This does not take away from the overall success of the Act in helping people plan for their own futures, and protecting those who become vulnerable to abuse or neglect because of dementia."

David McClements, a member of the Law Society of Scotland's Mental Health and Disability Committee who gave evidence on the legislation as it passed through Parliament, said:

"The Society welcomed the Scottish Parliament's decision to wholly revise the law on adults with incapacity which was out of date.

"The fact that the Adults with Incapacity Act 2000 was the first major piece of legislation to be passed by the Scottish Parliament is important in itself.

"The Society had highlighted the need for legislation for adults with incapacity at Westminster for many years but legislation was not brought forward due to "lack for parliamentary time".

"Thankfully the Scottish Parliament recognised the urgent need for change and ensured parliamentary time was available to make the new laws.

"MSPs listened to the Society's evidence which showed the previous law was creating serious injustices for many people and took account of our views along with other organisations and individuals."

The Adults with Incapacity (Scotland) Act 2000 received Royal Assent in May 2000 and was implemented in stages between April 2001 and October 2003.

The Act created the new Office of the Public Guardian, which is based in Falkirk.

The OPG is responsible for registering all powers of attorney and orders under the Act, authorising access to an adult's bank account under part 3 of the Act, supervising proxies with financial powers and carrying out investigations in response to complaints or where there may be concern that an adult's property or finances are at risk.

Local authorities and the Mental Welfare Commission also have functions under the Act, in relation to adults' welfare.

Mentally ill face 'Asbo' measures

People with mental health problems living in the community could be banned from leaving their homes under proposals to reform mental health law, a legal expert has warned.

Under the controversial draft mental health bill, people under assessment or receiving care in the community must comply with a code of conduct imposed by their doctor, according to Phil Fennell, a professor from Cardiff University's law school.

The professor said that the measure would exacerbate discrimination as it effectively treated mental health problems as a form of antisocial behaviour.

The draft bill, which ministers expect to become law in 2007, states that mental health staff could impose "a condition that the patient does not engage in specified conduct".

If the patient fails to comply with the conditions they could be forcibly detained in hospital. Speaking at a conference in London on mental health reform, Professor Fennell likened the code of conduct to antisocial behaviour orders (Asbos).

The professor said: "[The conditions] are like Asbos. For example, a person could be stopped from going out to the pub in the evening if it was considered their mental health problems could be exacerbated by drinking.

"It's a very wide power indeed especially when one considers that clinical supervisors [mental health staff] can decide to treat someone in hospital."

Vicky Yeates, a senior law lecturer at the University of Glamorgan in Wales, raised concerns that the proposed legislation would make carers responsible for ensuring that patients did not break the code of conduct.

Ms Yeates, whose daughter has mental health problems, said the measure would turn carers into jailers and push families already under pressure to breaking point.

She said: "Who will bear responsibility that your loved one isn't hauled off into hospital? The carer. You're effectively becoming a policing agent of the state. I think this will have a deleterious effect on an already strained relationship."

The draft bill has faced overwhelming opposition from mental health professionals and service users. A revised version of the proposed legislation is currently undergoing pre-legislative scrutiny by an expert parliamentary committee.

society.guardian.co.uk 27 Oct

SEND IN LIFESAVERS PLEA OVER MENTAL HEALTH CARE TRUST

Ministers have been urged to send in a top level team to take over a crisis-hit Devon mental health care trust before more lives are lost.

Calls for a shake-up of the embattled Devon Partnership NHS Trust were led by Tiverton and Honiton MP Angela Browning who has seen a handful of constituents commit suicide after they felt they were let down by health chiefs. She branded the treatment of disturbed patients in Devon a "disgrace which is quite wicked".

thisissouthdevon.co.uk 27 Oct

But while the Department of Health is set to send a support and recovery unit to Devon, health minister Dr Stephen Ladyman was unable to promise the level of intervention and high level investigation demanded by three county MPs.

At a debate at Westminster Mrs Browning joined forces with her Tory colleague, East Devon MP Hugo Swire, Richard Younger-Ross, the Lib Dem MP for Teignbridge and Torbay's Lib Dem MP Adrian Sanders to issue an urgent call for action over the trust that recently lost its chief executive and finance director and is in a cash freefall.

Mrs Browning presented a powerful and damning dossier of the troubled trust's performance to the Commons.

The Tory MP called for experts to be parachuted in to cover the gap left by sudden resignations.

Mr Sanders warned the crisis in mental healthcare in Devon was being paid for by the people who are most at risk.

He told Health Minister Dr Stephen Ladyman: "I warn the minister that cuts are being proposed at the Riverside unit in Torbay. The member for Tiverton and Honiton (Mrs. Browning) mentioned the problems at the Cedars unit. Pre-dating that, there was a problem with the Edith Morgan unit in Torbay.

"The recommendations were essentially what was created, the Riverside unit, and it is that which is now to close. Organising and sorting matters out is a process that is being paid for by the most vulnerable in the community."

Mr Younger-Ross told the debate: "Not only does the trust have to be looked at but the role of the strategic health authority.

"We actually need an investigation into both the trust, the strategic health authority and the other partners in terms of what has gone wrong with the trust and the over-seeing of it."

Dr Ladyman said Exeter MP Ben Bradshaw would soon be meeting the Health Minister over the troubled trust. He said progress towards targets was being made and more money was going into Devon PCTs.

Scrapping mental health bill preferable to multiple amendments

Scrapping the draft mental health bill and starting from scratch would be “preferable” to piling amendments on the “contorted and badly written” draft, writes Sally Gillen in London.

Chief executive of charity Rethink, Cliff Prior, told a conference organised by Harrogate Management Centre this week that it would be preferable if the pre-legislative scrutiny committee set up to look at the redrafted bill decided to “start again, amend the 1983 Act or look at the Scottish mental health bill”.

The Mental Health Alliance, a group of organisations opposed to the draft bill, had met last week to decided whether to “kill the bill or amend it”, but had decided it was “the only game in town”.

But Prior told delegates in London: “There is a real danger that we could see amendment piled on amendment”.

Earlier, Phil Fennell, professor of mental health law at Cardiff law school, said a clause within the bill which allowed people to be treated within the community contained a condition akin to antisocial behaviour orders.

Under the bill, people with mental health problems can be treated in a “non-resident setting” if they agree to conditions including not engaging in “specified conduct”. Fennell said this amounted to controlling behaviour.

Carer Victoria Yeates criticised the measure, arguing it would turn carers into “policing agents” because they would be expected to report lapses.

www.communitycare/co.uk 26 Oct

Mental health is losing out in Scotland

A new report from Audit Scotland has provided further evidence that spending decisions at local level are not reflecting the priority for mental health that the Scottish Executive wants to see.

Audit Scotland's report - "An overview of the performance of the NHS in Scotland" attracted widespread media coverage for supposedly depicting the NHS as a 'black hole' in which large sums of money were disappearing without monitoring or evaluation.

This slant was unfair - the report was more positive than that, but the report did note that it was "difficult to quantify the benefits from higher healthcare spending in Scotland because of the failure of information to keep up with changes in healthcare delivery."

The report also noted that the executive was likely to meet its targets for cancer, coronary heart disease and stroke (which along with mental health are the NHS clinical priorities).

On mental health the report had some interesting statistics.

In the year 2002/3 NHS boards spend "nearly £800 million on mental health services, an increase of 2% on the previous year."

However, further enquiries by the Scottish Assocation for Mental Health (SAMH) have revealed that overall NHS spend that year went up by over 6% in real terms (i.e. after inflation had been taken into account).

The 2% figure for mental health however does not allow for inflation - and the rate of inflation during that period was 2.08% .

So at a time when general health spend was going up by over 6% - mental health funding was going slightly down in real terms.

There are some caveats that need to be remembered - Audit Scotland also noted that councils planned to spend £52 million that year, apparently significantly higher than previous years.

There was also extra money (£20 million) through mental health specific grants and the £17.1 million for new mental health legislation - but this is all money either ring fenced or spent centrally - not by local health boards.

Moreover, the £800 million spend by boards included money for learning disabilities - and the true figure for mental health according to one source I spoke to is probably closer to £500 million.

All in all, it looks as though spending decisions at local level are not reflecting the priority for mental health that the government has been urging.

It is for this reason that SAMH has been calling for more ring fencing of mental health monies.

psychminded.co.uk 25 Oct

Nurses sacked after woman's death

Four nurses have been sacked from a hospital following an investigation into the death of a patient.

Powys Local Health Board confirmed that the nurses have been dismissed from Bronllys Hospital near Brecon after disciplinary proceedings.

A 26-year-old psychiatric patient who was under strict supervision at the hospital was found hanged in January.

The public service union Unison said it could not discuss the case, but it would appeal against the decision.

Dyfed Powys Police say their investigation into the death of Sylvan Money from Presteigne, who had a long history of depression, is ongoing.

Officers started their investigations in January and they told the Powys coroner that instructions to watch her every 30 minutes may not have been passed to staff at the change of shift.

Because of concerns about her safety, staff were told to keep an eye on her every 15 minutes, an instruction which was later changed to every 30 minutes.

But Ms Money was found hanged about 75 minutes after a shift change.

At the formal opening of an inquest into Ms Money's death in January, a police officer said it appeared that instructions may not have been passed on to staff at the shift change-over.

Mr Williams opened and adjourned the inquest after Pc Joe Davies gave evidence.

"Pc Davies told me that Ms Money was on a half-hour suicide watch," Powys coroner Geraint Williams said at the January hearing.

"At about 2pm there was a change of shift at the hospital and it appears the member of staff who took over was not told to watch the patient every 30 minutes."

A full inquest will be held in the new year, with 20 witnesses due to be called.

bbc.co.uk 25 Oct

The NO Force Campaign: Evidence on the Draft Mental Health Bill for the Joint Committee

The No Force Campaign was set up to provide a direct service user voice to express concerns about the Draft Mental Health Bill, without there being any conflicts of interest. All of our members have severe mental health problems, and are committed to ensuring, that our voices are heard, concerning the Draft Mental Health Bill. We believe that through our experiences of severe mental illness as well as mental health services, and being at the receiving end of mental health law, that our expertise, opinions and views should be recognised as being critically important, in helping to guide and direct, the development of mental health legislation fit for the 21st Century. To uphold our principle of providing a direct service user voice, and to respect the work we have done to provide you with our concerns about the Draft Mental Health Bill, we hope that you will read our evidence diligently, with reason and compassion, and provide us with the opportunity, to express the most important of our
concerns, to you orally.

SUMMARY OF MAIN CONCERNS

1.1 A statement of principles should be put on the face of the Bill and should include protection of life, mental health and dignity, equality and respect, informal treatment wherever possible, non-discrimination, respect for diversity, care and treatment determined by the patient, least restrictive alternative, personal autonomy, reciprocity, patient participation and consensual care.

1.2 We believe that principles could not be upheld with a Bill that is so unbalanced in terms of favouring minimising risk with more compulsion, and disregards the protection and enhancement of basic human rights, and cannot offer adequate holistic mental health services to enable statutory enforceable care plans to meet the `real' needs of people with mental health problems. Our main concerns include the following:
· When a person is under compulsion and can be treated, without their consent whilst having capacity. We want a capacity test introduced.
· When compulsion in the community has been introduced through
treatment orders
· By a person not being entitled to the protection afforded by the Mental Capacity Bill, particularly by being able to determine their own care and treatment, when having capacity, and by being able to produce a legally enforceable Advance Directive/ Statement
· By the NHS not identifying people who are poor metabolisers of drugs, through gene testing, and therefore putting them at a serious risk of harm due to medical drug interventions
· By enabling legally enforceable care plans, to be authorised, without ensuring a diverse range of holistic care and treatment options to be available to meet the `real' needs of people with severe mental health problems (see below).

2.1 The definition of `Mental Disorder' is too broad and ambiguous.

2.2 The conditions for compulsion are not sufficiently stringent.

2.3 We are strongly against the introduction of community treatment orders.

2.4 We strongly believe that any conditions for compulsion must include testing for capacity and provide therapeutic benefit.

3.1 There can be no balance when the Bill is so unnecessarily biased towards compulsion because of an un-realistic perception of violence.

3.2 No the Bill goes nowhere near enhancing and protecting our human rights.

3.3 We believe that the definition of mental disorder and the consequent conditions for compulsion are unnecessarily wide-ranging, and with the introduction of compulsory treatment in the community, no provision for capacity testing, no joined up thinking between the Draft Mental Health Bill and the Mental Capacity Bill, no opportunity for gene testing for `poor metaboliser' status, and lack of resources for implementation of therapeutic Care Plans, we see that the currently drafted mental health bill fails, quite dramatically, to achieve a balance between individual rights and personal or public safety concerns.

4.1 We believe the introduction of non-residents and compulsion in the community to be unnecessary, unworkable, not efficient, nor clear.

4.2 Omissions include not including capacity testing so that patients, not including important consent to treatment powers and safeguards, not interfacing the Mental Health Bill and the Mental Capacity Bill, not including the concept of `treatability' and not including gene tests to determine `poor metaboliser' status.

5.1 No the Mental Health Bill should be re-drafted. We believe there will not be enough resources, within Mental Health Services, to implement the care plans, particularly with the increasing number of people, from the current level, that will come under compulsion, if the Draft Mental Health Bill is introduced.

6.1 No the safeguards against abuse are not adequate.

6.2 However we very much welcome independent Mental Health Advocacy.

7.1 No the balance is not right the principles should go on the face of the Bill and the determination of supervisor should be in the Bill and not the regulations.

8.1 No the Draft Mental Health Bill is not integrated with the Mental Capacity Bill as it does not refer to the Mental Capacity Bill or to common law powers.

9.1 No the Draft Mental Health Bill is not in full compliance with the Human Rights Act, see above, and it must meet the requirements both of Human Rights legislation and the recommendations of the Council of Europe.

10.1 We believe that implementation of the Mental Health Bill, as it stands, would bring mental health service provision down onto its knees, in particular due to increases, that will be seen, in the number of people under compulsion, and the inability of the system to implement the care plans, which are additionally, not backed by adequate mental health services and resources.

10.2 Lack of resources will prevent what we believe to be mandatory, for the recovery of people with severe mental illnesses, and that is a mental health service provision shift, away from medical model dominance, towards a more balanced holistic model.

1. Is the Draft Mental Health Bill rooted in a set of unambiguous basic principles? Are these principles appropriate and desirable?

1.1 No, the Government has not rooted the Draft Mental Health Bill in a set of unambiguous basic principles. We believe that the Government, in targeting people who may be a danger to the public, but do not have a conventional mental illness diagnosis, and who have not committed a crime, have produced legislation biased towards legislating for risk, and have therefore focused on compulsion to an unacceptable degree, and without appropriate safeguards to protect individual liberties. We know that the Government needs to re- evaluate the balance between the three fundamental elements of mental health legislation, which includes the provision of mental health services, strict criteria on compulsion and protection and enhancement of human rights. Any principles underpinning the Mental Health Bill are distorted by this unbalanced mental health legislation and will become even less apparent when putting the law
into practice.

1.2 We believe that the scope and purpose of the mental health bill should be defined as far as is possible through a statement of principles on the face of the Bill. These principles should include protection of life, mental health and dignity, equality and respect, informal treatment wherever possible, non-discrimination, respect for diversity, care and treatment determined by the patient, least
restrictive alternative, personal autonomy, reciprocity, patient participation and consensual care.

1.3 We consider that it is unacceptable for the Bill to allow that principles will have no universal application, but will be conditional in that they can be disapplied, wherever `inappropriate' or impractical'; and will be excluded from applying to functions of the Secretary of State, in making certain regulations or directions.

1.4 We cannot see how the government can uphold any principles and values with integrity, towards individuals with mental health problems, within the mental health system and the public arena, particularly concerning stigma and discrimination, when the mental health legislation itself is un-balanced in favour of minimising risk with more compulsion, and disregards the protection and enhancement of basic human rights, and cannot offer adequate holistic mental
health services to enable statutory enforceable care plans to meet the `real' needs of people with mental health problems. Our main concerns include the following:
· When a person is under compulsion and can be treated, without their consent whilst having capacity
· When compulsion in the community has been introduced through treatment orders
· By a person not being entitled to the protection afforded by the Mental Capacity Bill, particularly by being able to determine their own care and treatment, when having capacity, and by being able to produce a legally enforceable Advance Directive/ Statement
· By the NHS not identifying people who are poor metabolisers of drugs, through gene testing, and therefore putting them at a serious risk of harm due to medical drug interventions
· By enabling legally enforceable care plans, to be authorised, without ensuring a diverse range of holistic care and treatment options to be available to meet the `real' needs of people with severe mental health problems (see below).

2. Is the definition of Mental Disorder appropriate and unambiguous?
Are the conditions for treatment and care under compulsion sufficiently stringent? Are the provisions for assessment and treatment in the Community adequate and sufficient?

2.1 No the definition of `Mental Disorder' is too broad and ambiguous. The Bill does not provide that no one may be dealt with as mentally disordered by reason only of promiscuity, immoral conduct, sexual deviancy or dependence on alcohol or drugs. The definition of `medical treatment' is too broad, which includes education, and work and social skills training. The definition of `hospital' is too broad which includes a private house converted to provide training for people perhaps with a personality disorder, who are drug
dependent, in work and social skills. The combination of the above allows conventional social intervention to be classed as `medical treatments' for mental disorder. We do not find it difficult to envisage the inappropriate use, however well meant, of mental health legislation for non-medical purposes of social control.

2.2 No, the conditions for compulsion are not sufficiently stringent. We are firmly against compulsion in the community and argue very strongly that if a person satisfies all the conditions for compulsion, which includes that they may be at risk to themselves or someone else, then they should be in a safe hospital setting, where they can have 24 hour monitoring, treatment and care. If they are not at risk to themselves or someone else, they should not be under any compulsory mental health legislation. We know, that if compulsion in the community remains in the bill, then many people with mental health problems will be at an increased risk of suicide, and many will succeed because of the lack of mental health service provision in the community. Furthermore, the introduction of compulsion in the community will also increase the number of people becoming subject to compulsory treatment; will increase the risk of people being harmed by psychotropic drugs, as there will be minimal monitoring of users in their own homes; will increase the risk of people, who are "poor
metabolisers" of psychotropic drugs, to severe adverse effects, toxicity and death, as it will be impossible for them to decide to reduce or withdraw from their medication, (1 in 10 white Caucasians are born without the enzymes to breakdown medical drugs. 1 in 15 admissions to general hospitals are due to patients suffering from severe adverse events related to the drugs they are taking. Hospital deaths due to medical drugs are much higher in psychiatric hospitals due to patients not being able to stop their psychotropic medication
and the government, DOH, the NHS and the Medicines and Healthcare
products Regulatory Agency do not recognise these facts); will drive people away from seeking mental health services when they need it the most; will also lead to increased discrimination and stigma in the community and will effectively destroy the therapeutic relationship between the patient and the professional, which is understood to be crucial for recovery.

2.3 No, we firmly believe that any conditions for treatment and careunder compulsion, must include a provision for capacity testing, so that if a person satisfies the conditions for compulsion, and they have capacity, then they have a right to determine what care and treatment they should receive, and any offered, must be with the full understanding and consent of the patient. We strongly believe that people with mental health problems should have the same rights as people with physical problems in being able to choose their own care
and treatment, as far as is possible. The following is an example to show the huge disparity between the rights of people, with physical problems and mental health problems, to determine their own healthcare needs; a person is under a section in a hospital or at home, they have capacity, and they have leukaemia, they have the right to refuse chemotherapy, even though they will most probably die from the illness over the next few months. However the same person, with capacity, and a mental illness diagnosis, cannot refuse, or even
change, the psychotropic drugs, even if it is against their wishes, and even though their life is not in any danger.

2.4 There is no requirement for patients classed under the mental illness or severe mental impairment categories that such intervention will provide any therapeutic benefit, therefore such patients may therefore be initially detained solely for their protection or for the protection of others. We believe that in taking out `treatability' from the conditions, then the Bill becomes open, to being used as a means for social control, instead of solely for the treatment and care of people with mental health problems.

2.5 We also have grave concerns about many other conditions for compulsion within the bill and believe them to be constitutionally inappropriate which includes: that a doctor may detain someone s/he believes requires assessment in the community; that who is authorised to detain an informal patient is not defined and left to regulations; that a single doctor may authorize a citizen's compulsory admission and detention if the approved mental health professional accompanying her/him is not also of the opinion that detention is appropriate or
that there is any urgent necessity for this; to use mental health legislation to allow constables to remove citizens, who are drug or alcohol dependent from their homes, without any need for a warrant; that the conditions for compulsion must be understood in the context of the very broad definitions of `mental disorder' and `medical treatment' referred to above; that the meaning of the word `lawfully' in Clause 9(5) needs to be clarified as does it mean or is it intended to mean that the person cannot be `sectioned' if s/he consents to informal treatment, or does it mean that an incapacitated person cannot be `sectioned' if s/he can be treated instead under the Mental Capacity Bill or the common law doctrine of necessity?; that provided a citizen meets the relevant conditions for compulsion, the Bill leaves to regulations the issue of whether s/he should be liable to be detained in a hospital; that the Bill provides that a citizen may be detained even though the medical evidence is evenly divided as
to the need for detention; that in certain circumstances the Bill authorises the detention of a citizen to be founded upon a single medical opinion, and this an opinion that may conflict with the determinations previously made by three practitioners; that the conditions which may be imposed on a non-resident patient are not properly specified and can be determined by regulations.

3. Does the draft bill achieve the right balance between protecting the personal and human rights of the mentally ill on one hand, and concerns for public and personal safety on the other?

3.1 No it does not (see 1 and 2 above). It is a myth and fabrication of the truth that people with severe mental health problems pose a very significant risk to the public in terms of being violent and dangerous. It is well known that the proportion of violence in society, attributable to mental illness, remains low and conversely the proportion of self-harm and suicide, attributable to mental
illness, is extremely high. Violence has much more to do with education, upbringing, alcohol and drugs than mental illness. The government in its haste to develop mental health law, which is based on the risk of violence by people with mental illnesses to the general public, have managed to create a Bill, which is seen by users of mental health services, as controlling and punitive, as opposed to enabling and therapeutic. The government would be wise to remember that 1 in 4 of the general public will experience mental illness at
some point in their lifetime, and we know, through our experiences of compulsion, that each person, within the general public, will then too experience the oppression, discrimination, stigma and the feelings of being completely out of control of; one's own life, mental health care and treatment options, as well as being at the mercy of an under-resourced mental health system, as we do.
Compulsion in hospital or coercion, in the community, is quite literally a shocking experience, with or without ECT, and it is known that this experience causes trauma in a high percentage of people with mental illnesses. Even the language of mental health treatment is punitive, such as a patient who has not fulfilled their compulsory obligations has "gone AWOL" or they are put into "isolation or seclusion" or they are "restrained" for enforced drug treatment. We need enabling, transparent and therapeutic services with a language, and care and treatment, based on healing and hope.

3.2 No we believe that the government has not come anywhere near enhancing and protecting our human rights, those of people with severe mental illnesses, particularly with the following critical issues. We know that over time the following litigations will occur against the government over breaches of our human rights particularly the following Articles in the Universal Declaration of Human Rights;

3.2.1 if the government does not put the principles, we have outlined, on the face of the Bill, so that they have to be enforced legally, then Article 1 (born free and equal with dignity and rights) and also, in particular, Article 7 (no discrimination on any grounds) will be breached, particularly when a patient is subject to compulsion.

3.2.2 if the government does not remove the concept of the non- residential patient, and compulsory treatment in the community, through treatment orders, then the government will face litigations concerning breaches of Article 3 (the right to life, liberty and security of person). We believe that a person must be at risk of harming them self, or someone else, to satisfy the conditions of compulsion, and should therefore, be in a safe environment in hospital, and if the person does not satisfy these conditions then they should not be subject to any compulsion. Also if a person harms themselves or commits suicide whilst under compulsion in the community then we believe there will be a justified case for litigation; Article 5, (no one shall be subjected to torture or to
cruel, inhuman or degrading treatment or punishment). It is common knowledge that a significant proportion of patients have severe adverse reactions and toxic events, which may result in death, to many of the psychotrophic drugs. The risk of these events occurring and going unnoticed will be much higher, if the person is under compulsion in the community, as there will be minimal monitoring, due to lack of resources. When this occurs we believe that patients could litigate, particularly if the person is shown to be a `poor metaboliser' of medical drugs, through gene testing, which is not yet
available in the NHS (we are currently working on raising awareness of this important issue), also the quality of life of many people on psychotropic drugs, long term, is severely compromised by this treatment, and in many cases the person will not be able to recover, and lastly Article 12 (right to privacy, family, home or correspondence), where just the concept of compulsory treatment in
the community, and its unsubstantiated legal basis, in terms of people being able to meet all the conditions and then be "safe" at home, makes a mockery of any person's rights to privacy, when the Bill states that the "non resident" will have to take drugs and attend places for treatment, or be under threat of hospitalisation, and allow mental health professionals to access their property. Not just the person under compulsion will lose their privacy, but so will any members of their family and household, and the person will also be open to probable further discrimination, stigma and potential harassment from neighbours and the community. Again this is not mental health care and treatment, it is punitive, with the analogy being to that of criminals having to do community service, or being allowed home with a tag and monitoring device, and any breach means going to prison, when none of this is necessary.

3.2.3 If the government does not introduce capacity testing and therefore allowing a patient to be treated without their consent, whilst having full capacity to make their own decisions for their own care and treatment, then the following Articles will be breached; Articles 1, 2, 3, 5, 7, 18, 19 and 25 (Universal Declaration of Human Rights 1948). Significantly Article 5 (No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment)
will continue to be breached when a patient is a `poor metaboliser' of drugs, and will be harmed by the drug intervention, and not be able to refuse or even change the drug they are being administered. We want compulsory treatment of patients, without their consent, whilst having capacity, to be removed from the Mental Health Bill and want capacity testing introduced, to determine whether a person is capable of making relevant decisions, with regards to their treatment, when under mental health legislation. If compulsory treatment of patients, without their consent, whilst having capacity, remains in the current Mental Health Bill, the repercussions of this will continue to be phenomenal. More explicitly: it can prevent them from trying to heal themselves in different ways to the medical model; or can prevent them from trying a different drug that may be beneficial to them; and it will prevent any person with a severe
mental illness, and under a section, from benefiting from the Mental Capacity Bill, and in particular from being able to enforce an Advance Directive or have their treatment preferences in an Advance Statement even acknowledged. This section of mental health legislation makes a mockery of all that the government says it is trying to achieve, in terms of reducing stigma and discrimination,
through implementation of the NHS Plan, the National Service Framework for Mental Health and its more recent Social Inclusion Policy through the NIMHE.

3.2.4 If the government does not interface the Mental Health Bill with the Mental Capacity Bill appropriately then we believe that we will again lose fundamental rights, that people with or without mental capacity, should be entitled to (as stated above). We believe that we should have the statutory right to be able to make our own care and treatment decisions concerning our own recovery from mental health problems and to be able to produce Advance Directives, which
can specify what treatments that we do not want, and Advance Statements which can specify what treatments we would prefer to have, when subject to compulsion.

3.2.4 We believe that people who may be `poor metabolisers' of drugs should have a statutory right to a gene test, and if positive, be able to follow specialised treatment regimes that are therapeutic, rather then the conventional treatments regimes, that frequently result in severe adverse events, toxicity and death. The EC Convention on Human Rights and Biomedicine Article 4 on Professional standards states; that any intervention in the health field, including research, must be carried out in accordance with relevant professional obligations and standards. The government, despite being given evidence on `poor metabolisers' of medical drugs, has still failed to take this on board and urgently needs to raise awareness of this within the NHS. People, who will be shown to be `poor metabolisers' of drugs (all medical drugs including psychotropic drugs) are right now, going through unnecessary suffering and harm, and are not able to get therapeutic benefit from the drugs they are taking. We believe the Government is opening itself up to future litigations of negligence, by not introducing gene testing within the NHS, to determine who are poor metabolisers of drugs. This applies to all patients within the NHS and not just patients subject to compulsion (see above 2.2).

3.2.5 We firmly believe that the Government must provide a Mental Health Service, which has the capacity to provide for the population of people with severe mental health problems, and that it be mandatory, that these resources are holistic, and therefore relevant, and specific, to their `real' needs, so that they can get therapeutic benefit, from the care and treatment on offer, and be able to choose their own individual paths to recovery. Until such a time, we believe that Article 25 (everyone has a right to medical care, which of
course, must be healing) will continue to be breached, each time an individual has a Care Plan, which can be enforced legally, where drug treatment is the predominant, and in most cases the first line choice of treatment. We know that drug treatments alone do not "cure" people of mental illness, and many people including `poor metabolisers' of drugs may be harmed by any drug treatment, and that Mental Health Services are predominantly medical model based. People need to be able to access a holistic Mental Health Service, and be able to
choose and determine their own path of recovery from severe mental illness, which may or may not include drug treatment. If the Government does not develop and produce a mental health service provision shift, away from medical model dominance, towards more holistic models, the repercussions of this will continue to be phenomenal. More explicitly: the medical model of mental health
service provision will continue to dominate and this will continue to reduce peoples chances of recovery; people will not be able to recover fully, as at best the drugs can stabilise, but more commonly they repress recovery and cause debilitating side effects, which contributes to a very low quality of life; many people, particularly those who are poor metabolisers of drugs, will be at risk of an impoverished quality of life, toxic events and death; the population of people, with severe mental illnesses, in every locality, in the country, will continue to be made up of the same individuals, with more people joining them over time, as they are not being given the right resources to enable themselves to recover; and it will encourage, the already un-holy alliances that have been made between mental health professionals and pharmaceutical companies, that
threaten patient safety, with enforced drug interventions. At present, there are various litigations occurring against the large drug companies, and proof of falsified evidence from clinical trials, as well as huge abuses concerning conflicts of interests where, some psychiatrists and general practitioners are being asked to validate incomplete clinical research data, being "wined and dined" at conferences, even overseas and are being given sponsorship money, by drug company representatives. Drug companies are aware of the existence of `poor metabolisers' too and have withheld this information from the public arena. This makes a mockery of the Hippocratic Oath and the validity of psychotropic drugs being used to treat mental illnesses and puts people's health and lives in danger.

3.3 We believe that the definition of mental disorder and the consequent conditions for compulsion are unnecessarily wide-ranging, and with the introduction of compulsory treatment in the community, no provision for capacity testing, no joined up thinking between the Draft Mental Health Bill and the Mental Capacity Bill, no opportunity for gene testing for `poor metaboliser' status, and lack of resources for implementation of therapeutic Care Plans, we see that the currently drafted mental health bill fails, quite dramatically, to
achieve a balance between individual rights and personal or public safety concerns.

4. Are the proposals contained in the Draft Mental Health Bill necessary, workable, efficient, and clear? Are there any important omissions in the Bill?

4.1 We believe the introduction of non-residents and compulsion in the community to be unnecessary, unworkable, not efficient, nor clear.

4.2 Clinical supervisors must be qualified to assess if a person meets the conditions for compulsion in order to be able to keep under review if the conditions continue to be met. It is totally inappropriate that determination of clinical supervisor status be qualified in the regulations.

4.3 Compulsion should only be possible, other than in an emergency, if two doctors certify that the patient suffers from a mental disorder, satisfying the conditions.

Omissions
4.4 Not including capacity testing so that patients, who have capacity, can determine their own care and treatment regimes for their own, self determined recovery (could we ever envisage compulsory homeopathic treatment for example?)

4.5 Not including important consent to treatment powers and safeguards; such as abolition to consent to medication, removal of emergency treatment safeguards regarding psychiatric medication and allowing tribunal authorisation of `generic' care plans in the absence of consent.

4.6 Not interfacing the Mental Health Bill and the Mental Capacity Bill and in particular so that people can produce Advance Directives/ Statements.

4.6 Not including the concept of `treatability', or care and treatment being of benefit to the patient. We believe that all mental health care and treatment must be of therapeutic benefit for the patient and this should be reflected in conditions within the Draft Mental Health Bill.

4.7 Not enabling people to have a gene test to determine `poor metaboliser' status.

5. Is the proposed institutional framework appropriate and sufficient for the enforcement of measures contained in the draft bill?

5.1 No the Mental Health Bill should be re-drafted.

5.2 No it is totally inappropriate that any person can request for any one else to be examined and assessed.

5.3 No there will not be enough resources, within Mental Health Services, to implement the care plans, particularly with the increasing number of people, from the current level, that will come under compulsion, if the Draft Mental Health Bill is introduced.

5.4 There are not enough Mental Health Professionals in the workforce, nor services, to implement the measures contained in the Bill.

6. Are the safeguards against abuse adequate? Are the safeguards in respect of particularly vulnerable groups, for example children, sufficient? Are there enough safeguards against misuse of aggressive procedures such as ECT and psychosurgery?

6.1 No the safeguards against abuse are not adequate.

6.2 However, we welcome the right to independent advocacy and believe this to be an important advance in ensuring that our voice is heard and our rights protected. However we believe that independent advocacy is under-funded, and that more money will have to be directed towards advocacy posts, in order to ensure that all people with severe mental health problems, including in the community, can access a mental health advocate when needed.

6.3 We welcome, with some reservations, as mentioned above, the role and responsibility of the Mental Health Tribunal.

6.4 No it is totally inappropriate that any person can request for any one else to be examined and assessed. This will lead to abuses and further stigma and discrimination of people with mental health problems.

6.5 The Bill abolishes the existing right of patients to an independent, binding, second-opinion concerning the appropriateness of the medication they are forced to take.

6.6 The broad definition of what constitutes a hospital leads to a correspondingly broad list of places where citizens may be held down and given medication by force.

6.7 It will be too easy in practice for consultants to by-pass the protective scheme set out for ECT.

6.8 There should be gene testing of people who may be `poor metabolisers of psychotropic drugs and before they are given any further psychotropic drugs. These are people that appear to be very sensitive to drugs, and suffer from severe and adverse effects, and toxicity, and who will have inherited drug breakdown enzymes, which do not work. Failure to do this will result in professional malpractice in terms of a medical drug intervention causing a
patient's condition to deteriorate, causing acute pain and suffering and even death.

6.9 Many safeguards against the poor or inappropriate use of compulsion have been abolished as mentioned above. In addition the Bill: revokes the powers of a patient's nearest relative; provides that the guidance in the Code of Practice may be qualified; abolishes the statutory duty to provide long-term after-care; revokes the discharge powers of NHS bodies and local authorities; may endanger professional independence; does not provide for an independent,
standalone, Mental Health Commission.

6.10 Tribunals should continue to have a discretionary power to discharge people from compulsion. The Bill should provide that a tribunal must release a citizen from detention unless it is satisfied that clear grounds, which Parliament has determined, justify depriving a citizen of her/his liberty are met. It is a matter of concern that a tribunal may authorise a person's further detention
for up to eight weeks when it has just determined that s/he does not satisfy the relevant conditions for compulsion.

6.10 A patient's spouse or partner should retain their existing power to object reasonably to admission to hospital.

6.11 It should be clear from the legislation, that a care plan presented to a Tribunal would include the statement, that identified treatments will only be given with the patient's consent (subject to an emergency treatment clause).

6.12 Mental Health Practitioners, that are co-ordinating the care and treatment of patients, should not be to put into the role of `policing' community treatment orders, nor be involved in any part of the assessment and sectioning process, as this will destroy any therapeutic relationship with their client.

6.13 People with mental health problems are fully aware that the Government, in the Draft Mental Health Bill, has given far more, and far reaching, and unnecessary, powers to groups of mental health professionals, then ever before, and rather than enhancing and protecting our rights, they have even removed some. This is totally unethical.

7. Is the balance struck between what has been included on the face of the draft bill, and what goes into Regulations and the Code of Practices right?

7.1 No the balance is not right and some of these issues have been covered already above.

7.2 The principles should go onto the face of the bill

7.3 Some important regulations, like who has the power to assess and compel a person to compulsory treatment, should be specified in the face of the Bill.

8. Is the Draft Mental Health Bill adequately integrated with the Mental Capacity Bill (as introduced in the House of Commons on 17 July 2004)?

8.1 No as the Bill does not refer to the Mental Capacity Bill or to common law powers.

8.2 Users of mental health services believe they too have a fundamental right to be able to benefit from the new Mental Capacity Bill, in terms of being able to produce Advance Directives/ Statements. As it stands at the moment, the Mental Health Bill will trump the Mental Capacity Bill and bar any user of mental health services, who is under compulsion, from being able to utilize key parts of the new legislation. This would be a travesty.

8.3 The rights, and safeguards, should be the same for people under the Mental Capacity and the Mental Health Bills.

9. Is the Draft Mental Health Bill in full compliance with the Human
Rights Act?

9.1 No the Draft Mental Health Bill is not in full compliance with the Human Rights Act and the issues have been covered already, above.

9.2 The Mental Health Act for England and Wales must meet the requirements both of Human Rights legislation and the recommendations of the Council of Europe.

10. What are likely to be the human and financial resource implications of the draft bill? What will be the effect on the roles of professionals? Has the Government analysed the effects of the Bill adequately, and will sufficient resources be available to cover any costs arising from implementation of the Bill?

10.1 We believe the human and financial resource implications of the draft bill will be much higher than the Government and society can afford.

10.2 We believe that implementation of the Mental Health Bill, as it stands, would bring mental health service provision down onto its knees, in particular due to increases, that will be seen, in the number of people under compulsion, and the inability of the system to implement the care plans, which are additionally, not backed by adequate mental health services and resources.

10.3 We believe community treatment orders should never become a part
of mental health law and that the money saved would be better invested, in developing a Mental Health Services that is fit for the 21st Century.

10.4 The Bill will take much needed money away from developing therapeutic mental health services and will result in more people remaining and becoming severely mentally ill. Lack of resources will prevent what we believe to be mandatory, for the recovery of people with severe mental illnesses, and that is a mental health service provision shift, away from medical model dominance, towards a more balanced holistic model. Holistic mental health resources need to be available throughout the NHS, within primary and secondary care, and
most importantly within the community as well as in the hospitals. This would vastly reduce the burden of suffering and the financial cost to society, as the service would enable prevention, reduce re- admissions, and promote long term recovery. Mental Health problems are caused by genetic pre-disposition as well as stress. Stress from the mind will affect brain biochemistry, which in turn will affect the mind. Stress can be caused externally, for example, difficulties
related to money, homelessness, work and relationships. Stress can also be generated within the mind, due to adverse life experiences, causing conflicts, confusion and traumas. To become mentally well these stressors need to be minimised through practical support for environmental stresses, talking therapies for internal stresses and a combination of treatments such as medical drugs, homeopathy, nutrition and massage, for overall mind and body healing, as well as well as enabling (not controlling) care and support structures, to
promote self confidence, self esteem, to enable nurturing relationships to be developed and to facilitate meaningful occupation. It is mandatory that a person is given all the tools to enable their recovery such as being able to understand mental illness, the effects of stress and coping strategies and being able
to choose a holistic treatment that supports their own individual needs, of which drug treatment, may or may not be, one of them.

10.5 Further research is required to assess the realistic likely impact of the proposals, on people who use the service, in terms of therapeutic benefit, and the workforce, in relation to numbers, recruitment, morale and to the types of services available. However it would be more prudent to carry out this research from a set of proposals, whose starting point, is one that keeps compulsion to a
minimum, that protects and enhances human rights and provides for a holistic mental health service, which is delivered in an ethical manner.

No Force Campaign – Evidence on Draft Mental Health Bill for Joint
Committee - Oct 2004

£60m plan for mental health is approved

A £60 million scheme to unite mental health services and create four new centres in Birmingham has been approved.

The city council's development control committee has granted planning permission for Birmingham and Solihull Mental Health NHS Trust to go ahead with the scheme.

icbirmingham.icnetwork.co.uk 22 Oct

Three of the new buildings will replace the existing Queen Elizabeth Psychiatric Hospital in Edgbaston, which will be demolished.

A fourth facility will be built on the former women's hospital site in Sparkhill. It will form part of joint plans with University Hospital Birmingham NHS Foundation Trust for a new £521 million acute hospital trust and five mental health centres.

Work on both sites is due to start next spring and the centres are expected to open in January 2007.

Sue Turner, chief executive of the trust, said: "These developments are wonderful news for our patients and staff because we will be able to offer much better quality services, in modern buildings, with speedier access for people who have mental health problems.

"People can expect a significant improvement in services, more closely connected to the area where they live.

"In Sparkhill and Sparkbrook, which is a deprived area with a high Asian population, we will create at Showell Green Lane a centre that is more culturally appropriate for the local population.

"We intend to work closely with local residents during all phases of this development to ensure it becomes something the local community is truly proud of."

The new mental health facilities in Edgbaston will include 64 adult acute beds for patients from the South Birmingham Primary Care Trust area, a tenbed psychiatric intensive care unit, and an education and training centre.

It will also include a 30-bed unit offering services for people suffering from eating disorders and hearing problems.

The new 32-bed facility at Showell Green Lane, Sparkhill, will provide key services for patients with mild to moderate mental health problems in the area.

It will include out-patient and day hospital services and be a base for mental health teams.

DEATH SENTENCE FEARS OVER MENTAL-PATIENT CARE

Patients could be starved or dehydrated to death "in the most horrible of ways" under a Bill going through Parliament, former Tory leader Iain Duncan Smith warned yesterday. He said that "a fatal flaw" at the heart of the Mental Capacity Bill gives the licence to withhold tube-delivered food and water from a patient who would otherwise live.

Mr Duncan Smith said: "When a patient is denied food and water, his death is a horrible process. Before he dies he will suffer seizures, heaving, nosebleeds, cracked lips and a parched, blackening tongue.

"The patient does not simply slip away quietly, his death becomes a terrible ordeal for relatives. For the vast majority of people, the idea that a civilised country could consider dehydrating and starving patients is unthinkable. But that is exactly what we are doing now.

"If the Mental Capacity Bill, now before Parliament, goes through, the possibility of withdrawal of food and water will be extended to patients who, through illness or accident, have lost basic mental functions.

"The Bill will produce the worst of all worlds. Not only will people be sentenced to death but they will die in the most horrible of ways."

He said the Bill contained a number of worthwhile provisions, but he described it as having a "fatal flaw at its heart".

"There is the licence to withhold tube-delivered food and water from a patient who would otherwise live.

"The Government protests that this is not euthanasia. I cannot agree. It is a death sentence for the patients in question."

Mr Duncan Smith said the Bill contained an attempt to protect patients, including the appointment of a lasting attorney to make medical and other decisions if the patient becomes incapacitated.

"But it is one of a number of devices the Government is relying on to protect mentally incapacitated patients that have already been found wanting in other countries."

He said that polls showed the vast majority of doctors did not support euthanasia. Under this Bill doctors could be compelled to end the patient's life by denying life's essentials.

"It is unreasonable to place the burden of implementing a living will, or power of attorney decision, on to already overworked, hard-pressed doctors and nurses."

He said people should consider what MPs were being asked to sanction: "For those who cannot communicate and who are out of sight, the possibility is that they could be starved or dehydrated to death."

westpress.co.uk 22 Oct

Mental hospital for knife mugger

A schizophrenic who carried out a knife attack on a young mother, is to be detained indefinitely at a psychiatric hospital.
Robert Reid, of Brixton, south London, admitted wounding and robbing Milisa Duker-Brown, 23, in September 2003.

She was getting on a bus with her baby daughter when Reid, 37, snatched her bag, the Old Bailey trial heard.

She chased him and managed to get her bag back but Reid followed her onto the bus where he stabbed her several times.

She then chased him, retrieved the bag and ran back onto the bus where her child was.
But the court was told, Reid chased her and pulled out a knife with a nine inch blade.

Mr Kelly told the jury: "She recalls telling him she was sorry and he could have the bag back. The attack continued."

Ms Duker-Brown pleaded with Reid as she lay on the ground - telling him she did not want to die and she was unaware where her baby was, the court heard.

She had suffered lacerations to her head, deep wounds to the neck, shoulder and hand.

Eventually Reid ran off, chased by members of the public. He was arrested at his home later.

Reid, who was diagnosed with schizophrenia when he was 17, said later he was deeply sorry.

Psychiatrists deemed him a risk to the public if he failed to respond to treatment.

He was ordered to be held under the Mental Health Act, without limit of time.

Brendan Kelly, prosecuting, said that Ms Duker-Brown was with a friend getting on the bus when Reid took her bag.

bbc.co.uk 21 Oct

BASW's submission to the Joint Scrutiny Committee

BASW's submission to the Joint Scrutiny Committee plus a paper analysing the conditions for compulsion

Download Evidence to Scrutiny Committee

Download Analysis of conditions for compulsion

DRAFT MENTAL HEALTH BILL: SUBMISSION BY IMHAP

The Institute welcomes some of the changes that the Government has made to the Draft Bill originally published. For example, we support the amended conditions for compulsion, the new safeguards for children aged under 16 and the removal of Part 5 of the original Bill (which concerned the informal treatment of incapacitated patients).
The Institute remains concerned about several aspects of the Bill...

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Doctors call for 'more balance' in mental capacity bill debate

Press release date: Tuesday, 19 Oct 2004 (BMA London)

The BMA is concerned that debate surrounding the Second Reading of the Mental Capacity Bill (England and Wales) has been misdirected in key areas. The Bill begins its Committee Stage in the House of Commons today (19 October) and the BMA is calling for more balance in this important discussion.

Opponents of the Bill have claimed that it allows euthanasia through the back door, but the BMA believes this is not the case. The BMA is opposed to euthanasia and is satisfied that nothing in the Bill permits it.

Dr Michael Wilks, Chairman of the BMA Ethics Committee, said today: "There is no getting away from the fact that extremely difficult end of life decisions have to be made on behalf of patients who lose capacity to make or communicate their wishes. The Bill does not alter this but improves the current situation by allowing patients to choose for themselves who should be consulted about treatment decisions. The Bill increases protection for incapacitated people."

He added: "The BMA supports this Bill because it allows the incapacitated person to nominate someone they trust to make end of life decisions on their behalf. Finally the incapacitated person will have a voice."

The BMA supports the Bill because for the first time the following will be enshrined in law:

A Lasting Power of Attorney (LPA) permits the appointment of specific individuals, chosen by the patient, to make decision on their behalf about life-prolonging treatment. Without an LPA decisions would need to be made by health professionals in discussion with those close to the incapacitated person. An LPA therefore enhances the voice of the incapacitated person.
An Attorney can only make decisions regarding the withdrawal or withholding of life-prolonging treatment where the LPA specifically authorises it, ie where the incapacitated person has specifically granted the power.
Where an individual retains the capacity to make and to communicate a decision, even if the method of communication is via a series of movements, such as blinking, those views will override any advance statement or refusal which only takes effect when capacity is lost.

Ends

bma.org.uk 19 Oct

European mental health advocacy groups and politicians unite for first time ever to address lack of access to vital information for people affected by schizophrenia

– “Discover the Road Ahead”, a new patient and carer initiative, set to help improve the lives of millions in Europe –

Eighteen pan-European and national mental health advocacy groups representing millions of people affected by schizophrenia, have joined together for the first time as INFORMED, International Network For Mental Health Education, to launch an initiative which aims to improve access to information on this serious, yet treatable disease. “Discover the Road Ahead”, a comprehensive and user-friendly resource that gives people with schizophrenia and their families information, advice and support has been launched today at the 17th Annual Meeting of the European College of Neuropsychopharmacology (ECNP).

responsesource.com 18 Oct

European Politicians Endorse Initiative

The new initiative from INFORMED has been welcomed by Members of the European Parliament, who recognise the need for people with schizophrenia to have greater access to information about their symptoms, treatments and side effects to help improve their quality of life and that of those caring for them. Dr Charles Tannock MEP, a former psychiatrist, said “I am delighted to support the launch of the INFORMED initiative. I spent my professional career treating patients with schizophrenia and all measures taken to relieve their suffering and better inform the families of the patients is extremely welcome.”

Rodney Elgie, President of the Global Alliance of Mental Illness Advocacy Networks (GAMIAN-Europe), Europe’s biggest umbrella patient organisation in mental health, who is leading the initiative said: “We know that knowledge is power, and as a person affected by schizophrenia, if you aren’t informed about your illness, your access to the latest treatments, rehabilitation and support, accommodation, and employment are severely reduced.”

“It’s the aim of INFORMED, through initiatives such as “Discover the Road Ahead”, to bring about greater and equal accessibility to user-friendly and up-to-date information, particularly on the latest treatments, so that people with schizophrenia and their carers can make informed choices about their lives and management of this condition,” he continued.

Research Reveals Information Gap Impacts on Provision of Care

The development of this unique handbook has come about as a direct result of recent research. Whilst numerous surveys show that information, and access to it, is a critical aspect in providing good care and helping people to manage their condition [1], new data highlight that there is a serious information gap. One in four carers said they did not have any information to help them and that often information is denied or withheld. Among those who do have some information, one in three revealed that they do not have enough. [2]

Carers want to know a lot more about medication, specific mental health problems, new treatments, local service provision and coping strategies. Patients felt current information fell between two stools – leaflets did not provide sufficient depth of information, particularly for those who had recently been diagnosed with schizophrenia. In comparison, the Internet and textbooks overwhelmed and put off other patients, particularly as they were not considered to be user-friendly. [3]

“Access to information on the latest treatments available, particularly those that patients can adhere to, is critical to improving the quality of life for people with schizophrenia so that they can get better and make a contribution to society. “Discover the Road Ahead” is a much needed resource that can deliver this essential information,” said Preston Garrison, Secretary-General & CEO, World Federation for Mental Health.

“Much needed” Resource Piloted in UK

“Discover the Road Ahead” provides helpful information on detecting the early signs of schizophrenia, how to deal with diagnosis, the progression of the condition, and outlines the latest treatments and support that is available. The handbook was produced by people with first-hand experience of coping with schizophrenia, including advocacy groups, health care professionals and university professors. The resource was piloted with people with schizophrenia in the UK, who reported it to be “different, very much needed, easy to read, open and accurate with useful case studies from a range of ethnic groups”.

Early Access to Information Essential

Schizophrenia, which affects 1 in 100 people across Europe, is a serious brain disorder, which is characterized by symptoms that make it difficult for a person to tell the difference between real and unreal experiences, and to organise their thoughts. In addition, the diagnosis of schizophrenia, more than any other illness, is feared and misunderstood. It is therefore critical that information is available to help people understand their condition so that they can seek appropriate help in the early stages of this serious, yet treatable disease.

“Discover the Road Ahead” is being made available across Europe to patients with schizophrenia and their carers free of charge.
For your copy contact INFORMED@uk.ogilvypr.com

The INFORMED initiative is supported by Bristol-Myers Squibb Company and Otsuka Pharmaceuticals Europe Ltd.

Media Contacts: Dafni Kokkidi, Ogilvy PR Worldwide
Tel: + 44 (0) 207 309 1050
dafni.kokkidi@uk.ogilvypr.com

References:

[1] Rethink data on file
[2] Rethink, 2003. Who Cares? The experiences of mental health carers accessing services and information, p.7.
[3] Mentality UK data on file

INFORMED is the network of the following organizations:

Association of Community Mental Health Nurses of Ireland, Republic of Ireland; Associazione per la Riforma dell’Assistenza Psichiatrica (ARAP), Italy; Associazione Italiana Donne Medico, Italy; European Federation of Associations of Families of People with Mental Illness (EUFAMI); German Schizophrenia Network, Germany; Mental Health Europe, Belgium; mentality, UK; National Coalition of Associations of Patients Suffering from Chronic Diseases (CnAMC), Cittadinanza Attiva, Italy; Organisation of the Carers and Families of People with Serious Mental Illness, Croatia; Panhellenic Association for Families of Mental Health, Greece; Penumbra, UK; Rethink, UK; Sane, UK; Schizophrenia Solidarity Association of Izmir, Turkey; The Global Alliance of Mental Illness Advocacy Networks (GAMIAN-Europe); Union Nationale des Amis et Familles de Malades Psychiques (UNAFAM), France; Vereinigung der Angerhörigen van Schizophrenie/Psychisch-Krnaken (VASK), Swizerland; World Federation of Mental He
alth, USA.

College Statement on Covert Administration of Medicines

Patients who are unable to choose as a result of severe mental incapacity, are entitled to good quality effective care. Processes to achieve this need to be simple and effective, but also safeguarded to prevent abuse. In exceptional circumstances, it may be necessary to give medication covertly. This is only justified where there is no alternative and when the patient may suffer harm otherwise. It is always right to try to give medication normally, but there may be times when this is not possible (see example attached). The Nursing and Midwifery council and the Mental Welfare for Scotland have already produced guidelines on this issue.

Guidelines produced by the Royal College of Psychiatrists reflect these, but also consider some issues of the relationship between Mental Capacity legislation and Mental Health legislation. Proposals for lasting Powers of Attorney in the Draft Mental Capacity Bill currently being considered in the UK parliament, may make this practice easier, as donees will have the power to agree to such measures when they are essential to preserve health or avoid harm to the patient. The Adults with Incapacity Act (Scotland), 2000 also seems consistent with this approach.

Case examples
Joan is a thirty year old woman with severe learning disability and epilepsy. She always refuses to take tablets or liquid medicines, but without antiepileptics she suffers from severe fits, and injures herself as a result. Without treatment she needs constant nursing attention and cannot be managed at home. With treatment her fits are controlled and she can live at home where she has a better quality of life. Her parents give her medication three times a day in her food. Otherwise she will not take it.

John is a sixty six year old man with severe dementia, and long standing diabetes. He always refuses to take tablets or liquid medicines, but without medication his diabetes becomes uncontrolled and he will die. With treatment he can live at home where he has a better quality of life. His daughter gives him medication three times a day in his food. She has been unable to find another way of doing this.

Download file

Joint Committee on the Draft Mental Health Bill - Written Evidence

Joint Committee on the Draft Mental Health Bill - Written Evidence

Here you can browse the Written Evidence which were ordered by the House of Lords and the House of Commons to be printed 15 October 2004.

Click Here

Prevalence of mental incapacity in medical inpatients and associated risk factors: cross-sectional study

Summary

Background: Although mental incapacity is becoming increasingly important in clinical practice, little information is available on its frequency in medical inpatients. We aimed to estimate the prevalence of mental incapacity in acutely admitted medical inpatients; to determine the frequency that medical teams recognised patients who did not have mental capacity; and to identify factors associated with mental incapacity.

Methods: Over an 18-month period, we recruited 302 consecutive acute medical inpatients. Participants were assessed with the MacArthur competence tool for treatment and by clinical interview. Cognitive impairment was measured by the mini-mental state examination.

Findings: 72 (24%) patients were severely cognitively impaired, unconscious, or unable to express a choice and were automatically assigned to the incapacity group. 71 (24%) refused to participate or could not speak English. Thus, 159 patients were interviewed. Of these, 31% (95% CI 24-38) were judged not to have mental capacity. For the total sample (n=302), we estimated that at least 40% did not have mental capacity. Clinical teams rarely identified patients who did not have mental capacity: of 50 patients interviewed, 12 (24%) were rated as lacking capacity. Factors associated with mental incapacity were increasing age and cognitive impairment.

Interpretation: Mental incapacity is common in acutely ill medical inpatients, and clinicians tend not to recognise it. Screening methods for cognitive impairment could be useful in detecting those with doubtful capacity to consent.

Full Article (free registration required)

FEARS OVER MENTAL HEALTH EXPANSION PLAN

Concerned residents have hit-out against proposed changes to expansion plans for a controversial mental health centre in their village. More than 100 people packed into a public meeting at the Loggerheads Hotel last night to oppose proposals to expand Ashley House Hospital, in Ashley, ahead of a site visit by councillors later this month.

Residents have formed the Stop Ashley House From Expanding (SAFE) action group and have sent more than 700 letters of objection to Newcastle Borough Council.

Villagers only discovered the site was home to some convicted criminals earlier this year, when the expansion plans came to light.

thisisstaffordshire.co.uk 14 Oct

Now they fear the development - three nine-bedroom, single-storey houses surrounded by a five-metre high security fence - will bring more high-risk patients.

Villagers say the description the company has given of its clients having "learning difficulties" is misleading as many are sectioned and mentally ill.

Greg Hopkinson, who lives 100 metres from the site, said: "We are very supportive of helping people with learning difficulties, but not of violent people being brought into the village."

Organisers of the protest want a large show of support at the site visit on October 23 - where they plan to demonstrate with banners and a mock-up fence to show councillors the height of the one proposed at the centre.

SAFE member Dianne Perry said: "We want to make people aware of the amendments. The plans have placed the entrance on the opposite side of the original plan, which is in the prettiest and oldest part of the village, making these proposals even worse."

* Members of SAFE will be meeting outside Ashley House on Saturday October 23 at 9.30am when councillors from the planning committee arrive to inspect the site.

Survivor haunted by suicide tragedy

The mother of a teenager who survived a suicide pact in which her friend died has told how her daughter is still haunted by the tragedy.

Alison Ling said her 13-year-old daughter Rebecca was in constant anguish after her friend Laura Rhodes died when the pair took a drugs overdose.

Police officers investigating the death of Laura Rhodes yesterday said they were satisfied there were no suspicious circumstances.

The pair, who met on the internet, went on the run for three days before being found in a bed and breakfast hotel in Bath by police.

Laura, aged 13, of Cimla, Neath, south Wales, had spent the summer holidays with Rebecca in Greece.

Mrs Ling, from Longbridge, Birmingham, said: "It's a lot for Rebecca to go through at her age. It's going to affect her for the rest of her life.

"I think both girls wanted to die and Rebecca is taking Laura's death really badly. She hasn't spoken to me about the overdose, but there are questions to be asked once she's better able to answer them.

"It has been awful because she had never run away from home before and this was the last thing I expected. But I have the support of my family."

Rebecca is currently being treated at a Birmingham clinic and has refused to speak to her mother about the incident.

Ms Ling, who described Laura as a "polite, friendly girl", said: "I have asked her what happened but she's not speaking to anyone at the moment.

"If she had problems she wouldn't confide in me. I don't think she would have spoken to anybody.

"Laura was the only person she would have confided in. Girls tend to confide in girls of their own age.

"Hopefully when the time is right, we will talk. But I can't pressure her and I cannot say what will happen in the future. Until she's opening up and talking to me, there's not much I can say."

icbirmingham.icnetwork.co.uk 16 Oct

Highlands on suicide watch after 50 deaths

Few leave a note. None is thought to have been making a plea, however desperate, for attention. In the words of one Highland politician who has studied the issue, “they make sure they do the job right”.
Suicide in the Highlands and Islands is running at “epide mic” proportions, according to one expert in the field, yet agencies are at a loss to explain the phenomenon.

sundayherald.com Oct 17

Forty-two people have taken their lives in the region this year to date, according to the Inverness-based Suicide Aware ness Group (SAG). That figure does not include eight people from outside the area who travelled north to kill themselves. Most were in their 20s or 30s; most were male; most hanged themselves.

Suicide rates have long been higher in the Highlands and Islands than elsewhere in Scotland. However, the issue has been thrust into the open after a spate of deaths in Inverness this year which has left the city’s population stunned, unable to explain the tragedies in their midst.

Dr Rory O’Connor, who heads the Suicidal Behaviour Research Group at Stirling University, said it was recognised that “there’s essentially an epidemic going on up north”.

Across the UK there has been a huge increase in the suicides of young men in the past 10 to 15 years, mainly because, due to the stigma associated with mental ill-health, young males are less likely than others to seek help, he said. However, while suicide rates have stabilised in England and Wales, in Scotland they are still rising.

“We need to understand better why it is that in England and Wales the suicide rate seems to have plateaued, and in some age groups decreased, whereas in Scotland it is still increasing. We don’t know the answer to that,” O’Connor said. “Suicide is a complex phenom enon and we need to tackle it from many different aspects.”

Just how complex an issue it is was highlighted by the deaths earlier this year of three friends who all played for an amateur football team in the Highland capital.

Richard Burnside, 36; Mark Thow, 40; and Ivor Robertson, 35, all lived in the Hilton area of Inverness. They played for the same team, Glenalbyn. All were of similar age and each man had gone through a period of unemployment. First, Mark hanged himself, then, within four months, Ivor and finally Richard did the same.

Richard had been wrestling with a drink problem for around 10 years. But things seemed to be looking up for him, according to his father, John Burnside, who runs the Cromarty Arms on the Black Isle with his wife Edna. He has gone over and over the circumstances of Richard’s suicide but is still no closer to understanding how he got so low as to take his own life.

“Richard had no history of depression,” he explained over coffee beside an open fire in the bar, autumn sunshine warm ing the narrow street outside. “I have no doubt he was fighting his demons for a while, but he seemed to have come out of it.”

Richard had split up with the mother of his daughter Kay leigh, eight, but he was being granted full access rights. He would take Kayleigh to swimming lessons on Friday eve nings, which also kept him out of the pub. He was apparently shocked at how many other fathers he met there were in the same situation.

Despite outward signs of stability, on August 3 he went to his local and ordered a pint, left without finishing his drink, and went home and hanged himself with an electric cord in front of Kayleigh’s room.

His father, a former psychiatric nurse, said Richard had been greatly affected by the death of his friend Mark Thow in April. He also blames the macho culture prevalent in this land of Celts and Picts.

“I have watched them, small men, but after a few pints they’re giants,” he said. “Yet they can’t talk about their prob lems. If it’s something of a personal nature, these men are not capable of relating that problem.”

Richard, Mark and Ivor were not big men, said Burnside, who coached their team . “But on the football ground they would take on a giant, such was their heart.”

They were impetuous, however, and earned more red cards between them than the rest of the team put together. When asked why they had let their team-mates down, they had no answer.

“They couldn’t explain it. They had to do it. That seemed to run right through them. That’s the thread they all had. It was amazing to watch: quick-tempered, very frenetic, yet they were the heart and soul of any team.”

The Burnsides have had letters from friends of Richard’s from around the world, telling them of some act of kindness he had performed, in at least one case dissuading some one from suicide.

“I thought I more or less knew everything about him …” his father trailed off.

Since Richard’s death he has channelled his energies into working with the SAG and campaigning for greater understanding of the issue across the Highlands and Islands. He has been shocked by the number of people who have approached him and his wife to say that they too have experience of suicide or attempted suicide in the family. Four people stopped them in an Inverness supermarket in one day.

The official statistics only record those whose attempts at taking their lives succeed, but John Burnside believes there is a growing realisation that the numbers who attempt suicide are “overwhelming”.

In SAG’s tiny offices overlooking Inverness railway station, Neil Gillies of Skye explained that he established the group in July in response to the high rate of suicides.

“There were eight suicides in a spate in Inverness and there was nowhere to support the families,” he said. “Now it’s just non-stop with people coming in off the street, and we’ve got a 24-hour helpline. Three weekends ago we were called out on six occasions.”

Each case is different, he says, and often revolves around relatively trivial troubles, from a court case to a social security problem. SAG intervenes and acts as a mediator with the appropriate agency. But SAG’s clients are not confined to the ranks of the unemployed. They include professionals such as lawyers and doctors struggling to cope at work.

Volunteer Karen Shaw said many people in Inverness were struggling to adapt to the changing nature of the Highland capital, which, despite city status and an influx of jobs and wealth, has led in some cases to feelings of alienation.

Shaw knew Richard, Mark and Ivor personally and has organised fund-raising activities for SAG in Hilton. Bringing suicide into the open and de-stigmatising mental ill-health has helped, she said. “Up here was like morgue city, the city of doom, but it has changed. Everybody’s a lot more open.”

Local SAG groups are being mooted in Wick and the Western Isles, while individuals and groups from Aberdeen and Dumfries and Galloway have been in touch. Now SAG is appealing to the Scottish Executive for emergency funding to help with staff and training.

“This is Highland families, this is our population,” Gillies added. “It’s a very worrying trend.”

A spokeswoman for the Scottish Executive pointed out that the Choose Life suicide pre vention strategy was launched in December 2002, and had allocated £9 million to local areas with the aim of reducing suicides in Scotland by 20% by 2013.

Mary Scanlon, Conservative MSP for the Highlands and Islands and vice-convener of the Scottish parliament cross-party group on mental health, urges further research.

“There are no easy answers ,” she said, “but we have all got to learn a bit more about it. It’s just knowing where to start.”

COMMON MYTHS ABOUT THE DRAFT MENTAL HEALTH BILL: A RESPONSE

This short briefing note by Professor Anselm Eldergill is a response to the Department of Health’s recent press release, ‘Common Myths about the Draft Mental Health Bill.’

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