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Two more fly out for assisted suicide

Two British women living in chronic pain as a result of motor neurone disease have flown to Switzerland in the past fortnight to commit assisted suicide.

In both cases the women, who did not know each other, were supported by their husbands on the difficult journey to the Swiss clinic in Zurich. Both men, who have remained anonymous, now face prosecution under British law for helping their partners to end their lives.

The deaths bring the number of British motor neurone patients who have gone to the controversial clinic Dignitas up to nine. In a few months, the Lords will produce a report that may recommend a change in the law to offer more help to the terminally ill.

One of the women, a 61-year-old from Yorkshire who had been married for only five years, spoke to The Observer about her decision before flying out last Friday. She died late that night, after being given a lethal dose of barbiturates.

Earlier in the week, the woman, who is an Anglican, was given communion by her vicar. 'I think God is a forgiving God' she said. 'I think he would understand why I am doing this.

'The pain is becoming much harder for me. Soon my arms and legs will go. I know that things can only get worse, and I also know that the marvellous doctors and nurses can't help me to die.

'I'm angry that I've had to put my family through this, angry that I have to go abroad, because it should be possible for people like me to die in my own country so that I can have a dignified death.'

The other motor neurone patient was a 64-year-old woman from Wigan who had lost virtually all movement, apart from the use of her right arm. Her husband arranged for her to fly by private jet to Zurich, where she died on 16 February. He did not accompany her on the flight, in order to minimise any risk of arrest.

Like the other woman, the Wigan patient completed all the forms herself and arranged the £2,000 payment to Dignitas through her own bank in order to try to avoid her family breaking the law. Under the Suicide Act of 1961, it is an offence to counsel or help anyone end their own lives, although this has not yet been tested in relation to the Swiss clinic.

Her husband told the Wigan Evening Post that she had managed to write a goodbye note: 'The Eagle has landed. See you again.'

He added: 'It's wrong to take a life, but we are an enlightened society. If an animal was suffering, you wouldn't keep it alive. If it's a person's wish, then respect it.'

Both women had to be seen by doctors and lawyers before they were allowed to commit suicide, and the Swiss authorities have been informed of their deaths.

The plight of motor neurone patients once they enter into the final stages of the disease was highlighted three years ago by Diane Pretty, who went to the European Court to try unsuccessfully to win the right for an assisted suicide. But the issue of care for the terminally ill has not gone away. The House of Lords has been considering a private members' bill which would give terminally ill patients with less than six months to live the right to have an assisted death if it was agreed by a series of doctors.

It has provoked fierce controversy, with many arguing it is too close to euthanasia and it would harm the doctor/patient relationship.

The Voluntary Euthanasia Society said that the two women's cases highlighted the need for a change in the law. Mark Slattery, a spokesman for the society, said: 'The government should have a lot on its conscience today.'

The Motor Neurone Disease Association has remained neutral. 'Only when the best palliative and terminal care are available to everyone will those considering ending their life early genuinely have a choice' said a spokeswoman.

Last December, a chronically ill British woman was at the centre of a High Court battle over attempts to prevent her from dying in an assisted suicide in Switzerland. Her local authority brought the case after learning of her plans. The woman, known as Mrs Z, was accompanied to Zurich by her husband of 45 years.

She died on 1 December, after a judge decided not to frustrate her wishes to die abroad. He lifted a ban on her husband, 66, a former insurance clerk, taking her abroad in the first case of its kind, but stopped short of sanctioning what has become known as 'suicide tourism'.

society.guardian.co.uk 27 Feb

Stalker loses human rights case

A stalker who claimed police breached his human rights by warning women he was a danger has lost his bid to win £50,000 in damages.
Simon Zarpellon, 41, who had earlier been jailed for harassment, alleged he was subjected to "stress and anxiety" following a police campaign.

Officers distributed posters bearing his photograph and a warning in Derby.

A judge rejected his case against Derbyshire's chief constable, saying the action taken was "reasonable".

The Derbyshire force insisted it was right to put up the posters because of fears he would re-offend after he had served his second jail sentence.

Zarpellon, from Markeaton Street, Derby, claimed the posters breached the terms of the 1998 Human Rights Act and amounted to an "illegal witch hunt" against him.

He sought damages from Derbyshire Chief Constable David Coleman in a hearing at Nottingham County Court.

Giving evidence, the former soldier claimed police had been shadowing him for five years and had left him a virtual prisoner in his own home.

In 1997 Zarpellon, then of Nottingham, was jailed for three years after a court heard how he had left his neighbours living in fear.

Two years later he was sentenced to six months' jail by Derby magistrates after repeatedly harassing a terrified woman he had met in a bar.

The court heard police decided to distribute the posters warning of his possible behaviour in 2000 and 2001 after receiving new complaints about him.

Judge Peter Clark said of the police: "I am quite satisfied that their sole concern was the protection of women in Derby.

And he said of Zarpellon: "At 6ft 2ins it takes little imagination to appreciate the alarming effect his attention may present to women in the future as it has in the past."

bbc.co.uk 10 Feb

Hospital that let out killer has history of fatal errors

A psychiatric hospital that let out a violent schizophrenic who then stabbed a cyclist to death has a history of management failures which resulted in at least four other killings by patients.

John Barrett, 42, who pleaded guilty last week to the manslaughter of Denis Finnegan, 59, had been allowed out on "ground leave" by Springfield hospital in Tooting, south London, even though he had a record of mental illness and violence.

He was told to return within an hour, but went to a DIY store, bought a set of kitchen knives and attacked Mr Finnegan as he rode his bicycle in Richmond Park, last September.

Barrett was allowed out despite the fact that at least four other Springfield patients have killed people in the past 13 years.

The South West London and St George's Mental Health Trust, which runs the hospital, was criticised in an independent report published in 2000 for "serious management and systems failures", after one patient, Anthony Joseph, was set free and went on to kill Jenny Morrison, his social worker.

Ms Morrison was not told by hospital authorities that Joseph, a paranoid schizophrenic who believed he was the son of God, had already threatened staff, had a conviction for carrying a knife and had a history of sleeping with a machete under his pillow.

Nor was she informed that Joseph claimed to be plagued by "demons" and that he had said she would be "brave" to see him.

As a result, she visited him alone in the hostel where he had been living since his release. Within minutes, he had stabbed her more than 100 times.

When Joseph was discharged from Springfield hospital, he was given no written care plan, no risk assessment or systematic monitoring of his medication and no outpatient follow-up. Other killings carried out by Springfield patients include that of Mamade Chattun, a nurse beaten to death by Jason Cann in 2003. Earlier this month, Cann was convicted of manslaughter on the grounds of diminished responsibility. The Trust's report into the incident is due to be published shortly.

The killing took place on the day Cann was admitted, yet he was left alone and unobserved in the ward's lobby area, which should not have been used by patients, despite having attacked a social worker earlier and refusing to take his medication.

In 1993, Mark Ricketts stabbed Mark Kemp repeatedly in a Tube station, months after being released from Springfield. Mr Kemp, who had more than 20 stab wounds, survived only because the blade of the knife bent during the assault.

Two years earlier, John McCormack stabbed his father, Thomas, to death within minutes of running away from Springfield, where he was a voluntary patient. He was convicted of manslaughter and committed to Broadmoor high-security psychiatric hospital indefinitely.

Tim Loughton, the shadow minister for mental health, said last night: "These incidents raise question marks as to the procedures being followed at Springfield hospital for people who clearly need treatment.

"My fear is that the liberty of people with serious mental illness is being driven by the lack of available services for them rather than their clinical need."

telegraph.co.uk 27 Feb

Asbo bars suicidal woman from rivers

A woman who has repeatedly tried to kill herself was issued with an anti-social behaviour order banning her from going near railway lines, rivers, bridges and multi-storey car parks by magistrates in Bath.

The bench was told that Kim Sutton, 23, had attempted suicide four times.

She was rescued from the river Avon three times, had been found "hanging by her fingertips" from a railway bridge, and was repeatedly spotted loitering at the top of multi-storey car parks.

The court heard that Sutton caused panic when she was spotted in the Avon last summer. Two bystanders were about to jump in when police arrived and hauled her to safety.

In August she was found clinging to the parapet of a railway bridge. Train services were halted and she was rescued.

In November Sutton was rescued from the Avon twice in two hours. On the second occasion she told the gardener who had dived in to rescue her to leave her alone. The magistrates issued an Asbo preventing her from "going into rivers, canals or any open water in England and Wales", venturing on to railway lines or loitering on bridges. She can only go to car parks if accompanied and to park a car.

Sutton, of Odd Down, Bath, will face a jail sentence if she breaches the two-year order.

guardian.co.uk 26 Feb

Mental health services 'flawed'

Mental health campaigners have blamed flaws in the system for the fact that a schizophrenic man was able to walk out of a psychiatric hospital and kill.

John Barrett stabbed a cyclist to death in Richmond Park, south-west London, less than 24 hours after walking out of Springfield Hospital in Tooting.

Marjorie Wallace, of mental health charity SANE, highlighted a "shocking failure of mental health services".

The service was so hard pressed it could not protect the public, she said.

Ms Wallace said the service lacked both sufficient beds and staff.

People working in the service were sometimes so busy that they simply did not have enough time to give proper consideration to whether an informal patient - such as Mr Barrett - ought to be detained.

The case also reflected the fact that individuals who may be seriously disturbed and at risk were not taken seriously, or warnings of their families and friends heeded, she said.

She said: "SANE believes that many of the 40 homicides a year committed by people in contact with mental health services, if not predictable, could have been prevented had the patients been properly treated and cared for and not allowed to discharge themselves, abscond or simply leave psychiatric wards, with little effort being made to follow them up or give adequate information to families, police or those entrusted with their care.

"There seems to be a worrying increase in the numbers of patients who are allowed to disappear in the community while they are extremely disturbed, who then commit suicide and occasionally attack others.

"These cases further shatter the public's confidence in the care in the community policy and increase the stigma for the majority of people with mental illness who are never violent."

The reality is, say campaigners, that most mentally ill patients pose no risk to others.

Some critics have suggested the modern approach of treating mental illness in the community may have increased the risk of violent incidents.

But experts say there is little statistical evidence to back this up.

They say violent attacks by strangers are relatively rare, and it would be wrong to deprive many people of their liberty when they pose little threat.

There have been a number of high profile cases of mentally ill people turning into killers.

These include Christopher Clunis, a schizophrenic who killed Jonathan Zito on the platform of Finsbury Park tube station in north London in 1992.

Clunis had stopped taking his medication.

However, cases of this ilk are not common.

Andy Bell, director of communications at the Sainsbury Centre for Mental Health told the BBC News website that around 30-50 murders a year out of a total of 800 could be blamed on mental illness.

"That is still 30-50 too many, but it is a very low risk when you compare it to the number of violent incidents involving alcohol," he said.

Mr Bell said around 500,000 people in the UK were suffering from a severe mental illness such as schizophrenia or manic depression, which required specialist treatment. In total, one in six people has some form of mental illness.

He said the idea that all mentally ill people posed a threat to society was a stereotype which was not founded in reality.

"The policy of care in the community has allowed hundreds of people to live peacefully and normally as valued members of the community," he said.

"We don't want to go back to a Victorian policy of locking up people away from the community on the grounds that one day maybe they might be a risk.

"It is very, very difficult to predict violence, and so such a policy would require locking away hundreds, maybe even thousands of people in order to prevent one or two tragic incidents."

Violence is not a common symptom of mental illness. Most schizophrenic individuals, for instance, are not violent; more typically, they prefer to withdraw and be left alone.

Mr Bell said statistics showed that a mentally ill person was twice as likely to be murdered as anybody else.

He said support services continued to be under-funded. Mental health as a whole received a third of the increase in resources granted to the rest of the NHS this year, he said.

The draft Mental Health Bill currently going through parliament would enable the forced detention of mentally ill people deemed to pose a risk to the public who refused to take their medication.

bbc.co.uk 25 Feb

Mental patient admits stabbing stranger in Richmond Park

A paranoid schizophrenic today pleaded guilty to leaping out of a bush in Richmond Park and stabbing a total stranger to death as he cycled past.

John Barrett 41, pleaded guilty to the manslaughter of 50-year-old ex-banker Denis Finnegan on September 2 last year, on the grounds of diminished responsibility. The case was adjourned until March 22 for sentence.

Mr Finnegan, an unmarried former banker who lived in west Putney, was attacked in broad daylight at 10am as he cycled through the park, close to Sheen Gate, as part of his daily exercise routine.

He suffered multiple wounds and piercing to his aorta. He died three hours later after being rushed to Charing Cross Hospital. His brother John said after the hearing that Denis would still be alive today if Barrett had been cared for properly, and called for an independent inquiry.

The Old Bailey heard today that Barrett, who had a ten year history of mental problems and a previous conviction for violence, had walked out of a psychiatric hospital the night before he stabbed Mr Finnegan repeatedly with a kitchen knife.

In the past, he had spent a long period being treated in a secure unit at Springfield Hospital in Tooting, after he stabbed three people at an outpatients clinic. On that occasion he was convicted of wounding with intent.

He was conditionally discharged by a Mental Health Review Tribunal in October 2003, and was cared for in the community with the support of his partner, Jane Whittaker.

He spent five days back in hospital in May 2004, and by August bank holiday weekend his condition had worsened again. His relationship with Miss Whittaker broke up, and she moved out of the flat they shared together.

She became worried about his state of mind and on September 1, an appointment was made for Barrett to return to the hospital. Later that day he was admitted to a secure unit as a voluntary patient. He was assessed by a consultant forensic psychiatrist and was given an hour’s ground leave.

Prosecuting, Crispin Aylett said that the assessment had turned out to be "tragically wrong". Barrett discharged himself, promising to return the following morning.

Instead, he bought a set of kitchen knives from a DIY store, a Scotland Yard spokesman said. He went to Richmond Park that night but finding the gates locked he went to stay with a friend in Belsize Park, before returning the following morning by taxi.

Mr Aylett told the court: "The voices, he said, had returned - the voices, which in the past had said to kill himself, told him to kill someone else. Then, in what might be described as a lucid, but chilling process of elimination, he decided that the person he would kill would not be a woman, a child or an elderly person."

Detective Chief Inspector Chris Watts revealed that Barrett had told them that two other men had had a lucky escape, before Mr Finnegan met his death.

"He had identified two people he wanted to attack who fitted his criteria, who he did not attack," he said. "Mr Finnegan was the third person he selected. He was the unlucky one."

timesonline.co.uk 25 Feb

Bravery award for police officer

A police officer who risked his life to save people from a crazed knifeman at a bus stop in north London has received the Queen's Gallantry Medal.

British Transport Police inspector Michael Tanner was decorated by the Queen on Wednesday.

Mr Tanner was stabbed by Ronald McKoy when he confronted him outside Finsbury Park bus station in December 2001.

Schizophrenic Ronald McKoy, 34, from Kilburn, north London, was given two life sentences at the Old Bailey.

The 34-year-old father of three was stabbed in the arm and the chest by McKoy.

He said he made an "instant decision" to draw McKoy away from a crowd of people at the bus station, where the attack took place.

"It just turned horrible in a matter of seconds.

"He had a steely gaze. When he pulled out the knife, I was relieved it was not a gun," he said.

Despite the concerns of his wife Mr Tanner, who was on sick leave for nine months and had several stitches, decided to return to work.

"My father was a policeman, so there was really no doubt about me going back," he said.

McKoy also attacked two of his colleagues before he was overpowered.

Stab killer 'had mental illnesses'

A MAN who stabbed his girlfriend to death after she told him she did not love him any more was suffering from two mental illnesses at the time of the attack, a court heard.
Joanna Greenberg QC, defending Kieron Carpenter, claims the 30-year-old was in a deep depression and had Asperger's Syndrome which substantially affected his responsibility for the killing of Emily Bates.

Northampton Crown Court has already heard Carpenter savagely butchered the 21-year-old with a hunting knife at the flat they shared, in South Brink, Wisbech, on January 24.

Carpenter admitted to police that he stabbed Miss Bates 23 times with the 18cm blade when she refused him a "final hug" at the home.

He then turned the blade on himself, but called 999 more than four hours later when the pain was too great.

But Miss Greenberg told jurors yesterday that the degree of responsibility and guilt was affected by the thought process of the person who committed the crime.

She said: "The prosecution says it was murder pure and simple, and you may wonder why you are being asked to try this case.

"Undoubtedly it was an horrific killing by this defendant, he admits it. He described in graphic detail how he attacked Emily, and you would be forgiven for closing your mind to any possibility this was not murder."

Shortly before the killing, Carpenter's depressive illness made him despondent, the jury heard.

Miss Greenberg said the depression and Asperger's Syndrome would substantially impair his responsibility for his actions.

Carpenter took the witness stand during the fourth day of his trial and said he still had strong feelings for Miss Bates.

He said: "I worshipped the ground she stood on and I still do."

He had no idea Miss Bates had been unfaithful to him until he was in prison following her killing, he said.

Carpenter said: "At the time I was very down. I was worried about my state of health and had no job. Everything was wrong with the world."

Carpenter admits killing Miss Bates, but claims it was manslaughter. He denies murder.

'She was always happy' says victim's mum
EMILY Bates had been a girl who was "always popular, happy and smiling", according to her mother.

In a statement read to Northampton Crown Court, mother-of-four Helen Bates said no one ever had a bad word to say about her 21-year-old daughter.

She said Miss Bates had been involved in school activities, led an extremely active social life, did charitable work and had a wide circle of friends.

But all that changed after she moved in with Kieron Carpenter, the court heard.

In the statement she said: "She became less outgoing and did the things that Kieron wanted to do rather than what she wanted to do."

Mrs Bates also said that her daughter had begun to lose weight.

fenlandtoday.co.uk 23Feb

Nice restraint guidelines do not go far enough, campaigners warn

More mental health patients will die when they are physically restrained because the government has failed to introduce a time limit for its use, experts have warned.

communitycare.co.uk 25 Feb

Widespread criticism has greeted the publication today of guidelines by the National Institute for Clinical Excellence that fail to impose a three-minute time limit – a key recommendation of the inquiry into the death of David Bennett.

Bennett died in 1998 at Norvic Clinic, Norwich, after being restrained face down for 25 minutes by three or four nurses.

Inadequate response

His sister Joanna Bennett, who has led calls for reform of the use of ‘prone’ restraint, said: “Mental health services continue to be in denial about critical incidents and deaths associated with control and restraint.”

Co-director of Inquest Helen Shaw added: “The guide is a profoundly inadequate response to the appalling death of David “Rocky” Bennett…it is particularly shocking that there is no reference that alerts practitioners to the deaths that have occurred following restraint and the special dangers posed by prone restraint.”

Figures collected by the Mental Health Act Commission show that between 1997 and 2000 four people died after being restrained.

"Just as important"

Speaking ahead of the publication of the guidelines last week, mental health tsar Louis Appleby defended the decision to reject the three-minute maximum, arguing its requirement for “the shortest time possible” was “just as important”.

But senior race relations and health consultant at human rights organisation 1990 Trust Matilda MacAttram described it as “an insult”.

Dr Richard Stone, who sat on the inquiry panel, said it was “wishy-washy”.
“In the Bennett case a senior charge nurse had hold of his [Bennett’s] left arm. He had been through all the training. He should have just sat near his head making sure his airways were clear.”

“It is crucial to have the three-minute rule because people often forget their training when they panic because they are in a crisis”

“People will go on dying in these circumstances until the NHS has the courage to act on this, which it must do now,” added Stone.

The guidance says:

• During a physical intervention one team member should be responsible for protecting and supporting the head and neck, where required

• The team member who is responsible for supporting the head and neck should take responsibility for leading the team through the physical intervention process and for ensuring the airway and breathing are not compromised and that vital signs are monitored

Key priorities for implementation –

Prediction

Mental health service providers should ensure there is a full risk management strategy for all their services

Training

All service providers should have a policy for training employees and staff-in-training in relation to the short-term management of disturbed/violent behaviour

All staff whose need is determined by risk assessment should receive ongoing competency training to recognise anger, potential aggression and risk factors. Training should include ways of de-escalating violent behaviour

Staff who employ physical intervention or seclusion should as a minimum be trained in Basic Life Support.

Working with service users

Service users should have access to information about what their rights are in regard to consent to treatments, complaints procedures and access to independent help and advocacy

Service users identified to be at risk of disturbed or violent behaviour should be given the opportunity to have their needs and wishes recorded in the form of an advance directive.

Rapid tranquilisation, physical intervention and seclusion

Rapid tranquilisation, physical intervention and seclusion should only be considered once de-escalation and other strategies have failed to calm the service user.

The intervention selected must be a reasonable and proportionate response to the risk posed by the service user.

R (on the application of E) v Bristol City Council [2005] EWHC 74 (Admin) 23 February 2005

DoH Briefings on legal cases 25 Feb 2005

R (on the application of E) v Bristol City Council [2005] EWHC 74 (Admin) 23 February 2005
Gateway reference: 4606

Judgement

On 13 January 2005 the High Court handed down its judgment in this case, which concerned section 11 of the Mental Health Act 1983 (“the Act”) and the circumstances in which an Approved Social Worker (ASW) must consult and/or inform the nearest relative of a patient when making or considering an application to detain the patient, or make them subject to guardianship under the Act

The whole judgement can be accessed at the link below.

Background

Under section 11(3) of the Act, an ASW making an application to admit a patient to hospital for assessment under section 2 must “take such steps as are practicable” to inform the patient’s nearest relative of the application and of the nearest relative’s power of discharge under section 23(2)(a). Under section 11(4), ASWs must consult the nearest relative before applying to admit a patient for treatment under ssection 3 or to guardianship, unless consultation is “not reasonably practical” or would involve unreasonable delay.

In this case, the claimant asked her social services authority for an undertaking that, in the event that they were considering an application under the Act, its ASWs would not consult or inform her nearest relative (a sister with whom she wished to have no contact.) The authority (although sympathetic) felt that section 11 prevented them from giving this undertaking. The claimant sought a declaration from the High Court that it would be unlawful for the authority or its ASWs to consult or inform her sister under sections 11(3) or (4) without her consent.

Outcome

The High Court made a declaration that it was not “practicable” for the authority to carry out its duties under sections 11(3) or (4) to involve the nearest relative. In doing so, the Court specifically rejected the advice in paragraph 2.16 of the Mental Health Act 1983 Code of Practice that “Practicability refers to the availability of the nearest relative and not to the appropriateness of informing or consulting the person concerned.”

Implications

In the light of this judgment, the Department of Health accepts that the advice paragraph 2.16 of the Mental Health Act 1983 Code of Practice quoted above is no longer correct. In determining whether it is practicable to consult and/or inform the nearest relative under sections 11(3) and (4), ASWs may (and should) consider whether doing so would lead to a breach of the patient’s rights under Article 8 of the European Convention of Human Rights (right to respect for private and family life).

The Court suggested that this requires a balancing act to be performed. On the one hand, Parliament clearly intended nearest relatives to have the opportunity of playing a significant role in the protection of the patient or otherwise acting in the patient’s best interests. ASWs should not, therefore, lightly invoke “impracticality” as a reason for excluding them. On the other hand, there may circumstances where involving the nearest relative would lead to an infringement of the patient’s rights which could not be justified by the benefit of that involvement.

The key factors support the finding in this case appear to have been that the patient had very strongly expressed the view that her nearest relative should not be involved, the fact that the nearest relative herself did not wish to be involved and the likelihood that her involvement would have been distressing to the patient. It is also arguable that the issue might arise in other circumstances, for example where the nearest relative is known intensely to dislike the patient and/or would not act in the patient’s best interests or where the involvement of the nearest relative might adversely affect the patient’s health (eg by causing the patient severe distress.)

However, in the Department’s view it is very unlikely that the fact that a nearest relative is expected to object to admission or to seek the patient’s discharge would, of itself, make their involvement impractical and therefore relieve ASWs of the duty to inform or consult them. Section 29 of the Act already provides mechanisms for displacing nearest relatives who exercise their powers to object and/or discharge unreasonably.

Full Transcript

Give carers a break

Health Minister Stephen Ladyman today encouraged local councils to give carers a break from their duties by announcing an extra £60m for Carers’ Grants.

A fund of £185m will be allocated to councils in 2005/6 for the Carers Grant. This will enable them to provide support to England’s estimated 5m carers, bringing the total awarded since the Carers’ Grant was introduced in 1999 to £635m. The Minister also announced that the Carers Grant will continue at this new higher level until at least 2008.

Speaking at the National Family Carers Network Conference, Stephen Ladyman said:

"The care provided by family, friends and neighbours is invaluable and touches all of us at some time or another. Carers say that being able to take breaks from caring is the most effective way to support them and enable them to continue caring.

"I’m also delighted that the carers Grant will be extended for at least another two years confirming this Government’s commitment to sustained support for carers."

"We want to encourage councils to further develop innovative and high quality services that focus on the needs of carers, which is often the most effective way to prevent loss of independence.

"This Government was the first to recognise the needs of carers and publish a carers strategy and we are determined to do even more to help."

Ian Cash, 45, from Lancashire has been caring for his wife Sue, who has MS and uses a wheelchair, for 25 years. Ian and Sue are both studying for the same Open University course but found they both couldn’t sit their exams at the same time as this would leave Sue without care.

Ian and Sue were given a Carers Grant by Lancashire Authority and used it to provide a care worker to look after Sue during the exam. Without this support one of them would have had to defer the exam for a year, and they would no longer have been able to do the course together.

Ian Cash said: "The Carers Grant allowed us to get extra care when we needed it. It gave us both the independence to do what we wanted. I'm pleased to say that with the help of this support we both passed our exam and are on the next stage of our course."

Imelda Redmond, Chief Executive of Carers UK said: "We welcome the announcement of an additional £60m to be made available to local authorities through the Carers Grant and the news that the Grant will continue for another two years. The Carers Grant has made a significant contribution to recognising the crucial role carers play and the contribution they make. This money will go some way to ensure that the potential benefits of the recent Carers (Equal Opportunities) Act are realised".

The government is currently consulting on guidance relating to the Carers (Equal Opportunities) Act, which received Royal Assent on 22 July 2004.The Act will ensure that carers are able to take up opportunities which those without caring responsibilities take for granted. As a result of the new Act, existing legislation, namely the Carers and Disabled Children Act 2000 and Carers Recognition and Services Act, will also be amended

DoH 24 Feb

Violence - The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments.

The National Institute for Clinical Excellence (NICE) has today issued guidelines for the NHS on the management of disturbed/violent behaviour in psychiatric inpatient settings and emergency departments. The guideline provides a comprehensive framework for how to assess risk and prevent violence; de-escalate and calm down a potentially violent situation; and intervene safely when violence occurs.

23 Feb 2005

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Better mental health services for deaf people

DoH 22 Feb 2005

New guidance for providing better mental health services for deaf people

The NHS must provide specialised services for deaf people with mental health problems, such as a sign language translation in every GP practice, according to new guidance published today by the Department of Health.

The guidance, Towards Equity and Access: Mental Health and Deafness sets out how mental health services for Deaf people can be improved using the template of the National Service Framework for Mental Health as a starting point, and is supported by £2.5 million of funding for PCTs. Recommendations include:

front-line NHS staff being given deaf-awareness training;
child protection committees reviewing their procedures to ensure that Deaf children’s needs are being met;
every primary care facility having access to sign language translation services;
staff in mental health facilities being encouraged to learn sign language.
There is a higher incidence of mental health problems among Deaf people compared to the hearing population - studies show that 40 per cent of Deaf children have mental health problems, compared to 25 per cent of hearing children. Many Deaf people suffer from social exclusion and reduced educational and employment opportunities, and there are well-documented links between this and mental health problems. Deaf people with mental health problems are also over-represented in prisons and the criminal justice system.

Health minister Rosie Winterton said:

"A society is judged on how it treats its most vulnerable members. Deaf people who also have mental health problems are a group who really need our help, our support, and services that are specifically designed around their needs.

"This document brings into focus the needs of individuals whose access to mental health services have for too long been patchy. Many Deaf people with mental health problems have not had their needs properly catered for by existing mental health services. This document will change that.

"I hope this document will change that. We have made £2.5 million available for the NHS to put in place the changes recommended in this document, and the implementation of this guidance should result in a real improvement in the lives of deaf people with mental health problems.

"We are committed to improving mental health services for everyone, and reducing social exclusion wherever possible."

Welcoming the guidance, Steve Powel, Chief Executive ofSign, the mental health charity for Deaf people, said:

"Mental health services for Deaf people have traditionally been far from adequate. That's why Sign welcomes these recommendations as a major step forward in recognising that Deaf people have special needs when it comes to accessing appropriate mental health care, and redressing this imbalance. This guidance shows how we can improve mental health services for Deaf people so they are no longer discriminated against and receive proper care."

Sally Austen, Consultant Clinical Psychologist at South Birmingham Mental Health Trust, said:

"The guidance reflects the special needs of Deaf people with mental health problems, who have previously received care that was discriminatory and insufficient. That is why it is so important that these recommendations are implemented thoroughly."

Paul Tarbuck, Service Manager at Bolton, Salford and Trafford Mental Health Service also said:

"Towards Equity and Access has been eagerly awaited by both clinical and social support staff. This guidance will enable a sustained approach in developing and delivering appropriate and accessible care for Deaf people with mental health problems."

Download Mental Health and Deafness - Towards Equity and Access : Best Practice Guidance

33-stone man sues over detention

A man weighing 33 stone (210kg) who was taken to a psychiatric hospital against his will says he plans to sue the social services department involved.
Chris Leppard, 23, from Hastings, East Sussex suffers from Prader-Willi syndrome, an inherited condition which drives him to over eat.

He was taken to the Eastbourne Clinic last week, but returned home on Monday evening after being assessed.

Mr Leppard said the ordeal hampered the progress he was making losing weight.

"I am going to take social services to court for what they have done because I am not mentally ill and I have my own independent life," he said.

Mr Leppard said he now planned to return to his controlled diet to prove to the authorities he can lose weight without enforced care.

His mother Anne said she was upset by the disruption caused to her son's routine.

"Instead of going to these drastic measures, they could have put the money into getting the right support for my son.

"I am really upset because before this I had managed to get his confidence up after six years to fight this illness, but this has caused a real hiccup," she said.

Mrs Leppard said she had written a letter of complaint to East Sussex social services and had consulted a solicitor about the possibility of legal action.

East Sussex County Council said all proper procedures were followed and such orders were "in the interest of that person's health and safety or to protect other people".

"We have worked closely with Chris and his family for three years and will continue to offer our support," the council said.

Jackie Waters, from the Prader-Willi Syndrome Association, said: "In extreme cases patients with the condition do have to be taken into care for their own protection. But it is only advised as a last resort."

There is no cure for Prader-Willi syndrome, which affects one in 15,000 people.

For someone to be sectioned under the Mental Health Act doctors and an approved social worker have to approve the measure.

bbc.co.uk 22 Feb

Action urged over child suicide

The government must take action to reduce the number of child suicides in Northern Ireland, a watchdog has urged.

Nigel Williams, Northern Ireland Commissioner for Children and Young People (NICCY), said resources to tackle the issue needed to be combined.

Mr Williams was speaking ahead of a NICCY conference entitled "Hope".

He said the conference would give those responsible for developing policies to address the problem the chance to meet with over 100 young people.

"One of the things we want to happen is identifying ways that policy and working practices change. By bringing best practice together at today's event we can really focus on what works," he said.

Mr Williams said the agenda for Tuesday's conference was developed with the assistance of young people.

"While we at NICCY recognised the need for a conference to bring together best practice in this area, it was the young people who helped shape the day and identify the areas they wanted covered."

The conference is being held at the Park Avenue Hotel in Belfast.

A commissioner to look after children's rights in Northern Ireland was appointed in June 2003.

Mr Williams was selected by young people themselves from 39 international applicants.

It was the first appointment of its kind in Northern Ireland, and only the second in the UK following a similar role set up in Wales.

bbc.co.uk 22 Feb

31-stone man held in mental hospital

A 31-stone man has been detained in a mental hospital against his will because he cannot stop eating, it emerged today.

Chris Leppard, 23, of Hastings, East Sussex, suffers from Prader-Willi syndrome, which means he cannot tell when his stomach is full and could eat so much that it will kill him.

East Sussex social services "used powers normally used to detain mentally ill people who might harm themselves or others" to section him (forcibly detain him against his will), according to the Sun.

The council became aware of his condition after he was featured in a BBC documentary.

He was taken "without warning" to a specialist eating disorder unit at the Eastbourne Clinic, where he will be assessed for up to 28 days.

Mr Leppard's mother, Anne, told the newspaper: "Four people turned up and after some questions, said they were taking him away.

"Chris was really upset, crying, saying he didn't want to go and that he wasn't mental.

"We didn't know they were coming to take him. He is being punished for being ill. He has a physical problem. He was working well towards losing weight."

She added: "He asked social services to give him six months to prove he could lose weight. They didn't give him six days. I had stopped giving him money for food.

"For the first time in years we were getting somewhere. We had locked food cupboards, that was a big step."

East Sussex council told the newspaper that all proper procedures have been followed and such orders were "in the interests of that person's health or safety or to protect other people".

society.guardian.co.uk 22 Feb

Mental Health Tribunal for Scotland

Deputy Health Minister Rhona Brankin today announced the appointment of Mrs Eileen Davie as President of the Mental Health Tribunal for Scotland.

Mrs Davie has been an Advocate since 1989 with a substantial civil practice covering a wide range of subjects in both public and private law.

Prior to her legal training she was a senior psychiatric social worker. Mrs Davie does not hold any other ministerial appointments.

The appointment will be from February 22, 2005, until February 21, 2010.

The President's remuneration will be £122,139 per annum, pro-rata. It is expected that Mrs Davie will work on a full-time basis.

Ms Brankin also announced the part-time appointment of 98 legal panel members and 55 medical panel members. Interviews for general panel members are currently in progress.

The Mental Health Tribunal for Scotland is a Non Departmental Public Body established by the Mental Health (Care and Treatment) (Scotland) Act 2003 (the 2003 Act), sponsored by the Executive's Health Department. The President will play a key part in the initial set-up and ongoing directing of the Tribunal's hearings system.

The establishment of the Tribunal will mark a fundamental change in the way decisions are made about the long-term compulsory care and treatment of people in Scotland who suffer from mental disorders. Tribunal panels will consider both the compulsory powers sought and the plan of care proposed for the individual.

This Ministerial appointment followed the Commissioner for Public Appointments in Scotland (OCPAS) Code of Practice, as a means of best practice.

All appointments are made on merit and political activity plays no part in the selection process. However, in accordance with the original Nolan recommendations, there is a requirement for appointees' political activity (if any declared) to be made public. Within the last five years, Mrs Davie has not been involved in any political activity.

HEALTHY BODY AND MIND: PROMOTING HEALTHY LIVING FOR PEOPLE WHO EXPERIENCE MENTAL DISTRESS: NIMHE

NIMHE:

A GUIDE FOR PEOPLE WORKING IN PRIMARY HEALTH CARE TEAMS SUPPORTING PEOPLE WITH SEVERE AND ENDURING MENTAL ILLNESS
21 Feb 05

Download file

Women denied mental ward after surge in male patients

PLANS for a women-only ward at the Highgate Mental Health Centre have been ditched after a surge in male patients.

In a further blow to the centre's reputation, a patient at the hospital threatened to throw himself off the notorious Hornsey Lane Bridge for the second time in one week.

The Camden and Islington Mental Health and Social Care Trust (CT), which runs the centre in Dartmouth Park Hill, says it is using one-third of the Amber ward to accommodate men.

And it claims the design of the ward will not allow men and women to mix.

But the arrangement has been criticised by mental health workers.

Marjorie Wallace, president of mental health charity Sane, said: "There is a huge problem with beds in mental health at the moment.

"I am not surprised by this, when we know various mental health trusts have complained of an increase in male patients.

"It is the same problem as always, they [the government] have failed to provide the services that are required for in-patients, leaving vulnerable people in the community."

Scott Stephens, chairman of the Camden Mental Health Consortium, said: "It is concerning to see that the Highgate Mental Health Centre will no longer be able to support a women-only ward.

"The pressures on the service and the high number of male admissions will no longer sustain this position, which is in keeping with the national guidance."

Mental health chiefs admit they had slightly miscalculated the number of beds required in the unit, which opened last year.

A spokesman for the CT said: "After being open for some months it has become clear that the bed allocations linked to our sector admissions was slightly wrong.

"This reallocation of bed spaces will help to rectify this issue.

"The appropriate sectorisation of wards will provide for appropriate and enhanced models of care."

Further concerns have been raised about the standard of care provided at the CT, after a patient at the Highgate Mental Health Centre climbed onto the notorious "suicide bridge" over the A1 in Highgate on Thursday last week.

The man spent three hours on the bridge last week - eight days after he brought traffic in north London to a standstill by spending eight hours threatening to throw himself off the same bridge.

A CT spokeswoman said: "We cannot comment on his diagnosis but he has had contact with our services over the last week. That is all we can say."

hamhigh.co.uk 18 Feb

Increased funding for learning disabilities services unveiled today

Services for people with learning disabilities are set to receive over £41 million in Government funding, Stephen Ladyman, Minister with responsibility for community announced today.

This boost in funding has been allocated to Primary Care Trusts to provide services through the Learning Disabilities Development Fund (LDDF) and is almost double the amount received last year. The LDDF is an important mechanism for ensuring that the NHS funding which would have supported residents in long stay hospitals under earlier regimes is used to achieve the objectives of Valuing People.

Stephen Ladyman said:

“I am very pleased to announce that funding for the Learning Disabilities Development Fund has almost doubled for the coming year.

“These funds are intended to support the implementation of the Government white paper ‘Valuing People’, which sets out a wide ranging programme of action to improve services for people with learning disabilities based on four key principles – rights, independence, choice and inclusion.

“By doubling the amount of money given to Primary Care Trusts, I hope to ensure that existing areas of work will continue to be priorities for health and social care services in addition to the three new areas which will extend the reach of Valuing People. “

Priority areas earmarked for funding in previous years have been:

· Advocacy – developing and expanding services to support people to speak up,
· Person Centred Planning – a way of helping people get what they want in their life, starting with the person, their wishes and aspirations, and
· Leadership – developing and supporting leadership, including people with learning disabilities, families and others providing support.

For 2005-06 there are 3 additional priorities which reflect the significant increases in funding. These are:

· Day services modernisation
· NHS Campuses reprovision – redevelopment of the residential services developed by the NHS as a result of the contraction or closure of NHS hospitals, and
· Support for people with learning disabilities from black and minority ethnic communities.

The third annual report on the progress Government departments have made in implementing Valuing People and ensuring that people with learning disabilities are more fully included in society will be published later this year

dh.gov.uk 17 Feb

Man rang wife to tell her of suicide plan

A BARNSLEY man rang his wife to say he had put a noose round his neck and was planning to kill himself, the night before his body was found hanging from a tree.

Stephen Thompson, aged 40, of Goodyear Crescent, Wombwell, rang his wife Margaret four times after he left their house following a disagreement.
On one occasion he told her of his plans to end his life. They rowed when he told her he had been involved in "an incident" with a boy he found walking their teenage daughter home.
He went to Barnsley police station to talk about the situation and was told there was nothing to worry about. He was never seen alive again.
Mrs Thompson, who wept when details of their last phone calls were read out at an inquest into her husband's death, said: "He was over-protective to our daughter. He had problems letting her grow up, letting her be a teenager."
In a written statement, she detailed how her husband had previously attempted to take his own life on a number of occasions. She said he suffered from mood swings and took anti-depressants. Five months before his death he took an overdose of tablets and ended up in intensive care and on a ventilator for 12 days. She said medics doubted whether he would survive, but he pulled through.
She said he also took an overdose in 1993 and attempted to seriously harm himself in a car in Bretton Park in 1994, but police managed to find him before it was too late. Mrs Thompson said her husband had just learned that he had been referred for further tests to try to find the cause of a vomiting problem he had complained about for a long time.
"He was constantly complaining about the pain he was suffering," she said.
She added that because a cause for his problem had never been found he felt as though nobody believed him.
Dr Amil Karan, a consultant psychiatrist at Barnsley District General Hospital, said Mr Thompson was first referred for his mental health problems in 1993.
He said he had "complex personality-related problems" and had undergone various forms of treatment over the years to try to manage his condition.
He said that the day before he died Mr Thompson had been "relieved that something was being done about the vomiting".
Recording a verdict that Mr Thomson took his own life Sheffield coroner Chris Dorries said: "Clearly he had a difficult history.
"There had been an incident and there was the ongoing illness.
"It is not for me to speculate why someone took their own life but we know all this was going on."

barnsleytoday.co.uk 17 Feb

Hate Mail Campaign

A SCHIZOPHRENIC embarked on a hate mail campaign, sending death threats to Catholic priests and racist abuse to strangers with foreign sounding surnames.

Thirty-five-year-old Henry Stordy, of Sark Close, Lowry Hill, Carlisle, sent at least 14 abusive letters, including five to Roman Catholic priests in Scotland. Some of the victims were known to him and others simply picked from a telephone directory, police believe. The priests were listed in a Catholic directory.

Carlisle’s deputy mayor, Sandra Fisher, was another victim. Her letter read: “Dear Sandra, F*** off, you are a vicious, arrogant bitch. I hope you never become mayor.”

Stordy, who has battled schizophrenia since 1995, told police he was told to send the letters by voices in his head.

Carlisle magistrates heard yesterday how one priest received a letter in April which read: “I’m coming to blow your head off with a sawn-off shotgun. I will hunt you down like a wild animal and cut your heart out with a knife.”

Another Scottish priest received a racially abusive letter threatening to stab him, and instructing him to plan his own funeral.

News & Star photographer Jonathan Becker received a letter calling him a Nazi, and arts reporter Kate Rees also received threats and abuse.

A Chinese student in Carlisle was another victim, together with an elderly lady.

Pam Ward, prosecuting, said some were linked to Austin Friars school, where Stordy had been a pupil.

Mrs Ward said Stordy was arrested on October 12 last year after one of his victims recognised his handwriting. He immediately told police “Yes, I did it”, she said. “He said he was a schizophrenic and had been hearing voices in his head. ‘Paul’ ordered him to send the letters.”

Margaret Payne, defending, said Stordy was “extremely humiliated and ashamed” by the letters.

“He was bright and successful, with four A-levels and an honours degree. All of his life was before him then he was blighted by this dreadful illness which has taken over his life and that of his family.”

Stordy spent 14 months in hospital up to February 1998. Until 2003, he was responding well. “In early 2004, he was taken over by feelings of paranoia and was under an irresistible impulse to act under the directions he was receiving. He said it was like being a puppet,” Mrs Payne said.

“There isn’t a racist bone in his body, he was simply taken over by this illness. Mr Stordy is the most pleasant of individuals, almost saint-like.”

Stordy, who has no previous convictions, admitted sending indecent or grossly offensive messages to 12 people between April and October last year. Magistrates adjourned sentencing until March 14 for probation reports.

newsandstar.co.uk 12 Feb

Teenagers facing 'mental illness epidemic'

London's teenagers are suffering in a "hidden epidemic" of mental illness, experts said today.

One in every 100 children in Britain has an undiagnosed mental illness, according to doctors at the Priory Group. But they say London is at the centre of an explosion in early psychosis in children.

There are 37 NHS centres in Britain specialising in helping adolescents with psychiatric problems. However, doctors from the Priory independent mental healthcare-group say not enough is being done to tackle the issue.

The group's healthcare services director, Professor Chris Thompson, said London's children are most at risk.

He said: "London is a very impersonal place, and many of these children feel alienated and lonely. The sheer number of people here makes it very easy for a child to effectively become anonymous at school and to hide any problems.

"Parents also miss things. I would recommend they see their GP immediately if they think there is a problem, and the screening and treatment process can begin. In a lot of cases, it will be normal adolescent behaviour, but early treatment is the key."

Professor Thompson said the Government was not doing enough. "It can take up to two years at the moment before someone is treated. If left, this could develop into schizophrenia or bipolar disease."

The Priory unveils plans today for a centre at Roehampton to treat 16- to 21-year-olds.

Professor Thompson added: "There have to be a lot more than the Government's current 37 centres to look at this problem."

Marjorie Wallace, of mental health charity Sane, said: "The Government needs to overhaul the system radically. This is now virtually an epidemic. In London it's incredibly hard to get treatment even if the symptoms are spotted."

A Department of Health source said: "The Government has realised more needs to be done in the area of dealing with adolescent mental health problems, and it is something we are working on."

She confirmed only two regional development workers cover London to help GPs spot mental illness in children but said a ?300million programme will increase the number of workers across Britain.

thisislondon.co.uk 17 Jan

Axe feared for unique mental health centre

MENTAL health patients in need of urgent help could harm themselves and others if a 24-hour crisis centre is closed, a leading charity claims.

Founder and chief executive of SANE, Marjorie Wallace, said she was disgusted that the NHS was even considering closing the centre at the Maudsley Hospital, in Camberwell - the only one of its kind in the country.

She said: "People can walk in off the street and get help from professionals 24 hours of the day, without having to be referred. "I visited the centre 19 years ago when they tried to close it last time and I have seen how much people in distress need this place.

"If they shut it you will have people abandoned, walking about on the streets who will harm themselves and could harm others.

"I have seen single mums convinced their children are the devil. You can't possibly expect them to wait in the A&E department of a hospital. It is a terrible betrayal of members of our society."

A spokesman for the South London and Maudsley NHS Trust confirmed it was considering closing the centre but said nothing had been decided.

He said: "There would be savings we could make if we were to close the service.

"But that money would go to improving waiting times for psychiatric services at A&E and home treatment teams. So there would be an alternative."

Andrew Daw is a founder member of Save The Emergency Clinic Campaign Group, set up to fight proposals.

He said: "This is the only place people can go to when they can't cope and feel at crisis point.

"Staff are trained to know what to do and sometimes that's all it takes to stop you harming yourself."

Fellow campaign group member Aloyse Raptopoulos said: "There are several problems with hospital.

"You could be sitting in a room for hours feeling severely distressed and when you are in a bad way 10 minutes can feel like an hour.

"Hospital is not the right place for people with mental health problems."

icsouthlondon.icnetwork.co.uk 15 Feb

Psychosis can be positive, accepts the body which drives forward mental health policy

Psychosis can be a positive experience in some way, the body which drives forward mental health policy in England has acknowledged.

Such a recognition by the government's national institute for mental health in England (NIMHE) may be disputed by some mental health professionals.

But it is likely to be welcomed by critics of the predominant medical model within mental health.

The recognition of the valuable component to psychosis was made in a NIMHE 'guiding statement' which listed six definitions of 'recovery' in mental health.

The statement - released on Monday - is a bid to contribute to the development of recovery-oriented mental health services.

One of NIMHE's definitions of recovery is the "act of obtaining usable resources from apparently unusable sources (e.g. in prolonged psychosis where the experience itself has intrinsic personal value)"

NIMHE - headed by the mental health tsar Professor Louis Appleby - said it recognises recovery is a concept introduced mainly by people who have recovered from mental health problems, and who prefer not to describe their experience in medical terms.

NIMHE's guiding statement read: "Taken together, these six meanings suggest a broad vision of recovery that involves a process of changing one’s orientation and behaviour from a negative focus on a troubling event, condition or circumstance to the positive restoration, rebuilding, reclaiming or taking control of one’s life."

The six NIMHE meanings for recovery are:
1) A return to a state of wellness (e.g., following an
episode of depression)
2) Achievement of a personally acceptable quality of
life (e.g., following an episode of psychosis)
3) A process or period of recovering (e.g. following
trauma)
4) A process of gaining or restoring something (e.g.
one’s sobriety)
5) An act of obtaining usable resources from
apparently unusable sources (e.g. in prolonged
psychosis where the experience itself has intrinsic
personal value)
6) To recover optimum quality of life and have
satisfaction with life in disconnected circumstances
(e.g. dementia).

psychminded.co.uk 15 Feb

Stabbed man's family plan action

Relatives of a man stabbed to death by a mental health patient are planning to sue the NHS for failing to protect him from his killer.
Nico Meli, 35, from Aspley, Nottingham, was attacked by Stephen McGowan, 32.

McGowan was ruled unfit to be tried for murder and sent to a secure hospital after a jury ruled he was responsible for the killing in October 2003.

The Nottinghamshire Healthcare NHS Trust said it had launched a "rigorous internal review" after the attack.

Mr Meli was said to have befriended his killer after a chance meeting while out shopping.

Later a relationship developed between McGowan and Mr Meli's mother.

Mr Meli was stabbed at his mother's home in Beechdale.

His girlfriend, Tanya Wood, who had a son - now aged 10 - with Mr Meli, said health chiefs should have alerted them to McGowan's condition.

He was assessed in 1998 as having a personality disorder under the Mental Health Act.

But it was not deemed treatable and so he was not detained under the act.

He also had brain damage because he had been involved in road accidents.

Ms Wood said: "I wished they would have helped me in some way to protect Nico, to let us know he (McGowan) was violent and we could have done something to protect him.

"I will never forgive them for leaving us like this, for ruining our lives - our lives have completely changed now.

"I don't think I can ever cope with losing him, especially the way he died."

A statement from the Nottinghamshire Healthcare NHS Trust said: "Occasionally people with mental health problems become unpredictable...when that has tragic outcomes steps are taken to see what can be learnt."

It added: "These events in Nottingham have been subject to a rigorous internal review."

bbc.co.uk 14 Feb

Mental Health and Deafness: Towards Equity and Access

NIMHE 16 Feb 2005

An implementation guide for 'Sign of the Times'

In July 2002, the Department of Health launched a consultation document entitled Sign of the Times. It was focussed on Deaf people who used sign language (predominantly British Sign Language) and considered how well their mental health needs were being met.

Download file

NIMHE Guiding Statement on Recovery

NIMHE 14 Feb 2005

This publication aims to set out NIMHE's emerging view of mental health recovery. It is hoped that it will contribute to the development of recovery-oriented services nationwide.

Download file

Leading Roles in Mental Health: Social Worker

This paper explores how field social workers within adult mental health services, from the North East, Yorkshire and Humberside region are adjusting to the complex changes brought about by Government modernisation at a time of unprecedented change for the profession. Its findings are mainly the result of direct interviews with approved social workers to incorporate their role under mental health legislation, as well as the wider remit of social work in mental health and the overall social care perspective.

This paper is chiefly aimed at those within social services departments and the integrated mental health services in a lead role for workforce development, as well as those national social care and mental health agencies with such a brief. It is also intended to be of prime interest to those in the profession as well as other disciplines seeking to adjust within a dynamic and evolving service.

Download file (PDF file)

52 prisons experienced the suicide of a prisoner

Fifty two prisons in England and Wales suffered at least one suicide of a prisoner in 2004 and 13 prisons experienced three or more deaths, the Howard League for Penal Reform revealed today (Wednesday 9 February).

Blakenhurst 3
Gloucester 3
Leicester 3
Liverpool 3
Manchester 6
New Hall 3
Norwich 3
Nottingham 3
Pentonville 3
Shrewsbury 5
Wakefield 3
Woodhill 3
Wormwood Scrubs 3

The analysis of the annual suicide statistics carried out by the Howard League for Penal Reform also reveals that:

More than half of all deaths occur in local prisons
About 200 people are resuscitated from serious suicide attempts each year and some of these never fully recover
High suicide rates are associated with lower levels of purposeful activity in prisons
In addition to the prison suicides, a 14 year old boy took his own life in a secure training centre
Released prisoners are forty times more likely to die than their peers, due to drug overdoses and suicide
A quarter of the suicides occur within a week of arrival at a prison and a half within the first month
57% of the people who commit suicide in prison are on remand yet they represent only 19% of the prison population
Of the people who died in prisons only 7 were identified as at risk of suicide at the time they killed themselves
83 people hanged themselves, 10 suffocated or died from a ligature and 2 from cuts to the throat or wrist
13 women took their own lives in 2004
A total of 95 people committed suicide in prisons in 2004 and a fourteen year boy took his own life in a secure training centre.

Frances Crook, director of the Howard League for Penal Reform said today: “The death rate in prisons continues to be a stain on our democracy. Far too many people find prison intolerable and are dying as a direct consequence of our love affair with punishment and incarceration. Our society would benefit if we used prison less and got people to make amends in the community, and we would save hundreds of lives.”

Mental Health Nursing at Crossroads says UNISON

UNISON, the UK’s largest health union, today welcomed the review of mental health nursing announced by Chief Nursing Officer Chris Beasley, as timely and much needed.

Dave Prentis, General Secretary of UNISON said:

“”The review is an important opportunity for mental health nurses, and UNISON will be making sure that the views of both registered and non-registered nurse members are fully represented. UNISON will be looking specifically at three key areas, training – core and post registration, nurse prescribing and recruitment and retention.

“Mental health services have always been the Cinderella Service of the NHS and UNISON would like to see some of the £135bn announced by John Reid targeted at mental health services in the community.”

Peter Atkinson, Vice Chair of UNISON National Nursing Committee and a Community Psychiatric Nurse said:

“Mental health nursing is at a crossroads and we need to have a clear path forward to define and develop the broad range of vital roles that our profession is taking on in this field.”

unison.org 10 Feb

Mental patient armed arrest probe

An investigation is underway into why police on Merseyside were authorised to carry guns while arresting a mentally ill man in Liverpool.

The Independent Police Complaints Commission (IPCC) was called after the man's solicitor expressed his concern.

On July 29 2004 the local mental health trust asked for help in detaining the man, who has not been identified, under the mental health act.

The trust said the 42-year-old man was refusing to take his medication.

A senior officer authorised the use of guns for the man, who is known to have a history of violence.

The IPCC said he also has schizophrenia and suffered long-term mental health problems.

It said any decision to authorise the use of firearms should be taken with great concern and be open to scrutiny.

Issues raised in the complaint are of strong public interest and that any failings should be addressed at the end of the inquiry, the IPCC said.

In December, an inquest in Liverpool cleared Merseyside Police over the fatal shooting of schizophrenic Andrew Kernan in Wavertree.

Mr Kernan was shot while brandishing a samurai sword three years ago.

bbc.co.uk 10 Feb

Mental health crisis

SOUTH Manchester could lose all its psychiatric beds in a radical review of services.

Under the plans, inpatient facilities would be moved from Wythenshawe Hospital to North Manchester General in Crumpsall — meaning a 30-mile round trip for patients and their relatives.

It’s just one of the options that make up a series of proposals to go to public consultation later this year.

Bosses at Manchester Health and Social Care Trust have admitted that the cost of running a privately-run 77-bed unit at Wythenshawe called Laureate House is stretching their budget to the limit. Closing it could save them millions.

But mental health watchdogs and charities said the closure would add insult to injury. Psychiatric patients are the most vulnerable people in society and Manchester has the worst mental health problems in the country.

Former mental health patient, John Ford, 43, is now a representative at patient forums and speaks on behalf of people with mental health needs in south Manchester.

He said: “If that happens it will be catastrophic not just for inpatients but patients that go on a daily basis to see a psychiatrist. We are concerned that if it’s to be moved it may cause a lot of hardship for people going from south to north visiting, especially those using public transport.

“It’s a long journey for people, and their carers will have a lot more pressure put on them. It could take them four or five hours.

“If they have got kids then they have got to find somebody to watch the children. All this for only an hour’s visit. I don’t think the patients will want to move. When you start having to move people about it will make them even more agitated. Then if they think they won’t see their families it will make them worse.”

Mind in Manchester spokesman, Justin Warner, urged bosses not to include the closure in any of their plans.

He said: “It’s one of the options which, so far, has been mentioned to us in informal discussions but it’s not really a viable option as far as I’m concerned.

“From what we know about people’s mental health issues the travelling would be a big problem. They’d have to consider whether they would refund the costs of travelling and, if not, how they would expect patients, relatives and visitors to pay for the extra travelling.

“The costs of running the current site may be high but so are the benefits — patients may end up staying there for shorter periods so any analysis of the situation needs to take these factors into account.”

Health chiefs across Manchester’s Primary care trust are working together to draw up a revision of mental health services. It should have been published this month but has now been put back until the summer.

Following advice laid out in a ‘visioning’ report compiled last year, health experts plan to reduce the number of inpatient beds for mental health patients and increase care in the community. That would mean making more treatment available at GPs’ surgeries and clinics but analysts are unsure how much work staff could take on and how to guarantee their safety.

Withington MP Keith Bradley said: “I would be very concerned if there is a proposal to close Laureate House and my constituents had no easy access to services. Money should not be a guiding principal — it should be the quality of care both for inpatient services and the further developmentment of community services.”

southmanchesterreporter.co.uk 10 Feb

HOW DID THOM LEAVE MENTAL HEALTH WARD?

Mum likens son's vanishing act to tragic Daniel's

A Devon mother is demanding action after her son walked out of an Exeter psychiatric unit just days after being sectioned under the Mental Health Act.

Thom Stannard should never have been able to leave the Cedars Unit without permission.

But on Sunday he left without any of the staff knowing and turned-up at his Exmouth home.

His concerned mother, Barbara, is now calling for better security at the unit, which is based at Wonford House Hospital, as she fears for the safety of her 20-year-old son.

She is worried that if he is able to get out on his own again it could end in tragedy, like it did with patient Daniel Heard.

Twenty-six-year-old Daniel went missing from the unit in February last year and was found dead five days later. He was on 15-minute observation watch and was also not supposed to go out without supervision.

Mrs Stannard, 51, said: "I am afraid of what might happen to Thom if he is allowed just to walk out like this. There have been so many cases over the past couple of years of patients from the Cedars Unit absconding and meeting tragic ends."

And she is backing Daniel's mum in a call for the entrance doors to the unit to be locked. Currently the policy is that doors are not locked.

"It is beyond belief that when he is sectioned and really needs treatment, he can walk out," she added. "For the sake of a locked door, it is giving his family a lot of worry."

Devon Partnership Trust, which runs the unit, confirmed that "a formal service user" went missing without authorised leave on Sunday. A spokesman for the trust said: "The individual concerned was not under a high level of observation. He was seen by a member of staff at 3pm on Sunday and found to be missing five minutes later.

"Ward staff immediately followed the missing persons procedure, the police were called and the individual was back safely on the ward by 5.40pm the same day.

"A further risk assessment has been carried out and his observation levels have been reviewed.

"There will also be a full level investigation into the incident, in accordance with the trust's policies and procedures."

The trust's chief executive Iain Tulley, said staff reacted quickly when they discovered Thom was missing. He said: "Regrettably, there are occasions when inpatients leave the premises unauthorised but we have clear procedures in place to manage these situations. We understand that such events may cause anxiety to family and others and we do everything we can to try and minimise the risk of them occurring.

"In this case, everything that could and should have been done by staff was done and I would like to commend them for their response to the situation. The individual's absence was identified within five minutes and their prompt reaction and following of procedures played an important part in ensuring his safe return to the ward within a few hours."

Thom was sectioned last Wednesday under Section 3 of the Mental Health Act. This is an order which means that the patient can be detained for treatment for up to six months and should not leave the unit without permission.

She said her son had been suffering mental health problems since starting college. He first attended the Cedars Unit as a voluntary patient in February last year, when he stayed for a month. But last Wednesday he was sectioned. "The pressure of college has been getting to him and he realises that he needs help," said Mrs Stannard.

The trust has launched its own investigation into the events leading up to the death of Daniel Heard. His mother, Lynda Kelly, has been calling for the trust to change its policy on not locking doors on open wards, to help prevent other tragedies.

Devon MP Angela Browning, Exeter & Greater Devon Coroner Elizabeth Earland and the families of the patients demanded the trust revisit its policy.

The Tiverton and Honiton MP said the latest case of Thom walking out illustrates again her concerns about the Cedars.

"We need a closer look at the facilities in terms of preventing things like this happening. Also they need to firm up tighter controls on identifying people who are on their way out," she said. "I will be taking up these issues when I meet the chief executive next week. I have one constituent who has refused to go into the Cedars because of what's gone on there."

Last week the trust announced it is to carry out such a review at a national conference in April.

thisisexeter.co.uk 9 Feb

TREATMENT CONTROLS FOR THOSE WITH MENTAL ILLNESS

People with mental health illnesses in Moray will have new powers to safeguard their rights during times of ill health, under new legislation coming into effect in October.

A workshop, held at the Royal Hotel in Elgin yesterday, allowed service users, carers and interested parties to discuss how the changes will affect individuals.

Under the act, participants were told they will be able to write a statement in advance detailing how they would prefer to be treated if they become ill.

The manager of integrated mental health services in Moray, Margaret Christie, who organised the event, said: "The advance statement is designed to allow people to set out the kinds of treatment they would like, normally in discussion with their psychiatrist or GP, when they are well.

"A patient may stipulate that they don't like a particular medication because it has not worked well in the past or that they do not like medication that encourages weight gain."

The new provision was met with some approval by the 25 people who attended, but one service user, Graham Clark, who has a history of manic depression, expressed concerns over the practical implications of the statements.

Mr Clark, 52, said: "I am personally against all synthetic drugs and am not convinced that my wishes would be followed through on that matter.

"If you do make requirements concerning the medication you would like, there is no real guarantee that it will be honoured."

Mrs Christie acknowledged doctors can override requests but stressed they would have to write to the person, their named person, the mental welfare commission and a tribunal and justify why they were not going along with the requirements in the advance statement.

Under existing law, a close relative would be contacted to discuss the welfare of a patient undergoing treatment.

Now, service users will be able to designate a named person whom they would prefer to act on their behalf.

Mr Clark, who is from Lhanbryde, said: "In a lot of cases a relative is not the best person to consult, so to be able to choose someone is a brilliant idea."

Under the new act, people will also be entitled to an independent advocate to offer help and support while they are ill.

A series of workshops are being organised to allow further discussion on the new act, including three days of training next week for psychiatrists, doctors and other mental health practitioners.

thisisnorthscotland.co.uk 8 Feb

Tragedy of nurse killed by mental patient

A paranoid schizophrenic man was found guilty of manslaughter on Friday for beating to death a male nurse at Springfield Hospital in Tooting.

The Old Bailey jury heard Jason Cann, then 21, told a psychiatrist he heard Princess Diana's voice urging him to attack Mamade Chattun, 34, in June 2003.

Cann also said he saw the face of the paedophile who abused him as a child superimposed onto the face of Mr Chattun. He claimed he was woken by the nurse known to friends and family as Eshan tugging at his shorts, and he believed the man intended to rape him.

Cann reacted with a frenzied assault which left the father of two unconscious, with severe injuries to his head, body, breastbone, ribs and bowel, and a part of his ear severed, possibly bitten off. Blood was spread on the walls and floor of the lobby of the hospital's John Meyer ward, and on Cann's leg and shoe.

The alarm was raised when another nurse found Cann standing with all his weight on Mr Chattun, jumping up and down "like someone stamping on a cockroach". Mr Chattun died hours later in St George's Hospital.

Cann, who was sedated and required regular breaks during the Old Bailey trial, described the attack, saying: "I got up and started wrestling with him. I got him to the floor and started punching him and kicking him, and stomping on him. I didn't want him to get back up and hurt me."

The judge, Giles Forrester, ruled that Cann should be kept at Broadmoor, the high security psychiatric prison, indefinitely. A murder charge was dropped last week.

The case raised troubling questions about working practices at Springfield Hospital. The killing took place on the day Cann was admitted, but he was left alone unobserved in the ward's lobby area, despite having earlier atta-cked a social worker and refused to take his medication. In 2002, a Mental Health Commission inspection had ruled the lobby should not be used as a patient area.

Mr Chattun went to see the volatile patient alone, despite being warned by colleagues not to go unaccompanied. A post mortem also showed the nurse had cannabis in his bloodstream, and diazepam, despite having no prescription for the Valium-related drug.

The South West London and St George's mental health NHS trust said it would soon publish the report of its own internal inquiry, and confirmed three members of staff were disciplined. A separate inquiry by the Healthcare Commission will now begin.

Trust chief executive Dr Nigel Fisher said: "This was an appalling and unprecedented event. We have done and continue to do everything in our power to prevent anything like this happening again. Although no one could have predicted the ferocity of the assault we know we must provide our staff and patients with the safest possible environment."

He said there had been a major overhaul of 119-year-old John Meyer ward, costing over £750,000, with new CCTV cameras and state-of-the-art alarm system. He commended the Chattun family for their "remarkable dignity" and staff for their professionalism "while grieving the loss of a popular colleague and friend".

wb-news.co.uk 4 Feb

Mental health problems fuel rise in murders - police chief

The Metropolitan police's new chief today claimed his officers were having to deal with an increasing number of murders committed by mentally ill people.

Speaking at the closing session of the two-day Guardian public services summit, Sir Ian Blair said that although the "staples" of crime, such as burglary and domestic violence, were on the decline, his officers had to tackle a rise in serious crime, particularly murders committed by those with mental health problems.

He said "agencies" were failing to manage the problem.

"That is a failure between agencies at the moment and it is frightening," he said.

Sir Ian later conceded in a question and answer session that it was important to avoid stigmatising mental health problems, which could do so much to hamper the work of agencies attempting to reach out to people with severe mental illness who were most in need of support.

He backed government moves to force seriously mentally ill people in the community to take medication.

"[Through the draft mental health bill] the government has been trying to distinguish that group of people who are seriously ill who have been let back in the community to take their medication," he said.

"That is the people we are really worried about. People who can be controlled by their medication but over whom we have no supervision. There is an area where enforcement or checking up of medical regimes of people who can fall off into paranoid schizophrenia or something else - unless we get that right we have a problem."

He criticised the fragmented approach to health in London in place since the London health region was abolished several years ago, which he said left him confused about who to contact in the event of an emergency.

"I have no idea who to ring up," he said. "We have four regions, and two mental health trusts. "When the bomb goes off I still do not know who to ring. The sooner they bring back a regional health directorate for London the better."

Sir Ian said the breakdown in the fabric of society left the police to handle matters which would have previously been dealt with by local organisations.

As a result, the police now worked to the public's perception of crime requiring intervention, "such as their neighbourhoods, their travel to work, their leisure services, the smashed bus stop and the slightly mad in the street".

"The people who used to do something are not there anymore," he said. "People who used to do something were the agencies of social cohesion, like unions and churches, or the agents of social cohesion like park keepers ... and so they are looking to the police."

society.guardian.co.uk 3 Feb

Doctor is held at mental unit

A THORNTON doctor accused of murdering his nanny has appeared at Liverpool Crown Court.

Dr Abdalla Eltom is alleged to have killed the 48-year-old Sri Lankan woman at his home in Park View last Tuesday.

Her body was discovered by police at the semi-detached house after 52-year-old Eltom had walked into Crosby police station.

A post mortem revealed that she had been asphyxiated.

The identity of the victim is not likely to be known for some weeks, until officers have traced her relatives.

Detectives have asked the Sri Lankan authorities to help track down her family.

The woman lived at the house with Eltom, his wife, Haga, a neurologist, and their three children.

Eltom, a Sudanese national, appeared in court on Tuesday afternoon, wearing black tracksuit pants, green top and navy jacket.

He was charged with murder and spoke only to confirm his identity.

He was further remanded to the Scott Clinic, a mental health unit at Rainhill until April 22 when he is expected to enter his plea.

Eltom was accompanied by three female nurses from the Scott Clinic during the ten minute hearing.

icseftonandwestlancs 3 Feb

Call for restraint to tackle violent mental health patients

The NHS should consider the wider use of mechanical restraints, including handcuffs and straitjackets, to tackle the rising number of violent mentally ill patients, senior psychiatric nurses said today.

A huge surge in the number of assaults on mental health staff by patients, particularly those with drug problems, meant the use of mechanical restraints must be an option, said Kevin Gournay, professor of psychiatric nursing at the Institute of Psychiatry, London.

He said: "Ten years ago the use of mechanical restraint would not have been considered. But the level of violence in mental health care - particularly associated with crack cocaine users - is such that it has to be an option. It cannot be ruled out."

Prof Gournay, who has written guidance on the use of restraint in mental health services for the Nursing and Midwifery Council (NMC), said some patients had expressed that they would rather be strapped down than physically restrained by nurses or heavily sedated.

He added that there was a greater risk of asphyxiation and broken bones associated with the use of physical restraint, particularly when used in tandem with medication.

His comments came after SocietyGuardian revealed that members of an influential government group looking into how to manage violent and aggressive patients have been in talks with a US firm that manufactures and sells mechanical restraints. A member of the group, who asked to remain anonymous, said there were "clear signs of moves to reintroduce mechanical restraints as standard".

US company Handle With Care sells a range of restraining products, including a "ParaBed" that secures a patient's arms, feet and torso, leaving them incapable of movement. The firm's owner, Bruce Chapman, is confident its products will soon be commonplace in the UK.

Mechanical restraints are widely used in mental health services throughout the USA and Europe. Prof Gournay said staff in the US usually reacted "with horror" at being told their UK counterparts restrain patients by holding them down and injecting them.

The professor added that staff could more effectively communicate with patients who were mechanically restrained than those under sedation. Restraint devices could also prevent disturbed patients from harming themselves.

He said: "Some forms of mechanical restraint are punitive, but others are more therapeutic. I saw one seriously self-harming patient in the US with a flak jacket round his torso so he couldn't stab himself."

Joy Duxbury, divisional lead for mental health at the University of Central Lancashire, backed calls for the NHS to reconsider the use of mechanical restraint.

Ms Duxbury, a psychiatric nurse, said that following the death of David 'Rocky' Bennett, who died after being physically restrained in police custody, the need to explore alternatives to physical restraint had "never been greater".

She added that "demonic images of patients tied to beds" did not reflect the reality of modern day mechanical restraint.

Rick Tucker, lead adviser on the management of violence for the NMC, said there was a need for a national debate on the use of mechanical restraint in mental health care.

He said: "Currently it is not something we can really advocate the use of, but mental health service users' voices need to be clearly heard. Some have expressed they prefer mechanical restraint to physical restraint or sedation."

guardian.co.uk 2 Feb

Black robes and white coats: who will win the new mental health tribunals?

British Journal of Psychiatry Editorial Feb 05

Under current proposals for new mental health legislation, psychiatrists increasingly will be involved in tribunal processes examining the grounds for compulsory detention and treatment, both in hospitals and in the community. They will lose some authority over admission and discharge, with decision-making instead being given over to legal bodies that will regulate admission and discharge. The proposals for wholesale change in UK mental health law are an opportunity to devise a new type of legal hearing where all ‘sides’ are properly represented. However, the new mental health tribunals proposed in the draft UK bill sit in a twilight zone of ‘quasi-criminal’ courts. The use of single joint experts or ‘expert panels’, consistent with the recent civil law reforms, means that problems of undisputed medical evidence may become even more acute. American experience shows that judicial deference to clinical opinion, even in overtly adversarial commitment hearings, is considerable (Bursztajn et al, 1997). In this editorial, we argue that these proposals justify a re-examination of the values of law and psychiatry.

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Cannabis mental health risk probe

The government says it will review all academic and clinical studies linking cannabis use to mental health problems.
The Department of Health says it is now generally agreed among doctors that cannabis is an "important causal factor" in mental illness.

It follows a mental health group's call for the government to investigate "the link between cannabis and psychosis".

Rethink said its reclassification from a Class B to Class C drug sent a "confusing message" to young people.

The charity wants the Commons Health Select Committee to launch an inquiry into the effect cannabis has on users.

Its call was also backed by health campaign group Sane which wants the classification of cannabis to be reversed.

A Department of Health spokesman said it was already commissioning a review.

"We have no objection to the health select committee looking into this," he said.
"However we are in the process of commissioning an expert review of all the academic and clinical evidence of the link between cannabis use and mental health, particularly schizophrenia.

"There is medical clinical evidence now that there is an important causal factor between cannabis use and schizophrenia - not the only factor, but an important causal factor. That is the common consensus among the medical fraternity."
Cannabis was reclassified last year so that police could target hard drugs.

Home Office figures released on Friday showed that arrests for possession of cannabis fell by a third in the first year of its reclassification.

However, Rethink said there had been a 60% increase in people who smoked drugs and had mental health problems in the last five years.

Most medical experts agree that smoking cannabis in itself does not cause mental illness, but that people who are predisposed to psychosis are much more likely to develop symptoms if they use the drug regularly.

"Cannabis is not risk free," Rethink chief executive Cliff Prior said.

"We have known for years that using cannabis makes the symptoms of schizophrenia far worse in people who already have the illness."

Calling for further research, Mr Prior said the government should "concentrate on the real and specific mental health dangers, not general warnings that no-one takes seriously".

Marjorie Wallace, Sane chief executive, said Sane has campaigned for 18 years about "the destructive link between cannabis and schizophrenia" and that professionals and governments had ignored years of "mounting evidence".

"Far from it being a relatively harmless recreational drug - for vulnerable people, especially teenagers, the innocent spliff in the playground, or chilling out, could trigger a journey of lifelong disintegration," she said.

Campaigner Terry Hammond says his son, Steve, developed schizophrenia after taking cannabis resin.

"I have got absolutely no doubt at all, and neither has Steve - Steve is absolutely clear about it - that it was the cannabis that triggered it.

"It may not have been the absolute cause of it, but it was the trigger.

"It is Russian roulette," he said. "For some people it can ease pain, but for others it can be an absolute disaster."

But Steve Barker, of the Campaign to Legalise Cannabis Association, said that by prohibiting cannabis it was preventing information about its use being readily available, while cannabis could in fact aid those with medical problems.

"There is a larger proportion of people with mental health problems who claim cannabis reduces their symptoms than those for whom it is a problem," he said.

"To criminalise people and to put them though the criminal justice system rather than give them the medical support they need is completely wrong."

bbc.co.uk 29 Jan

Major review of mental health nursing announced

Chief Nursing Officer Chris Beasley today announced a major review of mental health nursing.

The review comes in the context of major government reforms such as "Choosing Health", "Delivering Race Equality" and the draft Mental Health Bill. As the largest professional group in mental health services, mental health nurses play an important role in delivering these reforms.

Chris Beasley said:

"Mental health nurses play a vital role in the NHS. It's extremely important that the profession is supported and has a clear direction and sense of its future role. This is why we are working closely with mental health staff and service users to develop a new strategic framework for the profession as it moves into a new era of mental health care.

"The context in which mental health nurses work has changed in recent years as a result of government reforms, lessons from serious incidents and the new professional roles that have grown across the health and social care system. The time is right to take stock of what these mean for the profession and to provide mental health nurses with a new direction and clear future role in order to deliver government reforms such as the Mental Health Bill, personalised care and choice.

"As mental health nursing improves, service users will see the benefits."

Professor Louis Appleby, National Director of Mental Health, said:

"Mental health nursing is an essential component in our plans to continue to improve mental health services. The CNO Review will provide an excellent opportunity to look at how nursing can best contribute in the context of changing roles and developing priorities. I am very keen that mental health nurses are able to make the most of any opportunities available to develop their roles and improve outcomes for service users."

The Review will consider how mental health nurses can best contribute to priorities such as:

Delivering Race Equality
Health promotion
Child protection
Developing non-medical prescribing
The review will report by the end of the year.

DoH 8 Feb

Interface between MCB and MHB: Two Bills Two Agendas

Powerpoint Presentation by Genevra Richardson

IMHAP Winter Conference Jan 05

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The Mental Capacity Bill:A Step in the Right Direction?

Powerpoint Presentation by Camilla Parker. Mental Health and Human Rights Consultant.

IMHAP Winter Conference Jan 05

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HL v UK

HL v UK for Mental Health Act Practitioners Download

HL v UK detention checklist Download

By Lucy Scott-Moncrieff. Presented at the IMHAP Winter National Meeting on the Capacity Bill and Bournewood HL case Jan 2005

Widower condemns mental health plans

PENSIONER Cyril Lee has slammed proposals to modernise mental health services in south Wiltshire as "totally impracticable", and warns of serious problems ahead caused by a shortage of nursing home beds.

Mr Lee (81) has personal experience of caring for an elderly person with a mental illness

He has also experienced the problems facing carers, when nursing and care homes refuse to offer a bed to a patient who requires respite care - and he has written to the south Wiltshire primary care trust, highlighting his concerns.

Mr Lee, who lives in the Salisbury area, said he was deeply concerned at proposals in the trust's consultative document to reduce the number of inpatient beds for older adults at the Fountain Way hospital, Salisbury, by almost 50 per cent.

He said, by implication, this would drastically reduce the length of stay for patients in the Amblescroft North unit, a building opened just 18 months ago for inpatient services for older mental health patients.

Mr Lee said: "My wife Dorothy developed Alzheimer's Disease at the age of 72.

"She was cared for at home by me for the next five-and-a-half years and, during this time, spent several short periods in respite care, as a fully self-funding patient.

"The care/nursing homes so involved all reported that they would not offer her further respite breaks because, they said, she was too demanding on staff resources.

"Three months after the last rejection, her condition was such that she was made the subject of a Section 2 Order and detained in the Fisherton Unit.

"There, she sustained injuries in a bad fall, adding to an existing condition of angina, a deep-vein thrombosis, and suffering other conditions and infections."

After about 18 months in the hospital unit and in failing health, Mrs Lee's relatives were informed by new senior management that she was to be discharged.

Mr Lee said: "In spite of impassioned pleas from the relatives about the inhumanity of moving a very sick person to an unfamiliar environment, my wife was transferred to Glenside Manor EMI Nursing Home.

"In just 70 days, she was dead.

"I now understand that Glenside will no longer take such patients. Therefore, where is it proposed that such a patient should be cared for?

"I fear that to say `in the private sector' is nonsense. Understandably, they will always `pick and choose'."

Mr Lee, whose wife died in October 2003, told the Journal: "The trust seems obsessed with treating patients in the community, but there are times when such treatment is inappropriate."

He said he shared others' concerns that there were insufficient nursing and care home places in south Wiltshire to meet demand and is also concerned that more and more nursing homes are refusing to accept elderly mentally ill patients.

"Where will they all go?" he asks.

thisiswiltshire.co.uk 7 Feb

'devil told me to kill'

A DEVOTED husband strangled his wheelchair-bound wife because he thought she was the devil.

'Demonic voices' drove Brendan Courtney, 50, of Heeley Road, St Annes, to kill his wife of more than 25 years, Preston Crown Court heard.
Courtney, a paranoid schizophrenic, pleaded guilty to manslaughter on the grounds of diminished responsibility at a hearing last year.
Today, he was ordered to be indefinitely detained under the mental health act.
Passing sentence, Judge Peter Openshaw QC, said Courtney killed his wife in 'brutal and terrible circumstances.' He added: "The reality is he (Courtney) may be detained for very many years and it may never be safe to release him."
Howard Bentham QC, prosecuting, told the court that Courtney, a former postman, was devoted to his wife and acted as her full time carer when she was hit by a muscle wasting disease.
The disease left Mrs Courtney, 47, dependant on others and while the couple's two adult children did what they could, it was their father who bore the brunt of the caring responsibilities.
But this put a lot of stress on the defendant and he would regularly empty drawers and clean the house for no reason as he struggled to come to terms with his own illness, the court heard.
On the morning of July 19, the couple's daughter, Louise, went to the family home to check on her parents and found her father sat in the front room next to her mother, whom he said was sleeping.
Mrs Courtney looked pale and had blood on her nose and lips so Louise called the police and ambulance. She was pronounced dead at the scene and Mr Courtney was arrested.
A Home Office pathologist found Mrs Courtney had been strangled and had a number of other injuries to her body.
Mr Bentham told the court that in his police interview, Courtney denied killing his wife and spoke of three demonic voices in his head.
He agreed that he had put his arm across her throat but said it was not his wife, it was a devil.
Mr Bentham said: "Courtney said it was not his wife, he said it was a very evil person and that his wife was not dead, just sleeping."
John Jones QC, defending, told the court: "The defendant loved his wife dearly and dedicated his life to her care and wellbeing.
"Quite clearly he was unable to cope.
"Where others perceived complete chaos in the house, his perception was that he was organising cleaning and looking after his wife.
"Nothing could be further from that."
After reading detailed medical reports Judge Openshaw added: "Mr Courtney has a long psychiatric history and has for a number of years suffered gross delusions and intrusions on his mental state.
"On the night of July 18/19 subject to the delusion that his wife was possessed by a devil he killed her in the most brutal and terrible circumstances."

blackpooltoday.co.uk 7 Feb

Schizophrenic detained over death

A paranoid schizophrenic stabbed his wife's stepfather to death 11 days after being discharged from a mental health hospital, a court heard.

Richard King, 35, of Wells, Norfolk, killed John West, 61, at his home in Sheringham, Norfolk, on 7 August 2004.

At an earlier hearing King admitted manslaughter due to diminished responsibility.

On Monday at Ipswich Crown Court he was sentenced to indefinite detention in a secure mental health unit.

Defence barrister Russell Flint told the court that King had received treatment for mental health problems since 1989. He was most recently admitted to hospital on 15 July 2004, but had returned home four days later against doctors' advice.

Before killing Mr West, King was last seen by a community mental health nurse who reported that King was making threats to himself rather than to others.

Last Updated: Monday, 7 February, 2005, 15:52 GMT

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Schizophrenic detained over death
A paranoid schizophrenic stabbed his wife's stepfather to death 11 days after being discharged from a mental health hospital, a court heard.
Richard King, 35, of Wells, Norfolk, killed John West, 61, at his home in Sheringham, Norfolk, on 7 August 2004.

At an earlier hearing King admitted manslaughter due to diminished responsibility.

On Monday at Ipswich Crown Court he was sentenced to indefinite detention in a secure mental health unit.

There is a real danger you will be violent to some other person at some time in the future

Judge John Devaux

Defence barrister Russell Flint told the court that King had received treatment for mental health problems since 1989. He was most recently admitted to hospital on 15 July 2004, but had returned home four days later against doctors' advice.

Before killing Mr West, King was last seen by a community mental health nurse who reported that King was making threats to himself rather than to others.

Multiple wounds

Prosecutor Graham Parkins QC told the court that, on 6 August, King told his wife Jane he was going to kill her stepfather before arming himself with a kitchen knife and driving to Mr West's home.

Mr West was discovered outside his home by his partner, Mrs King's mother, Jean Craske. A post-mortem examination revealed he had died from multiple stab wounds.

Judge John Devaux said that although King was discharged 11 days before Mr West's death, there was no criticism of anyone involved in the case.

He told King: "There is a real danger you will be violent to some other person at some time in the future."

bbc.co.uk 7 Feb

Offender Mental Health Care Pathway

This care pathway document lays down valuable best practice templates to guide providers and commissioners on mental health services for those involved in the criminal justice system. It is based on the best evidence currently available, sourced from both literature and innovative clinical practice.

Download file (PDF file)

Department of Health Jan 05

B v Secretary of State for the Home Department

An appeal by an asylum seeker (B) from a decision of the Immigration Appeal Tribunal (the IAT). After B had been refused leave to enter the UK, she had appealed to an adjudicator, contending that if she was sent back, her rights under the European Convention on Human Rights (the ECHR) would be infringed, as she faced a risk to her mental health and the risk of being raped. The Adjudicator allowed her appeal, holding that she was entitled to asylum under the 1951 Geneva Convention Relating to the Status of Refugees (the Refugee Convention), and that if she were made to return, her rights under the ECHR would be infringed. The Secretary of the State (the Secretary) appealed to the IAT under the provisions of the Nationality, Immigration and Asylum Act 2002, which post-amendment, conferred jurisdiction on the IAT to determine an appeal against an adjudicator's decision only on a point of law. The IAT, without identifying the errors on the points of law, reversed the Adjudicator's decision. B appealed. The Secretary then conceded that although the IAT's decision was flawed, as it had not identified the errors on points of law, such errors could be identified, therefore, the case should be remitted to the IAT for further consideration. B contended that there was no error of law with regard to the Adjudicator's decision on the ECHR issue, and that the remission to the IAT should be restricted to the question of whether she enjoyed refugee status. The court was required to determine whether an error in law had been committed in granting asylum to B.

The Adjudicator had erred in law while deciding B's refugee status. The risk of psychiatric injury could not have given rise to a well-founded fear of being persecuted for reasons of race, religion, and nationality as stipulated in the Refugee Convention. However, it was important that the errors on points of law in the Adjudicator's decision were clearly identified and established, both by the Secretary and the IAT. B's case, based on the risk of her being raped, resulting in an infringement of her rights under the ECHR, was not bad in law. However, the Adjudicator had erred in law by amalgamating considerations relevant to the risk to B's mental health and the risk of being raped, and his findings had been inadequate. The matter relating to the ECHR issue was remitted to another adjudicator for proper consideration.

Appeal allowed. Outcome: Appeal Allowed