Scotland

* provisions to allow service users to appoint Named Persons and to draw up Advance Statements will be introduced in October 2004;

* the right of appeal for patients detained in excessive security will be implemented in May 2006.

The Minister also announced that the additional £15 million will be made available to partner agencies, through NHS Boards, to work together to meet Partnership Agreement commitments for developing mental health services, including crisis services. This means a total of £45 million funding - £30 million has already been allocated to local authorities - to support planning and implementation of the new Act.

Mr Chisholm said: "The Royal Assent of this groundbreaking Act represented the conclusion of one stage for renewing mental health law in Scotland and the beginning of another. The implementation of the new Act is about ensuring the benefits offered by the Act are achieved in reality. A great deal of progress has already been made both nationally and by local agencies, and we are supporting all the agencies involved to work together to achieve the goals of the Act. "At the heart of the success in achieving the aims of the new legislation will be the development of services and support which meet the needs of those with mental health problems in communities in Scotland in the 21st century. I am pleased to announce that £15 million of Partnership Agreement funds will be allocated to meeting the commitments for planning and delivering mental health services set out in Partnership for a Better Scotland. "Joint Local Implementation Plans are to be prepared by April 2004 and this new, additional money will also help NHS Boards, local authorities and their partners in voluntary organisations - and of course users and carers - in the development of these. The plans will identify those priorities for the provision of services and set out the actions to be taken to ensure these are delivered. It is important these joint plans reflect and build upon the joint management and delivery approaches which follow the principles of the Joint Future initiative."The Executive's guide to the Act - Introduction to the Act - and the second edition of the Reforming Mental Health Law newsletter, are also published today. These provide further information on provisions of the new legislation and are intended to help all those involved in the implementation of the Act and in the planning and use of services". The Minister added: "The measures I have announced today run alongside other developments for mental health services already underway. For example, work is in progress to support users and carers to ensure independent advocacy is available as envisaged by the Act. Furthermore, the new National Mental Health Workforce Group is working to address issues of recruitment, retention and training for those involved in providing care and support to those with mental health problems. "I am also pleased to say that the Mental Health and Well Being Support Group will now have an enhanced role. The Group will co-ordinate the Executive's work on service development at national level and will provide support to NHS Boards and their partners for their local planning."

• Mental Health Officer Services: Structures and Supports - Research Findings
  

The Executive has outlined progress on the implementation of the Mental Health (Care and Treatment) (Scotland) Act 2003.

The update, issued in the first edition of a new dedicated newsletter, also seeks views on the target date for the Act to come into effect.

The newsletter, Reforming Mental Health Law, is the first of a planned series on implementing the new Mental Health (Care and Treatment) (Scotland) Act 2003, which received Royal Assent on 25 April 2003. The newsletter introduces some of the work the Executive will be taking forward to implement the new Act and to support service development, to ensure the benefits the Act promises are achieved in reality. It aims to:

increase awareness and understanding of the new Act
encourage people to anticipate the implications of the Act for them
explain what is being done to implement the Act, and to enable people to get involved in that process
The newsletter was launched at a Moving the Agenda Forward mental health services event held in Edinburgh on Thursday, June 19.

Recognising that there is a great deal of work to do before the Act can be brought into effect, the Executive is taking forward a number of strands of work that includes:

setting up the new Mental Health Tribunal for Scotland
developing a Code of Practice and other information on the new Act
supporting arrangements for training on the new Act
developing arrangements for monitoring, assessment and research
in some areas, developing and making secondary legislation (such as Regulations) for the legal framework
raising awareness of the new Act
The preliminary, provisional coming-into-effect date is October 2004. There is a need to fix a firm target date now that the Executive, together with the wider field and bodies concerned, have been able to assess the implications of the Act's provisions and the infrastructure needed to be in place to ensure the legislation is implemented in a way that does justice to these provisions.

Considering this context for implementation, views are sought on the proposals for:

aiming to bring the main provisions of the Act into effect on 1 April 2005
bringing some self-contained provisions (such as those relating to the making of advance statements and the nomination of named persons) into effect on 1 October 2004
As wide a range of views as possible are being sought on the target date for coming-into-effect, after which the Executive will announce a target date.

The deadline for comments is Friday 25 July.

The new Act provides:

new rights for people with mental disorders and places new and extended duties on those providing services to them
new, fairer procedures for the compulsory treatment of people with mental disorder
fairer and safer procedures in relation to people with mental disorder within the criminal justice system
The newsletter can be accessed on-line at www.scotland.gov.uk/publications and will be distributed to individuals, voluntary organisations, NHS staff, local authority contacts, agencies and other groups working in the mental health field.

Consultation responses on the date for implementation can be sent to:
Mental Health Act Implementation Team
Scottish Executive Health Department
St Andrew's House
3EN
EDINBURGH, EH1 3DG

e-mail: mentalhealthlawmailbox@scotland.gsi.gov.uk

OPINION OF LADY PATON in the cause RORY KEEN Pursuer; against TAYSIDE CONTRACTS Defenders: 26 Febuary 2003. In this action the pursuer sues his employers averring negligence. As a road worker, and foreman of a team of three road workers, he was on 15 September 1998 instructed by his supervisor Mr. Colville to attend urgently at a road traffic accident at Claypotts Junction, Dundee. He was to assist the emergency services by setting up a traffic diversion. At the scene of the accident, the pursuer became aware that a body lay crushed and burned in a car. Subsequently he became aware that there were in fact four bodies in the car. The pursuer avers that, despite two telephone calls to Mr. Colville (calls which the defenders deny: Answer 4, page 8A-B) advising him of the situation and requesting that he be allowed to leave the scene until the bodies had been removed as he had no training for such a situation, he was instructed to remain and to assist the police. He was then subjected to the sights and events outlined in Article 5 of Condescendence. He avers that as a result of the traumatic experience, he developed post traumatic stress disorder, which was further aggravated by a later assignment to Claypotts Junction in March or April 1999. He now sues his employers for damages on the grounds of unsafe system and vicarious liability for Mr. Colville. He avers failures on the defenders' part to take reasonable care (a) to issue instructions to supervisors well before 1998 that no employees should be required to remain at an accident scene where they would foreseeably be exposed to the sight and presence of dead and mutilated bodies or body parts, and (b) to provide post-incident de-briefing to any employees so exposed to allow someone such as the pursuer to come to terms with the experience in a safe and healthy way. He also avers breach of duty on the part of Mr. Colville in that the pursuer was refused permission to leave the scene although the risk of damage to the pursuer's mental health was reasonably foreseeable.

• Clarification of the circumstances in which someone can be given compulsory treatment
• Provision for a range of accessible community-based services to ensure that compulsion is only used where absolutely necessary
• More access to advocacy for all users of mental health services.

The Foundation also stated that there should be no Electro Convulsive Therapy without consent except in emergencies, and that there should be no pyschosurgery without consent under any circumstances. Maddy Halliday, Director, Scotland and UK Development at the Mental Health Foundation stated: "The reforms are based on sound principles, and many aspects of the Bill are most welcome. We certainly believe that it's a much better example of how to tackle reforms than the Mental Health Bill for England and Wales, which is under heavy criticism from all sides. But more needs to be done to ensure that compulsion is used only when absolutely necessary. The Scottish Executive must address the fundamental need for good quality services that are available when people with mental health problems need them." The Foundation welcomed the extended powers of the Mental Welfare Commission and the introduction of an independent Mental Health Tribunal.

• Mental Health Bill (Scotland): Covering Letter
  
  

Over the last 15 years there has been a move to reduce beds and treat people in the community, which is seen as a less restrictive alternative to hospital. This new Bill modernises thinking about detention by allowing for people to be cared for, under the provisions of The Bill, within the community when appropriate, rather than in hospital.

These welcome innovations depend on considerable additional resources, particularly in staffing levels. This is important if services for non-detained patients (the vast majority) are not to be compromised.

For further information contact Karen Addie, Administrator, The Royal College of Psychiatrists Scottish Division
Email: k.addie@virgin.net

Overhaul of mental health laws: Scotland's mental health laws are to be subject to their most fundamental reform for 40 years in a Bill published today. Key changes proposed are: New procedures for compulsory care and treatment, which will be tailored to meet the needs of the individual patient; A new mental health tribunal, involving doctors, lawyers and other experts, to make decisions about compulsory care; Stronger duties on local authorities to provide care and support services to people with mental health problems and learning disabilities; New rights for mental health service users to have their interests represented by independent advocates.
The Bill also updates the arrangements for dealing with the small number of people with a mental disorder who become involved in criminal offences.
Health and Community Care Minister Malcolm Chisholm said: "The Mental Health Bill is about protecting people when they are at their most vulnerable. It balances people's rights to make their own choices, with the responsibility of society to help people when they may not be able to make decisions for themselves. "That is a complex and sensitive task, and we have been guided by the landmark report of the Millan Committee, which set out detailed proposals for reform, alongside ten key principles. "The Mental Health Act currently in place is largely based on reforms introduced in 1960: before the major shift to community-based care, and before the rights of people who use mental health services to have a greater say in their own care and treatment began to be recognised. Furthermore, this Mental Health Bill is specifically tailored to Scottish needs. "The Bill replaces the 'one-size fits all' procedure for detaining people in hospital with a new, flexible, compulsory treatment order. For some people, that might mean that compulsory care could be delivered in the community. I know that some groups are concerned that this could result in too much power being taken from patients and given to doctors but the intention is the opposite: to ensure that patients can retain as much control over their own lives as possible. That is why the Bill greatly strengthens the legal safeguards for patients and their families. "Under the Bill, the new Mental Health Tribunal will have to be satisfied that compulsory powers are justified in the context of an agreed care plan. The Tribunal will be an accessible and user-friendly body, and patients will have the right to nominate a 'named person' to represent their interests, and to make advance statements setting out their views on their own care and treatment. "The Bill is not just about compulsory treatment. It aims to make things better for everyone who uses mental health and learning disability services. For the first time, there will be a legal duty on local authorities and the NHS to ensure that independent advocacy services are available to people who need them. We are also updating the powers of the Mental Welfare Commission, which will have a general responsibility to promote good practice in the operation of the Act. "The Millan Committee were right to say that the aspirations of the Bill will not be met without substantial improvements in mental health services. The Executive is committing £17.1 million a year to implement the Bill, alongside anticipated additional NHS expenditure of £6 million a year." Mary Weir, Chief Executive of the National Schizophrenia Fellowship (Scotland), and a member of the Millan Committee, said: "I'm delighted that so many of the Millan Committee's recommendations have been taken on board by the Executive in a Bill which will culminate in a new mental health law in Scotland, fit for the 21st century. Adherence to the principles outlined by Millan should ensure that interventions under the Act, for people with serious mental illness, will be appropriate, effective and sensitive to their needs and those of their families. "During the life of the Millan Committee, the difficulty of disentangling problems with the present law from problems with current service provision became very clear. It is crucial that substantially increased resources accompany the introduction of the new Act; resources not only to implement the Act but to ensure that the right services are in place to prevent, as far as possible, the requirement to use the Act." Dr Jim Dyer, Director of the Mental Welfare Commission for Scotland and another member of the Millan Committee, said: "I warmly welcome the publication of a new Mental Health Bill for Scotland, which is extensively based on the proposals of the Millan Committee. That committee was broadly based and consulted widely, so there is likely to be a lot of consensus around the new Bill. It is different in important respects from the draft Bill for England and Wales. "This is a necessary updating of mental health law, allowing involuntary treatment, which is necessary in some cases, to take place without compulsory hospitalisation, in keeping with the move to community care and with modern principles. It will strengthen the rights of users and their carers while giving the right degree of attention to public safety." 17 Sept 2002.

- new procedures to allow compulsory treatment to be tailored to individual patients, allowing for the first time some patients (like manic depressives) to be treated in a community setting rather than in hospital;

- the establishment of an independent Mental Health Tribunal to take key decisions on compulsory treatment, currently carried out in sheriff courts. Chaired by an experienced lawyer, with support from medical and community care experts, it will encourage the participation of patients who will also have access to free legal representation;

- stronger rights for patients and carers including new duties on local authorities and NHS Boards to develop advocacy services, together with the right for patients to make advance statements about their care at the new Tribunals.

Today's statement also confirms that mental health tribunals, chaired by sheriffs, will be responsible for decisions on the discharge of patients placed under restrictions by the criminal courts. But Ministers will retain the responsibility for overseeing their risk management.
Ms Deacon also confirmed that, following the decision of the Privy Council on Monday that legislation introduced after the Ruddle case in 1999 was ECHR-compliant, the new legislation would continue to ensure that there are no gaps. This will ensure that offenders placed under special restrictions, and who remain dangerous, are not discharged into the community.
Speaking at the launch of the new policy statement in Edinburgh, Ms Deacon said:

"Tackling mental health is one of the great health challenges our society faces today. Improving mental health for people with problems from mild depression to schizophrenia needs a broad approach. Better prevention, high-quality treatment, and modern legislation are all part of that.

"Twenty years ago the majority of patients with mental health problems were cared for in institutions that were closer to the 19th century than the 20th. Today, so much has changed. People are, wherever possible, cared for in the community , close to their homes and families. Mental health law must now catch up with mental health care.

"Today, we set out our proposals to bring mental health law up to date. Clearer, fairer, safer mental health legislation that puts the patient, their families and carers at the heart of our approach. Quite simply, these proposals represent the biggest ever overhaul of our mental health laws in Scotland.

"I want to thank Bruce Millan and his Committee for the huge amount of work they put into reviewing our outdated legislation, and for the detailed and measured recommendations they put before us in their report in January. We have consulted widely on those recommendations and have had the benefit of further advice and expertise from experts across the mental health field.

"Patients and their families will notice the difference. They will have stronger rights to independent advocacy, more protection against neglect and all types of abuse, a stronger voice in having their needs and conditions assessed, and free legal representation in the new mental health Tribunal system.

"The public too should be reassured that this wide-ranging package recognises the legitimate concerns of the community to be protected from the small minority of offenders with mental disorders who pose a risk. Scottish Ministers will still oversee those patients placed under restrictions by the courts.

"We also believe that it is right that the legislation introduced after the Ruddle case in 1999 should continue to ensure that there are no gaps in the law. This will mean that offenders placed under special restrictions by the courts, and who remain dangerous, are not discharged into the community.

"The Millan Committee made over 400 recommendations to modernise Scotland's mental health laws. We have accepted the vast majority of those. I believe that this package represents a very serious and balanced response to the changing needs of mental health service patients and those who care and support them.

"Work will now begin on preparing a Bill for introduction in the Scottish Parliament next year. The Mental Health Legislation Reference Group will continue to have an input to this process. I believe it will be another significant milestone for devolved government in Scotland if we are able to put in place a new mental health Act within the first term of this Parliament." Added 18 Oct 2001.

• Executive Summary

• HAVING YOUR SAY:Your right to accept or refuse medical treatment
• A TO Z HOSPITAL PATIENTS: An A to Z of your rights
• DETENTION IN HOSPITAL
• WHAT'S IN MY NOTES? Getting to see your medical and social work records
• CONFIDENTIALITY
• HELP FOR FAMILIES AND CARERS: Your Right to accept or refuse medical treatment
• A WAY THROUGH THE COMPLAINTS MAZE
• YOU, THE POLICE AND THE COURTS
• DISCRIMINATION

• Explanatory Notes (and other accompanying documents)
• Policy Memorandum

• Covering Letter

• Bill (as introduced)
• Explanatory Notes (and other accompanying documents)
• Policy Memorandum

• Draft codes of practice and regulations. Consultation documents.

• Executive summary Added 19 March 2001