Attitudes of non-discrimination and patient autonomy, and capacity should be taken into account in determining outcomes. The definition, while largely reflecting that of the Law Commission’s work in this area, should be broadly based so that patients “might be deemed to lack capacity when they reach a decision in respect of their treatment that they would not have reached had they been well”(Re C 1 WLR 290).
Mental health policies address risk management and crisis resolution, local agencies account against financial constraints for implementation bound by clinical governance. Commissioners of mental health services implement the requirements of the NSF in key areas. Empowerment issues being at the top of the list of priorities, these concerns are compounded by worries about the implications of the proposed reforms to the Mental Health Act (Draft Bill, 2002). The recent shifts in policy aimed at modernising institutions across the whole field of civil and social care, are areas of crime, education, legal services, housing, regeneration and community development, skills and workforce development the framework provided by the NSF plans to be an effective service for adults with mental illness and aims to prevent it in the first place (NSF, 1999).
The factors relating around risk management and assessment are that of: a) Emotional, practical and social support to people with mental health problems as interdependent. b) The client is likely to benefit in the long term if they are provided with a reliable relationship with a key individual or service, which aims to understand their emotional needs, to relieve their isolation and facilitates making links with other agencies (Barr et al, 2001). A case scenario, which can be used, is that of: “I was working in a warehouse in Coventry, and I came Home drunk in a psychotic outrage. They’d put wallpaper Up in the kitchen, which I didn’t want, and I began to peel off the paper, whilst I was cooking well I pulled it off and set fire to it on the balcony. I was arrested for arson with intent.”
This gentleman had a history of drug and alcohol abuse he was well known to the services CDT and CAS (Community Drugs Team and Community Alcohol Services) Low self-esteem, lack of motivation and difficulties in creating a daily structure, has been raised by agencies as key problems for their clients. Certain key elements have been raised for example at times of acute stress, when individual’s sense of internal order becomes more fragile, the lack of insight into their current difficulties and the effect they have on other people, requiring intensive management, which contains the emotional distress and attends to the external factors of daily living (Rethink, 2002).
A case scenario that emphasis is: “I left my son at the church with the priest, the turning point was when I broke the statue I felt free so I drove 26 miles on the motorway because my ex-husband said I could not drive on it, well he was abusive for years towards me, I didn’t take Jack because I didn’t want to upset him. I don’t think I did any thing wrong the priest was there so Jack wasn’t alone” Consequently this lady was diagnosed with a major mental health disorder she was never known to the services before, however she had been treated for Depression by her GP for years.
Services specific to the needs of clients from black and ethnic minority groups were identified in the North of Coventry however the West is less developed. It was suggested that groups to support people with mental health problems from the ethnic minorities and their families should be established. Behaviour related to mental distress encountered by the police included: bizarre behaviour for petty offences including shoplifting, fraud, public disorder, criminal damage and drugs/alcohol, and the more serious crimes of arson and violence. Police may become involved via their domestic violence unit, or providing advice and tracing AWOL clients. The police are faced with particular problems in identifying mental illness and managing people in distress. Several agencies said they felt the police interpret non-conformist behaviour as threatening, which, can lead to the inappropriate use of force. This in turn often frightens the individual already confused and disorientated and can then provoke a violent response (Turner, 1996). Another case Scenario:
“I attacked the man which a machete because I was defending myself I was told he was trying to kill me, I don’t know why I have no marks on me but he was trying to kill me. I knew you wouldn’t believe me you think I’m mad.” This gentleman has a long history in the psychiatric services he has been diagnosed as Paranoid Schizophrenia and his relationship with the Assertive Treatment Team (ACTON) has broken down due to his reluctance to engage with them. The man he attacked had his finger served off and also needed stitches for his head wound. At the time of the incident the victim was out walking with his girlfriend, she and many others were witnesses to the attack.
Information leaflets and Rights on Procedures There is an over-representation of the psychiatric and the criminal justice system in terms of certain themes, which occur throughout is the use of Section 136 (police removing someone to a place of safety) at times proving to be pragmatic, which does not always follow the agreed policy and is largely un-monitored with considerable discrepancies between the records of different agencies. However it is important that individual’s are assessed quickly and that the 72 hours are seen as the absolute maximum time to be detained. The police should issue information to the person on why they are being detained with their rights under PACE (1984).
ASW’s have a duty to unsure the person has been told of their rights and feel able to be interviewed by the Police. Individuals in custody should receive recognition of their basic human rights under the European Convention on Human Rights (ECHR, 1999). Another factor in terms of rights is that of patient Confidentiality and each discipline needs to abide by the rules of their particular governing body. Conclusion and Recommendation for Future Practice In-conclusion Section 136 is a good safety net if utilised appropriately, however there are also many criticisms regards the use and place of safety. Many suggestions can be made with the hope of decreasing individual distress when all agencies combine efforts together maximising a holistic approach. The new Mental Health Bill will hopefully incorporate some changes in approach and response times.
Emphasis on long-term flexible involvement is needed, in terms of help with managing medication, the payment of bills, or having regular contact with someone to talk to, if the individual is vulnerable or has any needs identified. MIND and CPN’s provide different home visiting services but resources of such services available to the individual are limited. The short-term resettlement and support services offered by housing organisations do not meet client’s long-term needs, the concept of the creation of a safe house/crisis centre and respite beds in non-medical environments may be beneficial.
Structured, therapeutic interventions would help reduce reliance on hospital provisions. There is a shortfall in Advocacy services, as is access to welfare Rights and employment training. While day care services are valued, there is some duplication in drop-in services, and often sometimes difficult to get to, clients often feel that these are related to psychiatric services, whereby they are labelled and stigmatised.