After the referral from the police, the Local Authority has a duty under s.47 of the National Health Service and Community Care Act 1990 (hereinafter referred to as NHSCCA) to assess Richard to see if his needs call for the provision of services. The Local Authority has the power to provide various services as set out in LAC(93)10 to the “ill”, the definition of which is defined in s.128 of the National Health Service Act 1977 (hereinafter referred to as NHSA). These services entail recreational and occupational facilities, day centre, meals, support, laundry facilities and respite care for the prevention, care and after care of the ill (NHSA s.21 & Sch.8).
Due to Richard’s alcohol problem he is able to receive both residential and non-residential facilities under s.7E(b) of the Local Authority Social Services Act 1970 (LASSA hereinafter). Established within the NHSCCA 1990 are arrangements for people with alcohol misuse problems and the Local Authority Social Services are responsible for planning and purchasing relevant social care services and for assessing the individual to determine what services they require.
Having assessed Richard’s individual needs, the Local Authority must pass on information to the health and housing authorities if it believes that they can help [NHSCCA S.47(3)]. Should Richard’s situation be seen as urgent (i.e. risk of suicide) then s.47(5)&(6) of the same Act states that services can be provided before an assessment is made. The LAC(93)2 does state, though, that this power should be used sparingly.
The National Assistance Act 1948 (NAA hereinafter) gives the Local Authority the power and the duty to provide support services for those who have a physical or mental handicap. Should Richard require help, not due to the circumstances in which he finds himself but because of who he is, i.e. suffering from ‘a mental disorder of any description’ (NAA s.29) then s.47(2) of the NHSCCA 1990 requires that he be assessed as a “disabled person”. A guide to the services available to disabled clients can be found in Schedule 2 of the Chronically Sick & Disabled Persons Act 1970 (CSDPA hereinafter), s.29(4) of the NAA and the DOH Circular LAC(93)10.
These services can include recreational facilities, practical assistance in the home, general support and advice in the home and elsewhere, suitable staff to deal with assessment, centres for training or occupation and assistance with travel to any of the facilities. A duty is imposed upon the Local Authority in Paragraph 2 of LAC(93)10 to make arrangements for “the prevention of mental disorder or for persons who are or have been suffering from mental disorder”.
These services are available to Richard within the community i.e. Richard does not have to be an in-patient in a hospital in order to receive those services. It may be that it is not possible for Richard to remain in the community with support but that residential accommodation is more appropriate. Richard may be offered accommodation if he “has a mental disorder, or is recovering from one or is at risk of one” (Brayne&Martin 1999).
Alternatively, s.21 NAA is applicable to Richard if he is unable to cope at home “due to mental incapacity” (Balloch et.al 1999). NAA s.21 comes within Pt.III (Accommodation) of the NAA which allows the social services to arrange residential accommodation for person aged 18 or over who “by reason of age, illness, disability or any other circumstances are in need of care and attention which is not otherwise available to them” (Brayne&Martin 1999). Richard’s problem with alcohol must be taken into account when considering residential accommodation.
Richard cannot be forced to accept the accommodation offered to him unless he refuses help and is a danger to himself and others. A community doctor has the power to apply to the Magistrates Court for an order to remove Richard from his home. The criteria for compulsory admission into residential care are stated within s.47 NAA and apply to persons who: – 1. Are suffering from grave chronic disease or, being aged, infirm or physically incapacitated, are living in insanitary conditions; and 2. Are unable to devote themselves, and are not receiving from other persons, proper care and attention.
It is important that both the criteria are met in order to show that Richard is unable to look after himself and is not merely choosing to live that way. Should Richard’s situation be regarded as an emergency then the applicant can apply for an order which will allow him/her the power to remove Richard without giving him notice and to detain him for up to three weeks. The community doctor plus another doctor must certify that it would be in Richard’s best interests to remove him without delay (National Assistant (Amendment) Act 1951 s.1). Richard does, otherwise, have the right to at least 7 days notice of the court hearing. The order lasts for 3 months and is renewable indefinitely provided that the grounds for the order are satisfied. Once the compulsory detention lapses then Richard can leave or remain voluntarily.
In order to be aware of the range of services and service providers available it is possible to consult the Community Care Plan. It is required by every social services department that they publish a community care plan and update it at least once a year (NHSCCA s.46) in order that a wide range of needs are met within the area.
If, after a period of assessment, Richard is diagnosed as needing treatment under the Mental Health Act (MHA hereinafter) he must, before any application is made for an order, be interviewed in a “suitable manner” (MHA s.13). A suitable manner entails taking into account any barriers to communication that may exist (i.e. language, culture, environment etc.) and also that he not be interviewed whilst under the influence of alcohol.
If Richard is in agreement with, and consents to, treatment (Code para.15.13) the “informal admission” (MHA s.131 & Code para.2.7) into hospital may be in Richard’s best interests. The decision to admit Richard informally should be made by the doctor in charge of his treatment (Code para.2.8) and Richard’s views and feelings should be taken into account at all times. He is, in theory, free to leave the hospital at any time although, in an emergency, he can be temporarily detained (MHAs.5) by either the doctor or the nurse. The nurses holding powers [MHA s.5(4) & Code para.9.1] last for 6 hours and the nurse must be registered for mental disorder work under the Nurses Midwives & Health Visitors Act 1979.