A-Z of mental health
Information and advice on a huge range of mental health topics
A step forward for inpatient rights
Posted Wednesday 8 February 2012
Mind's CEO Paul Farmer welcomes a landmark Supreme Court judgement, which promises greater protection for people with mental health problems who admit themselves to hospital voluntarily.
For many years at Mind, we have stood up for people with mental health problems who find themselves in hospital care. Over 50 years ago, our campaigning helped lead to the closure of the long stay asylums, and since then, we have continued to campaign for the rights of some of the most vulnerable people in our society.
Much of this work is undertaken by Mind's small Legal Unit and our Policy and Campaigns team, which are both funded by public donations to undertake this work.
Along the way, we've seen some noticeable changes. Successive pieces of legislation have strengthened the rights of 'patients'. The effect of this has been a noticeable change in the way that people are treated, and as our crisis care inquiry found, a combination of legal change, more direct user involvement and improved resources to support staff has led to an improvement in inpatient care in much of the country.
But we also know that in some places, care is not as it should be, with insufficient regard to treating someone with dignity and respect. Our inquiry identified a number of ways to ensure a more uniform level of care.
Today, the Supreme Court's judgement has further strengthened the need for hospitals to treat people with dignity and respect. This case, following the tragic suicide of Melanie Rabone, now makes it clear that hospitals have a positive duty to protect the life of people who are voluntary patients by taking appropriate steps to prevent them taking their own lives.
This reinforces an earlier case, which Mind was also involved in, which made this duty clear for people who were sectioned. This may sound like a minor change, but this protection is now extended from the 40,000 people who are detained each year under mental health legislation to over 100,000 people who will receive inpatient care each year. Hospital staff will always do their best to protect people - this judgement will ensure that they receive the support they need from the NHS to do this well.
It's also important to recognise the role of Human Rights law in this case. Sadly in many people's eyes, human rights law has become associated with the extremist terrorist 'getting away' from justice, or unwanted European interference.
Yet this case is an example of what's good about human rights law - this decision was made in a UK court and will help protect the dignity of tens of thousands of people every year who deserve to treated with humanity and care. It acts as an important safeguard and helps support frontline staff, families and people themselves at one of the most difficult times of their lives.
This decision, achieved with skill by barristers who give their time for free, and interventions by Mind, Liberty, JUSTICE and INQUEST, should be welcomed widely as a thoroughly appropriate use of human rights law which will lead to more safeguards for people with serious mental health problems.
Read a summary of our report into acute and crisis care and find out how to become a Mind campaigner.
29 Comments
-
You have to be kidding me..care clusters and cuts to services have ensured that you'd have quite a fight to get into hospital voluntarily. If a GP referral is refused by secondary services because the patient didn't fit their criteria for 'serious mental illness' then that patient has to wait until they are in a type of crisis which is sectionable i.e. a nuisance or danger to others because danger to self counts for little now. There are consultants who are having to discharge sectioned patients within days and hand over to Home Treatment who do little else than doorstep medication delivery for 4 weeks. There are no safe guards in the community for people taken down from bridges by the police or those who present to A&E or their GP's with ASTI and Crisis teams only seeing people they absolutely have to. Payment by results also skews who gets referred i.e. not those who would be viewed as expensive or untreatable. Whether you are a voluntary or involuntary patient the problems with human rights being eroded from all sides to the point of being meaningless is a much wider issue than inpatient care alone now. Need has been reframed - critical to moderate, moderate to low need, low needs count for nothing, only critical but only with the right combination of scores from your 'cluster'. Frankly I think more people are worried about dying in their own homes because of housing and welfare policy than through inadequate care as an inpatient. Inpatient care is a drop in the ocean compared to having a roof,an income and living in fear of weekly work programme bullying or being forced into endless temporary 8 hr contracts and ESA yo-yo. For some people a hospital admission under any conditions might be respite from all that. Longer term support has been lost, 6 months or less in-out through ASTI, it's the loss of the longer term relationships and support that are going to have a more devastating impact and rack up those suicide stats [along with welfare cuts].
-
Mind's legal department could do with Time for Changes funding so it could do more of the work members need. This shouldn't be a small dept run on donations with barristers giving their time for free - this needs to be Mind's core work
-
Thanks for your comments Mindreader, you make some very good points. We certainly share your concern that in many areas people aren’t getting the right support.
We welcome the Supreme Court ruling as a step forward but know that very serious problems still need to be challenged. In our inquiry into crisis care we heard that not getting immediate access to help was one of the biggest problems people faced, and part of this is the criteria services use. We will continue campaigning for excellent crisis care to be available for everyone and the wider system needs to ensure that people aren’t going into crisis through a lack of support.
The Government has pledged extra funding for the Improving Access to Psychological Therapies programme but as you point out, cuts to local services mean budgets are stretched for existing services with waiting times increasing. We’re a partner in the We need to talk coalition and we want to see the waiting times reduced to within 28 days of requesting a referral, with people being given more choice in their therapy.
Losing necessary financial support will also have a serious impact on people’s long term health and that’s why we’ve also been challenging a number of issues around benefits and welfare reform. We think it’s important to campaign on a broad range of issues if we’re to properly represent the interests of people with mental health problems.
Thanks again for your comments, testimony like yours feeds directly into the work we do.
-
Eve, IAPT's is very limited in what it does, with whom and for how long, and it's not what many service users want [nor diagnostic defined group therapy]. People are missing their CPN's, care co-ordinators and social workers they had contact with regularly or more ad hoc but on a longer term basis because of the value of consistent relationships.
Now people are in-out within weeks/6 months and have to go back to their GP for any further access but each time will 'start again' with ASTI, as it will be treated as a new patient contact even though it isn't. This is like 'revolving door' but a community based version.
Everything is linked - the cuts to services/housing and welfare with criteria's to exclude as much as possible, they are intrinsically linked.
It is disproportionate regarding mental health, an oncologist wouldn't say sorry come back when your lump is a massive tumour but that's effectively what mental health professionals are being forced to do. This isn't about money - welfare reforms have been shown to save nothing, it costs the taxpayer millions for reviews/tribunals. The work programme costs millions and achieves nothing. This is ideological and this is where the argument should be focussed, on hard economic data and the clear prevailing ideology, not begging for crumbs which won't make that much of a difference. It would mean Mind [and Rethink] risking its DH funding and relationships with the civil service [not that they have any time for charities beyond polite placation]. Depends on how much balls the CEO's have but I won't be holding my breath I mean the Schizophrenia 'commission'?!! Mind and Rethink support Robin Murray's desperate bid to drum up more funds for brain research - that is so not what service users need right now. -
ps I still can't get my head around how Sue Marsh and colleagues achieved more than all the charities with no funding, I think charities should be backing activists who can do this practically and financially
-
I want Paul Farmer to confirm once and for all whether Mind is colluding with the work programme, see this comment in the Guardian:
As someone who as experienced A4E at first hand and also similar types of schemes, I can tell you they are nothing more than open prisons for the unemployed, where consecutive governments hide away the long term unemployed from the official statistics.
I spent 30 hours a week for 6 months being locked in damp old building in Newport Gwent with 200 other unemployed people playing cards and reading newspapers, the staff were unqualified and useless, in my first week on induction a staff member told us we were a bunch of lazy **** and spent all day watching daytime TV. After 1 week of induction the staff did nothing for us, when we approached them for work experience most of us ended up working as slaves for Mind and other charities.
http://www.guardian.co.uk/politics/2012/feb/09/a4e-welfare-to-work-contract
-
Hi Mindreader - Thanks for your comments. I’m sorry you’ve had such bad experiences of back-to-work support in the past. Anyone with a mental health problem who is able to take steps towards working should have tailored support to help them return to employment. What you describe sounds like something that would only knock your confidence even more.
Doing work experience can help people prepare for a return to work but organisations shouldn’t use these placements to cover the role of a paid worker. If you’ve had this experience with a local Mind, you may want to put your complaint in writing to register your concerns and request a copy of their complaint procedure.
To clarify our involvement with the Work Programme, Mind is part of Disability Works UK – a consortium of charities bidding for employment support contracts in 11 regions in England and Wales. The aim of the consortium is to improve people’s experience of the programme, so they can be supported by experts on a range of health problems. It works on a case by case basis, so if it’s apparent that a contractor isn’t compatible with our values then we wouldn’t work with them.
We’re concerned about the Work Programme not adequately supporting people with mental health problems and believe the involvement of local Minds in some regions is helping people to get the support they need and ensuring that people with mental health problems are not asked to undertake activities that are unsuitable for their circumstances. It doesn’t affect our commitment to campaigning and we will continue to speak out on this and other key issues around benefits and welfare.
-
That wasn't my experience of the Work Programme Eve I was quoting someone else's from the Guardian which directly referred to Mind.
The problem with Mind bidding for contracts is that people are forced by Jobcentres to do "courses" and "placements," it's not a choice. Charities have sometimes not even been paid for the practical assistance they've been subcontracted to do. The Work Programme isn't helping anyone let alone mental health service users [or more likely ex-users till their next crisis].
Work experience all too often means corporations using free labour and at times replacing paid posts with people forced to do so. How can you find contractors suitable with your values when people are being forced to participate? I can't see how people's experience of this appalling programme can be made better. Most placements are weeks of stacking shelves in Poundland and Tesco. -
The Govt couldn't have done a better job in making us feel less human.
Work programmes are just slave labour, nothing to do with training or support. As for support from mental health services forget it, you'll be discharged with a convenient label that you have to live with but excludes you from any meaningful help. We know what is happening and that just makes it worse. -
...although this often escapes notice, us professionals are equally concerned about the way MH services are going and the increasing "conveyer-belt" nature of hospital admissions, with no resources or time to pursue more creative and meaningful interventions. I work in a crisis team and completely see how frustrating our limited interventions can be. Our caseloads are increasing, with more admissions requested/required with less beds, and barely time to see everyone who needs to be seen.
I fear very much for the future of mental health services. I read something very wise the other day which I would urge people to remember...manning the lifeboats doesn't mean that you agree with the sinking of the ship...
-
Too right Liz and I applaud you for saying it, I know a lot of nurses are absolutely frustrated at what is happening. The increase in admissions must surely demonstrate to policy makers that conveyor belt services at breakneck speed simply don't work for anyone - whether you use services or work in them
-
This is a really good ruling and long needed. For a period of a year when I was really unwell I ended up in a situation where the ward I was on made a decision that a) they wouldn't talk to me (I had a named nurse but they did not identify themselves to me); and b) that I would be allowed to leave the ward even if suicidal...my life was to be my responsibility. Unfortunately at the time I was under the delusion that the best thing for my family would be for me to be dead. I made repeated and serious attempts on my life almost exclusively off the ward as I wished to protect the staff and patients. In the whole year only one member of staff actually refused to let me out because he said he had a duty of care, and it was always very obvious when I was very unwell. It quite honestly is a miracle I survived (and an apparently iron constitution).
Only a couple of years ago I had to ring the police from an acute ward because a informal suicidal patient had left the ward after being told that she was about to be discharged at 10.30 pm without seeing a doctor. The ward staff would not ring the police. She was arrested on a railway line about an hour later, the trains having been stoppped. I was told the next morning that I had breached the patient's confidentiality. The police were very good to me and reassured me that I had done no such thing...My fears had been both for the patient and members of the public: she had repeatedly said she was going to throw herself under a car or lorry.
Finally, bad nursing decisions will not be able hide behind the excuse of the patient being informal anymore.
And to Liz, I know there are good mental health workers out there, and i know you are suffering because you are aware that you cannot remotely meet the needs of your clients. The introduction of fast track systems is not laughable, it's a disgrace. How can anyone be assessed in 3 days and cured in 3 weeks? -
...social workers work in mental health too, not just nurses! Remember we're still multidisciplinary! Although don't worry that's being killed off... For now myself and other social workers are still trying (alongside our nursing colleagues) to deliver meaningful mental health services against almost impossible conditions...
-
Hi, my name is Jules & I am currently detained on Poppy Ward, a Mental Health hospital. Having read some of the comments I wanted to tell people what it is like on the inside... personally I & my partner, are SHOCKED... I feel like its the 1600's, nothing has changed.
I used to think that people on the outside had a stigma about mental health & that you were treated differently if you had a mental health problem. How wrong can one be! General public are smypathic about mental heath (MP), but that is so not the case. It is the Consultants & nurses who have the stigma, Since being brought in 3 wks ago, I have been treated like a 3 yr old, who after 45 yrs of independant living,has suddenly lost all rights which one would normally have as a human being. It is so debilitating, exhausting, constantly trying to "GET YOURSELF HEARD". It is somewhat like being accused of a crime which you did not commit, being sent to prison & having to then prove you are inocent, This in itself is so very difficult, because what ever you do, it is seen as part of your mental illness, even if you do not have one. Purely the fact that you state you do not have an illness is not believed because in the Doctors eyes, that is proof that you are ill.
My partner, Dominic & I, have wrote many many letters for the last three weeks to the head consultant and not one has been addressed either by letter or verbally.
Any notes made by nurses on one shift is NEVER noticed by the next shift, so you are constantly have to repeat yourself.
From the moment you arrive, you are pressed to have medication, no explanation give, no details of the medication, no details as to why they think you are mentally ill.
So for three weeks, I have, myself, found out information on the internet and gained information from Voice Ability & Mind, all of which have been a massive support and help.
Help run out of space & still more to tell...Jules
-
Things were better in the late 80's/early 90's as the last asylums were closing, there was more staff-patient contact, and models aside nurses were allowed to do more basic nursing care.
It's going to get worse out of hospital though because as people lose their secondary care discharged back to GP they will in turn lose welfare without specialist back up.
Then face being forced to work for greedy corporations for free and with NO LIMIT of time:http://www.guardian.co.uk/society/2012/feb/16/disabled-unpaid-work-benefit-cuts
-
epetition against slave labour Workfare exploiting the disabled:
https://submissions.epetitions.direct.gov.uk/petitions/29356
-
The Royal College of Psychiatrists (RCP) fears that managers in jobcentres and private companies who specialise in getting people back to work have inadequate health expertise and will push those with mental health issues into inappropriate placements. In a consultation response sent to the DWP, the RCP said one of its key concerns was around "the capacity of relevant members of staff in Jobcentre Plus and work programme providers to make appropriate decisions about what type of work-related activity is suitable for claimants with mental health problems".
The college also said it would prefer the placements to be optional
The key word here is 'prefer' rather than stressing placements *should* be optional
-
Pressure has made some shops and charities withdraw from participating in the Work Programme because of the compulsion and sanctions. See here who participates [Scope has just withdrawn]:
http://www.boycottworkfare.org/?page_id=16
People are now walking into shops and charity stores and asking 'do you have people working on forced placements?' and if the answer is yes they take their custom elsewhere
-
http://www.dpac.uk.net/2012/02/shame-of-the-third-sector-how-charities-got-it-wrong-on-workfare/
You need to be very clear about what position you take because in the last 2 days charities and business have pulled out of the work programme due to protests in actual stores and massive online protest which has resulted in Scope withdrawing [member of the Disability Consortium along with you].
Please please be clear and refuse to use unpaid work of people forced under threat of sanction to do so. -
Hi Mindreader,
We've just released a statement on work fare and the work programme. If we find any volunteers who are working with us because of workfare we will bring the relationship to an end. Please see - http://www.mind.org.uk/news/6425_statement_on_the_workfare_scheme_and_the_work_programme for the full statement.
-
@Jules, I’m sorry to hear you had such a distressing experience whilst being an inpatient. We think all people should be treated with care and respect and being stigmatised and dehumanised just isn’t acceptable.
I hope you’re reaching out to friends and family members for support at the moment. Remember also that the Samaritans can provide support 24/7 on jo@samaritans.org or 08457 90 90 90.
Our infoline info@mind.org.uk / 0300 123 3393 can also help you think about your options, like maybe finding a mental health advocate.
We’re not able to pass feedback on from here directly so have you asked the provider what their complaints procedure is? You could also give your feedback through Patient Opinion - http://www.patientopinion.org.uk/
Sadly discrimination and dehumanising behaviour is something that came up quite a bit during our research into our Crisis care campaign -http://www.mind.org.uk/crisiscare
Take care of yourself, Taryn from Mind
-
I share many concerns about mental health services in the community and on the wards, the resources are depleted. It currently feels as though projects in the voluntary sector are needing to take over from community mental health teams to manage long term service users who are being discharged hurriedly. Then secondary care services will only see those who are high risk and equivalent to assertive outreach patients for anything more than very time limited brief help which can mean one outpatients appointment before going back to the GP. The acute wards of the future will contain those with forensic histories and match intensive psychiatric care unit facilities. The commissioners and mental health service in my area are looking to develop centres of excellence for inpatient mental health services. There is acknowledgement that crisis teams will treat the majority of those in acute crisis and only the most severely unwell would enter hospital. This will mean the loss of beds and more reconfigation of services into fewer units further away for visitors to travel and no local connections.
I am not sure what will be left of mental health services by the end of this parliament. The services we think should be better now may not exist by then.
I would like to hear more about how Mind can challenge service cuts as these are widespread but don't appear in the news. I think that there does need more attention and alarm, though it must feel like fighting a wave of already decided changes.
Together with people's fear of benefit cuts it's a toxic mix. I know it's very scary for people already vulnerable and losing support that may have been relied on for a long time. Honesty on the part of providers would also help knowing the changes aren't recovery improvement ones but actually cost based. -
Thanks Taryn, this is good to see, because it is the Jobcentres that impose the sanctions.
The face of crisis care is going to change from some Trust docs I've read with no acute care unless you have SMI and even then to be treated primarily by Home Treatment and Crisis services. This means inpatient care will become intensive care and more forensic.
-
Having been a nurse since 1990 I am still disheartened with the way patients with mental health problems get treated. I am a general nurse and these patients often get treated with contempt and prejudice. People look down their noses at them. It's so sad. I hate it. I trymy best to re-educate my colleagues but some of them just won't have it. I have to say though that many MH pts do get treated nicely in our unit but then they get transferred out. Their physical health is sorted but not their mental health. I have experienced this myself when a hca told me after I'd self harmed and my friend was making me laugh that 'a serious car accident had come in' and 'could we keep the noise down as there was more serious situations to deal with' I saw an on call member of the self harm team and was discharged. No follow up.
-
purpletrumpet, so sorry you have been treated that way, but I know that is the usual course, most people who self-harm have a cursory 5 min "assessment" asking the same questions 'were you trying to kill yourself/will you do it again' and the expectation is to say 'no', and whatever is said won't illicit a response. They might as well hand over a tick box list to tick off.
Mind - now you won't use workfare claimants in your shop , - but - will you be pulling out of workfare completely because that's still not clear?
If you are still going to be involved in any other way such as providing training or skills sessions than that still would be a difficult position because you would still be part of a PROCESS which has the power to to leave people with no income. It doesn't matter that you would not be imposing those sanctions - to be involved in workfare in any capacity is still to condone it indirectly all the while people can be forced and have their income removed.
Can you clarify please? -
Mind will never clarify this, we have asked repeatedly and they respond in the way a good politician would: carefully-worded phrases that say very specific things but not simply "we are not involved in workfare in any way".
Mind's response continues to be they will not impose sanctions, well we know that anyway, it's the JobCentre that imposes the sanctions not Mind!
Mind has stated that if they find any coercive placements they will be brought to an end. I wonder if those people will face sanctions or further problems because of this? It's not enough to just end placements, people need to be supported to ensure they are not forced to jump from a Mind placement to e.g. a retail placement.
Personally if I was already being forced into an unpaid position within an LMA I'd hate that to be ended and get sent to a supermarket! There are worse things than forced labour in an LMA, and Mind has to do the follow up work as well as just ending the placements - they need to commit to clearing up their own mess which includes helping those already subject to workfare to survive after they've shut down any current placements within the organisation.It's been a week now Mind since your statement saying you're trying to find if there are any coercive placements. An update would be good.
"Disability Works UK will not play a role in imposing sanctions and will only seek contracts with providers whose values are compatible with our own."
This says nothing of substance and is the sort of sentence you'd expect to come from David Cameron, not from an organisation which claims to speak for us.The ONLY way in which Mind could keep its integrity intact would be to remove themselves from the process completely. As they refuse to do this and continue giving responses that use a lot of sweet words but don't actually say anything concrete, they're just as bad as the DWP. Worse, because everyone knows the DWP aren't to be trusted but people trust Mind to help them.
-
@Mindreader @Tooty Frooty - Sorry for the delay in replying to your questions - we've clarified some of the points on our earlier statement here http://www.mind.org.uk/campaigns_and_issues/policy_and_issues/making_benefits_fairer-welfare_reform/welfare_reform_and_empl
-
http://www.latentexistence.me.uk/sanctions-removed-from-work-experience-but-only-a-small-victory/
So work ‘experience’ no sanction but work ‘programme’ still sanctions and no time limit through third party providers.
If people could be sanctioned for treatment non-compliance and discharged from a section straight into a work programme I bet many would vote for it and pass it as an Act.
-
Feeling disinclined to comment here, however salient the topics discussed. People on here close ranks and vett everything so its not a balanced discussion in any case. Most marginalisers are the 'in-crowd' of some hot-house club. MIND prove themselves no different I fear.
Commenting is now closed.