Care before compulsion best route to reduce risk, says Mind
Posted Friday 15 September 2006
Providing treatment and care when people need it is the key to stopping tragedies, mental health charity Mind said today in response to the Department of Health's 'risk programme initiative' announcement.
Homicides by people with mental health problems represent a tiny percentage of all homicides; the number has not increased in the last thirty years.
Mind chief executive, Paul Farmer, said:
"The Government's stated aims in reforming the Care Programme Approach are encouraging. Giving service users choice over their own care is crucial to wellbeing and recovery, and something that Mind has long campaigned for. However, even the best guidelines are useless if they are not implemented. It is too often the case with the rare homicides committed by people with mental health problems that services have failed to engage with people who are actually going and asking them for help, let alone put together a care plan with them.
"Mind urges the Government to review its approach to amending mental health legislation to ensure that the law empowers people by giving them the right to help when they ask for it. This is the best way to reduce the risk of tragic incidents occurring.
"Compulsory treatment cannot make any difference here, when the problem is not that people are refusing treatment, but that they are not being given treatment when they seek it."
In the headline cases of murders committed by people with mental health problems, it is too often the failure of services, resources, or communications that has led to tragic incidents occurring. For example, the cases of Ismail Dogan, Daniel Gonzalez (see note 1 below). In both cases these men or their relatives sought help but were turned away. Mind has consistently supported the Mental Health Alliance's call for a right for anyone to be given a comprehensive assessment of their mental health.
Mind has always opposed the introduction of compulsion in the community beyond already existing powers. We fear the threat of it will deter people from seeking treatment when they need it, and would destroy the essential trust and therapeutic relationship between service users and mental health professionals. This concern was included in a study last year, also revealing that compulsion in the community would create no better outcomes in terms of reducing hospital admissions, quality of life, or satisfaction with care. (2)
Mind welcomes the Government's commitment to improving communications between different agencies. Breakdowns in communications are often a reason for people failing to get help when they ask for it. We are pleased to see a review of the Care Programme Approach to give service users more say in their treatment and recovery.
1) Ismail Dogan and Daniel Gonzalez: repeated requests for help were ignored.
Ismail Dogan randomly attacked six people with a knife, killing one. At his trial, Ismail's mother told the court that her "cries for help" went unanswered. The family GP refused her request for a visit, even though she told him Ismail would not go to the practice. Ismail's mother also approached Haringey Social Services for help, who she says told her to contact his GP. When concerns of this degree about a person's mental health are expressed by one of their relatives, services can act under the law. In Ismail's case, no one acted.
Daniel Gonzalez killed two women in Sussex and two men in north London in September 2004. Daniel's mother repeatedly asked for help. She told the court that at one point she wrote a letter to social services asking, "Does my son have to commit a murder to get help?" She told the court that at one stage Daniel had taken a letter to his GP, which said: "Please, please help me, this is very urgent. I really, really do need medical help to find the correct environment and the correct medication." Daniel's family say they repeatedly pleaded with health services, social services, and the police, but that Daniel was turned away, passed from one group to another, and left without support. No one took responsibility for developing a care plan with Daniel.
2) The Cochrane Collaboration, 2005, Compulsory community and involuntary outpatient treatment for people with severe mental disorders (Review)
Mind is a member of the Mental Health Alliance, a coalition of 78 organisations working together to secure better mental health legislation. www.mentalhealthalliance.org.uk