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Fatso Gets Militant!

Thursday, 15 January 2009

Mental Health Advocacy.

On Monday night I was flipping through the TV channels looking for something interesting and rested on the Parliamentary channel. There’s rarely anything interesting on there but the practically empty House of Commons Chamber caught my interest - one bloke isolated in a vast space with about five other MPs there.

It turned out to by a very interesting adjournment debate about statutory mental health advocacy as required by the Mental Health Act 2007 which was implemented at the beginning of last November except for the advocacy duty which doesn’t come into force until 1st April this year. I thought this important development deserved an airing here, so I’ll mainly let extracts from Hansard speak for themselves:

“Mr. Charles Walker (Broxbourne) (Con): ... The Bill has now become an Act and its measures came into force on 3 November 2008. Many parts of the Act were welcomed by all sides of the House. However, some parts of the Act caused many Members on all sides of the House great concern. The Act contained significant powers to detain and treat people against their will. Many of us in this place were concerned about that. The Act also incorporated safeguards in the form of independent mental health advocacy that would ensure that people who were being detained against their will or faced being detained against their will for mental health problems could receive the support of an independent advocate. That is crucial.

When someone has a mental illness and has an episode that requires or may require their detention, their liberty is removed and their freedom of movement is restricted. Some people are committed to secure hospitals. Others are subject to community treatment orders which restrict their liberties and freedom of movement in the community. The role of the advocate is to support those people in their dealings with health care professionals. Someone having a mental episode may be extremely bewildered, upset and frightened. They get a great deal of information, some of which they do not agree with and much of which they may be hostile towards. They can feel very alone and isolated.

The role of advocates is to stand and sit by that person and to ensure that they understand as far as possible their rights under the Mental Health Act 2007—their right to say no and to question the treatments and recommendations proposed by health care professionals and clinicians. That is a hugely important part of the Act.”

“Tim Loughton (East Worthing and Shoreham) (Con): My hon. Friend is absolutely right. My concern is that the Mental Health Act 2007, which represents a reform of mental health legislation for the first time in about 25 years, contains a lot of innovative, controversial and technical legislation. To have advocates in place by April, late though that is, is demanding. To have well trained and well qualified advocates in place capable of offering the service to many vulnerable people in complicated conditions is a great challenge. My fear is that those people might not be available.”

Charles Walker then goes on to speak about financing the service (which I’ll quote later on next to the Minister’s reponse) and then about the importance of advocacy to the BME communities. He says:

“I have received representations from organisations and clinicians who represent and deal with ethnic minority groups, and they are very concerned about the delay in the implementation of advocacy services. A black Afro-Caribbean male exhibiting the same symptoms as someone who is white is twice as likely as a white person to be detained under mental health legislation. That is fairly horrifying, and it needs to be addressed. We need to ensure that people providing advocacy services have cultural relevance.”

Tim Loughton underlines this:

“My hon. Friend continues to make a strong case. There are subsections within black and minority ethnic communities, particularly young Afro-Caribbean men, for whom the figures are far worse than just twice the likelihood of being picked up. Not only are there problems with encouraging members of BME communities experiencing mental health problems to access services—they are often less likely to come forward—but once they are in the care of those services it is vital that they have trust in somebody who is going to advocate for them.”

Mr. David Drew (Stroud) (Lab/Co-op) then the up the debate making a great deal of sense as have the others. He says:

“...Those of us who know a little bit about it, perhaps not through direct experience but through talking to people who have been sectioned and those who undertake the sectioning, have found it somewhat bizarre that the advocate of the person being sectioned has, until the present change, been the very person undertaking the sectioning... but one has to be somewhat naive to believe that there will not be occasions when the person being sectioned genuinely feels that it is wrong, and that they cannot get the advice that they want, whether from a community psychiatric nurse whom they know or an approved social worker...we need to recognise that the independence of the advocate’s role in giving advice to someone who has faced the most trying circumstances is right and proper.”

And then: lo and behold, someone I’d come to think of as some sort of perverted Government tokenistic illusion due to his invisibility since the announcement last Autumn that Ivan Lewis would be replaced as Minister for Social Care - wait for it - “The Minister of State, Department of Health (Phil Hope):”

After many paragraphs of half waffle, half party political broadcast Mr Hope eventually conmmented on the delay in implementing the advocacy duty. He said:

“Hon. Members have expressed concern about the delay in implementing the measures. The statutory provision for independent advocates comes into force in England from 1 April, as the hon. Member for Broxbourne rightly said. He asked why it had taken so long. My hon. Friend the Member for Stroud summed up the dilemma quite nicely. We want to get on with it and make things happen, but also ensure that we get it right...We wanted to ensure that the introduction of the new advocacy service went smoothly, which has meant developing appropriate local commissioning processes and putting training arrangements in place,

Last month, I reached the conclusion that primary care trusts were best placed to commission those independent advocacy services. That will have a number of advantages. PCTs can commission jointly with other PCTs, or they can delegate commissioning responsibilities to them. That will provide a powerful degree of flexibility, which will be particularly important when patients are moving between treatment providers in different areas.

The system might also include advocacy services in partnership arrangements with local authorities, which would be useful, given local authorities’ experience in commissioning other types of advocacy.”

I’ve put Charles Walker’s comments about funding earlier in the debate here for ease of comparision with Phil Hope’s response. Charles Walker said:

“...The 2007 Act also set aside £8 million in the regulatory impact assessment to fund the provision of additional advocacy services for people suffering from mental illness who face having their liberty removed and restrictions being placed on their freedom of movement. I believe that the £8 million is still in place and will go to primary care trusts and it is very important that it should. That is additional expenditure.

One of Mind’s concerns is that the money may not materialise and that we will have to rob Peter to pay Paul—that the PCT funding for advocacy services working for other groups of patients will be reduced, so that PCTs meet their statutory obligation under the 2007 Act. I am sure that the Minister will answer those very real concerns as he winds up this evening.”

And Phil Hope’s response was:

“... I want to turn to funding... We have taken into account the new statutory duty when setting PCT allocations for the next two years, so I can tell the hon. Gentleman that there is money in the system to support these measures, and we will expect PCTs to fulfil the duty effectively. Of course, different areas have different needs, and it will be for PCTs and their local partners to decide how best to use their resources to meet their statutory duty,...”

Not exactly a clear and straightforward reply to ‘Is the £8 million still there?’ and maybe, just maybe, an underlying threat that PCTs are going to have to scrape around their budgets to fund statutory advocacy - or is that me being cynical again?

And earlier in the debate again, David Drew made a comment which, for me and for many others, is centrally important. He said:

“I would like to think that some of the advocacy could be undertaken by people who have themselves suffered from mental health problems. I never cease to be amazed by the way in which those who have recovered from such problems are the best at knowing about the service, its strengths and weaknesses and, if you like, where the bodies are buried. For all sorts of reasons, the matter has to be handled incredibly sensitively, but I hope that when we hand out the commission for the work that is to be undertaken, there is a genuine effort to use people who have had mental health problems and are prepared to use their expertise to advocate on behalf of those who are currently going through such problems. That can be incredibly powerful. It has to be done carefully, but I would like to think that it will be considered closely.”

Phil Hope’s response was:

“Assuming that any individual—my hon. Friend the Member for Stroud made the particular suggestion that previous service users become advocates—meets the requirements, there should be no barrier to their appointment, but they really must meet the requirements set down in the legislation. Under the regulations, advocates must have appropriate experience or training for the role, and the Department website gives advice on what that involves.”

He spoke further about advocacy training:

“My Department is also working with City & Guilds to develop a national advocacy qualification, which will include a specialist module for independent mental health advocates. I anticipate that this qualification and its training materials will be available before independent advocates take up their positions on 1 April, and I expect all of them to complete their training within a year of starting practice. Alongside that, the National Institute for Mental Health in England is producing an effective practice guide, including issues such as patient engagement and working with other mental health professionals.”

This is a personal thing but mention of the involvement of NIMHE (more than once) sends a shudder through me!

I make no apologies for the length of this entry - I consider it to be very, very important. There is, of course much more in the actual debate which can be found at: http://tinyurl.com/8sxoqz

The very sad element here though, was the indifference and lack of care in important mental health matters MPs demonstrated by their absence from this debate. It is a matter for national disgust that here were only about half a dozen MPs present in the chamber.

Where was your MP - why not ask him/her!

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