Annual Review 2004
Joint Chairs: Dr Lynne Jones MP, Rt Hon Virginia Bottomley MP, Sandra Gidley MP
Secretary: Lord Alderdice
Mental health services faced another mixed year in 2004. In February the service reached a new low with the publication of the Rocky Bennett Inquiry Report, which highlighted institutional racism and bad practice in the health service. The lessons of this tragedy must but be forgotten. The Social Exclusion Unit published its Report on Mental Health in June and its recommendations are now being implemented. In June, Maca (the Mental After Care Association) celebrated its 125th anniversary, it is the oldest mental health charity in the UK and the Group hopes that it will continuing working as long as its services are needed. In September the Department of Health published the long-awaited Revised Draft Mental Health Bill. Parliament has established a Joint Committee to scrutinise the legislation and the Group welcomes this move.
Review of the Year
March At the first meeting of the year, the Group discussed Therapeutic Communities and possible treatments for Personality Disorder. Dr Kingsley Norton (Consultant and Director of Henderson Hospital) and Dr Rex Haigh (Chair Association of Therapeutic Communities) presented their findings. Dr Norton outlined the difficulties surrounding the diagnosis of personality disorder, particularly the stigma attached to it, including prejudice held by the medical profession. The diagnosis is also sometimes used to exclude people from receiving treatment.
Dr Haigh addressed the issue of whether PD can be treated, explaining that therapeutic communities have been treating PD since the Second World War when group therapy experiments began with soldiers. There is evidence that these communities provide a very effective treatment as well as being cost-effective. Research is currently being collated for future publication. The Royal College of Psychiatrists’ Research Unit hosts the Community of Communities project which aims to improve the regulation of therapeutic communities and share best practice.
April
In April the Group asked ‘Are Mental Health Services Improving?’ Professor Louis Appleby, National Director for Mental Health, outlined the achievements of NHS mental health provision since the National Service Framework (1999). He talked through the expenditure on mental health services and the indicators, showing that the investment is having some success. He also presented detailed statistics on the number of beds, admissions, discharges, consultants, nurses, NHS plan teams, prescribing patterns of anti-psychotic drugs, and mortality rates.
Dr Andrew McCulloch, Chief Executive of the Mental Health Foundation, focused on the premise that mental health provision is primarily about protecting human rights. He criticised the Government for not listening to the sector and noted that the draft Mental Health Bill has united the sector in opposition. He commented that the draft bill is wrong in both principle and practice. Dr David Taylor, Chief Pharmacist at the Maudsley Hospital detailed the NHS expenditure on services for schizophrenia and the response to treatment, which have shown a 40% improvement. He detailed the potential adverse effects of antipsychotic drugs and noted that in atypical anti-psychotics, the level of adverse effects was markedly improved. Dr Jacqueline Atkinson from Glasgow University reported on the progress made in Scotland since the creation of their new Mental Health Act. She stated that it has been a year since the Mental Health (Care and Treatment) (Scotland) Act received Royal Assent, despite the fact that the whole process starting after the reform south of the border.
June
In June the Group joined forces with the Drugs Misuse All Party Group to discuss whether enough is being done for people with complex needs. Lord Victor Adebowale, Chief Executive of Turning Point said that his organisation provides substance misuse services and also provides services for people with mental health problems and learning disability. Many of their clients have complex needs. Many of the people who Turning Point work with are homeless and many are from BME backgrounds. Using the term ‘dual-diagnosis’ can be helpful as a medical diagnosis of concurrent problems but it may also cause people to be excluded from services, which fail to provide joined-up care.
Eloise Cooper, Complex Needs Service Co-ordinator and Cognitive Behavioural Therapist, at Turning Point’s Drug link Hammersmith and Fulham spoke about the people she works with, many of whom have severe and enduring mental health problems, complicated by substance misuse, physical and/or learning disabilities. These people were very affected by stigma and exclusion and many faced exploitation by drug dealers. Liz Garrod, Director of the London and East of England Regional Office of Maca spoke about their work, which offers a range of services incorporating people with dial diagnosis and complex needs. Maca provides residential services, personal development and forensic workers in probation services.
October
The Group held the first of a series of meetings on the Revised Draft Mental Health Bill by looking at Workforce Issues with a talk by Dr Mike Shooter, President of the Royal College of Psychiatrists.
Dr Shooter began by explaining that there are workforce shortages across mental health including psychiatrists, psychologists, CPNs and social workers. He noted that the stigma which is attached to mental illness also affects the workforce and people are often put off entering psychiatry because of prejudice within medicine. The College is working with the Department of Health and other bodies to address the recruitment and retention problems as well as training issues. There is also a NIMHE strategy to develop new ways of working for senior psychiatric personnel.
On the Revised Draft Mental Health Bill, Dr Shooter noted that the proposals were likely to lead to a huge increase in workload due to the extension of the use of compulsion. The Bill, as it stands, would also be detrimental to the relationship between psychiatrists and service users as more people would fear compulsion and be scared to give their psychiatrist the full details of their illness.
November & Annual General Meeting
The Group held its AGM on 9th November followed by a discussion on the Revised Draft Mental Health Bill which contributions from Rosie Winterton, Minister of State, Professor Louis Appleby, National Director for Mental Health and Paul Farmer, Chair of the Mental Health Alliance. This was the best attended meeting of the year and a provided a good opportunity for Group members to find out more about the proposed legislation. The Group’s officers were re-elected for another year.
Conclusions
- The Group welcomes the establishment of the Joint Committee on the Draft Mental Health Bill and hopes that its report will provide a balanced perspective on this controversial piece of legislation. The Group will invite the Chair of the Joint Committee to present the findings of his report to the Group.
- The Group is worried that mental health services are currently understaffed and that the proposals in the Revised Draft Mental Health Bill will further exacerbate this problem.
- The Group is very concerned about the lack of provision for people with dual-diagnosis. These people with complex needs are often neglected by services, which are too rigidly divided into one area of care or another.
- The publication of the Rocky Bennett Inquiry Report presented a shocking picture of institutional racism in the NHS. The Group hopes that the Inquiry’s recommendations will be implemented swiftly and effectively.
- The Social Exclusion Unit published its Report on Mental Health and Social Exclusion in June. The Group warmly welcomed this Report and it is hoped that it will be implemented across government departments.
Programme for 2005
Details of future meetings will be circulated later this year. Topics are likely to include further meetings on the Revised Draft Mental Health Bill including particular aspects such as advocacy; a presentation of the findings of the Joint Committee on the Draft Mental Health Bill; a meeting on mental health and cannabis and the findings of the Health Select Committee Inquiry into the Pharmaceutical Industry.