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Children in custody have a high risk of poor health and self-harm

Published March 19, 2013 Criminal Justice , Early intervention , Youth Justice Closed
Tags: Layard report

Sean Duggan, chief executive, Centre for Mental Health

In their report released last week the Justice Committee called for legislation to make sure that only the most ‘prolific and dangerous’ young people are sentenced to custody. The report describes how looked after children are at a greater risk of being ‘pulled into an express route into the criminal justice system’ because bad behaviour is dealt with by the police instead as, as is the case for most children, by their parents or carers.

The report also shows that young people who have been diverted away from formal criminal justice processes are much less likely to go on to serious and prolonged offending, and calls for the expansion of diversion services, which are currently patchy and inconsistent. Children who end up in custody are three times more likely to have a mental health problem than those who do not. Very often these children have many difficulties, including with speech, language and communication. And, shockingly, children in custody are eighteen times more likely to commit suicide than other children. Liaison and diversion services in police stations and courts mean that these young people can be identified quickly, and given care and treatment rather than costly custodial sentences.

It’s clear that the children who end up in custody are among the most vulnerable in society. Children with difficult family circumstances, who have seen domestic violence, been excluded from school, or who have spent time in care tend to ‘cluster’ in young offender institutions. It’s these children who are much more likely to self-harm. While the number of young people entering the criminal justice system has decreased in recent years, this report shows that too many of the most vulnerable young people are still being given custodial sentences instead of the care and treatment that they need.

Read the report here.

What the Francis report means for mental healthcare

Published March 13, 2013 NHS Closed
Tags: Francis report

Originally posted in the HSJ blog Leadership in Mental Health, 6 February, 2013

The Francis report today set out some 290 recommendations to protect NHS patients from neglect and poor care. The report’s recommendations reach across the health services, from the accountability of individual professionals for their own conduct to the roles of the national regulators, professional organisations and the Department of Health.

‘The report raises questions about the relationship between personal and corporate accountability’

Like all parts of the NHS, the report will have a major impact on mental health care. It will change the way mental health professionals and organisations work, as well as affecting the wider systems and processes in the NHS within which mental health services operate.

The report’s publication comes just weeks after the publication of the government’s report on the abuse of patients at Winterbourne View and the system failings that surrounded it.

Last week, the Care Quality Commission’s annual report on the use of the Mental Health Act reminded us that a significant minority of people who are detained in hospital compulsorily are not given the quality of care and support that we would expect to receive or indeed that the act requires.

New duties

Taken together, all three reports suggest while there has been genuine progress towards giving service users a bigger voice in their own care, in treating people with dignity and respect when they are in hospital, and in responding positively when things go wrong, we have a long way to go.

Too many people’s experiences of being in hospital are of losing power and control, of feeling bewildered and “done to”, and of not knowing what is happening to them. For detained patients, these painful experiences can be magnified many times without the active support of families, friends and advocates.

For mental health professionals, managers and leaders, the Francis report’s recommendations will create new duties and forms of accountability. Professionals and organisations will have higher expectations in the way they conduct themselves and tougher sanctions, including proposed new criminal offences, when things go wrong.

This will, and should, provoke debate about the balance between professionalism and regulation in the maintenance (and improvement) of standards in healthcare. It raises questions about the relationship between personal and corporate accountability when care falls below the proposed “fundamental standards”.

Consequences for all

These are not new issues, but with decision making in the NHS increasingly devolved to local organisations it is vital that everyone in the system is clear about where accountability lies and what to do when they are concerned about quality of care. As Robert Francis’ report acknowledges, any new system must have the support of the health professions and be clearly understood by patients and families.

The implications of the report are no more nor less applicable to mental health services as to other parts of the NHS. However, we will need to examine closely how any new arrangements intersect with those in place in social care, for adults and children alike.

‘A considered response to Francis should include a full assessment of what it will entail for mental health services’

Unless quality regulation and accountability are well aligned between the two systems, service users and their families will be left to negotiate a difficult path between them both. Mental health care extends well beyond NHS facilities to private and voluntary sector providers, prisons and police stations. Again, it must be clear how standards will be applied: how, for example, might any new system help to prevent more deaths of vulnerable people in custody?

The Francis report demands a considered and timely response. Service users, families and professionals need to know what it will mean for them. That considered response should include a full assessment of what any actions will entail for mental health services and their partners, inside and outside the NHS. How, for instance, can we ensure that the proposed new standards and the “duty of candour” will help to protect detained patients and those on community treatment orders?

The NHS has a lot of reflecting to do. It must balance decisive action with the avoidance of knee-jerk responses to a report with profound consequences for all of us. A mature response − with a clear sense of what it means for people with mental health conditions, their families and those who support them.

http://www.hsj.co.uk

A report that shines a light on the way people who have been detained are treated

Published January 30, 2013 NHS , Recovery Closed
Tags: CQC report

Andy Bell, Deputy Chief Executive

The Care Quality Commission’s annual monitoring report on use of the Mental Health Act has drawn attention to rising use of the Act both to detain people in hospital and to continue to use compulsory powers when they return home. The number of people who have been detained has risen steadily each year since the 1983 Act was amended in 2007, while the introduction of community treatment orders is extending the use of compulsion when people are discharged.

The report shines a light on the way people are treated once they are detained. Like recent reports from Mind and Rethink Mental Illness, it describes wide variations in the quality of experience of detained patients. It shows, for example, that a significant minority of detained patients are not involved in decisions about their treatment or in planning for their discharge from hospital. Yet if people are to be supported effectively in their Recovery journeys, planning for the future should begin as soon as they are admitted to hospital, with families and friends involved as partners throughout. Hope, control and opportunity may be harder to maintain when people are detained but they are key to supporting Recovery in even the most difficult of times in a person’s life.

The report draws our attention to the continued high rates of detention, and in particular the use of community treatment orders, among many Black and minority ethnic groups. Debates about the reasons for this disparity continue, but that should not distract attention from efforts to improve race equality in mental health services and their relationships with community organisations.

Worryingly, the report also finds that too few people are offered access to independent advocacy. Access to an advocate is a fundamental safeguard in the 2007 Mental Health Act and research by the Mental Health Alliance and others has identified a gap in provision of advocacy services, especially for some Black and minority ethnic communities. It is vital that local authorities ensure they commission sufficient high quality advocacy services when they take over responsibility for this in April.

The report sets out how the Care Quality Commission itself will continue to monitor use of the Act and makes recommendations for the reformed NHS in how it manages the use of compulsory powers. As health and social care organisations begin a year of considerable structural change and new ways of working, it is crucial that commissioners and providers maintain a keen eye on the use of the Mental Health Act and the needs, wishes and aspirations of those who are subject to it.

Download the report here
Download the summary here
Download the easy read version here
Download the audio version here

A decade of austerity should spur on fundamental care reform

Published January 3, 2013 Mental and Physical Health , NHS Closed

Originally posted in the HSJ blog Leadership in Mental Health, 17 December, 2012

This month the NHS has been reminded from all directions of the scale of the financial challenge it faces. While much of the focus of debate about the NHS continues to be the structural changes that are now taking shape, the bigger question remains how the health and care system is going to cope with the financial pressure it faces in the coming years.

At the beginning of December, the chancellor’s autumn statement announced the government’s intention to continue to maintain health spending up to 2015/16 while most other departments are likely to continue to experience real terms reductions in their funding.

‘We have heard a lot about integration but too often it has been two dimensional’

But a report by the Nuffield Trust the same week warned that the NHS could face a “funding gap” of up to £54 billion by 2012/22 without real terms funding increases.

In the shorter term, it warned, the NHS faces the prospect of cutting services or reducing the quality of care by 2014/15 as the prospect of making continued productivity gains begins to tail off − in other words, many of the more painless methods of saving money are going to be exhausted.

Artifical divides

The challenges facing the NHS are to some extent much less acute than those of many other public services. Local authority budgets, the police and welfare spending are all falling much more rapidly. But taken together with social care, the NHS and its partners face the longer term trend of steadily rising demand as the population ages and chronic illness and disability take up an ever larger proportion of its funding.

Whether the scale of the “Nicholson challenge” is £15 billion or £54 billion, the implications for the health and care system remain much the same. Small-scale, one-off efficiency savings are not going to do the trick. The entire system has to reform itself, not so much structurally as in the way it supports people’s health, wellbeing and independence.

Artificial divides, be they between health and social care, physical and mental health, or primary and secondary care, need to be dismantled.

We have heard a lot about integration this year but too often it has been two dimensional and focused on only part of the picture. From the perspective of the service user, any form of dis-integration is unhelpful and sometimes disastrous.

Stark choices

One of the biggest forms of dis-integration in our system continues to be that between physical and mental health support. Yet this year the Centre for Mental Health reported clear evidence that up to 10 per cent of the NHS budget is spent on the extra costs of treating long-term physical illness caused by the coexistence of mental health problems.

‘A decade of austerity may in the end spur on some long overdue fundamental changes’

From having liaison psychiatry teams in general hospitals to better collaborative care arrangements in the community, much of this cost could be saved.

The first clinical commissioning groups to be authorised will begin to face some stark choices in the way they spend their money next year. Most are already grappling with these dilemmas as they consider how to cut costs.

Perhaps uniquely among public service commissioners, they do not have to make dramatic immediate cuts to their spending. They have the opportunity − the necessity in fact − to take their time; to reform patterns of service provision and established ways of working; to shape health services on a different footing.

A decade of austerity may in the end spur on some long overdue fundamental changes to our health and care system. To do otherwise is to risk the health and wellbeing of every one of us in the years to come.

http://www.hsj.co.uk

The Schizophrenia Commission report sets out a radical, positive agenda to change mental health services

Published November 21, 2012 Inequalities , Mental and Physical Health , Schizophrenia , Uncategorized Closed
Tags: Schizophrenia Commission report

Professor Geoff Shepherd is a Senior Policy Advisor at the Centre and works mainly on the recovery project with the NHS Confederation.

The recent Schizophrenia Commission report, The Abandoned Illness, has shone a strong light on the way we as a society respond to people with psychosis. It pointed to the shockingly curtailed life expectancy of people who are diagnosed with schizophrenia as well as the low employment rate (at just 7%) and poor provision of NICE-approved psychological therapy. It exposed the continued stigma and discrimination that the vast majority of people with schizophrenia, and their families, experience in their everyday lives. And it drew attention to continued weaknesses in inpatient services for people with psychosis, including secure hospitals and crisis care.

The report, commissioned by Rethink Mental Illness, took a broad look at the lives of people with schizophrenia and the support that is offered to them and their families. It made a number of wide-ranging recommendations. And it is in these recommendations that the report offers not just a bleak picture of the problems we face today but a positive and radical agenda for the future.

The report calls for a fundamental change in the ways people with schizophrenia are enabled to enjoy a fairer chance in life and better health. These include ‘a radical overhaul of acute care…including better use of alternatives to admission’, better prescribing of antipsychotic medication and improved access to psychological therapies. It calls for urgent and concerted action to improve the physical health of people with schizophrenia and for improved support from primary care services.

Underlying many of the recommendations is a strong message about recovery and the importance of putting the recovery approach at the centre of support for people with severe mental illness. The report points to persuasive evidence about the potential of personal budgets to enable more people with psychosis to direct their own support. It offers strong support for the growing role of peer support workers in assisting more people to make their own recovery journeys. And it calls for more access to Individual Placement and Support employment services so that no one is denied the most effective help to gain and retain paid work if they want it.

The report points out that to focus fully on recovery, mental health services need to change on every level: from the individual interactions between professionals and service users to the pattern of service provision and strategic planning. The Centre continues to work alongside the NHS Confederation Mental Health Network in delivering the ImROC programme to support the organisational change that will help to make this possible.

The Commission’s report can now be a catalyst for wide-ranging changes in society’s attitudes to people with schizophrenia. At the base of recovery are the key values of hope, control and opportunity. For too long, people with schizophrenia have been subjected instead to crushingly low expectations, fear and isolation. Having hope for the future is not easy without opportunity for a life outside illness. Belief in yourself is not easy when you live with a condition that is shrouded in fear, prejudice and misunderstanding. But by refocusing mental health services on supporting recovery we can begin to turn the tide, to make hope, control and opportunity a reality for people living with psychosis and to show society that having a mental illness does not stop you having a life.

Why we expect more from the media when it comes to mental health

Published November 20, 2012 Mental and Physical Health , Mental health at work Closed

Jen Glyn is Press Officer at Centre for Mental Health

The stars (and the paps) were out last night for the 6th annual Mind Media Awards, celebrating the broadcasters, journalists, and programme makers changing the way mental health is portrayed in print and on screen.

There was an impressive list of nominees, judged by a prestigious panel of journalists and programme makers (including, hearteningly, one from the ‘new world of digital media.’)

What struck me about the list was its variation.

One in four of us is will experience an episode of mental ill health and, as the Mind shortlist shows, mental ill health can affect anyone. In This is England ‘88, Lol copes with a mental illness and motherhood. Waterloo Road depicts a teenager struggling with school work and schizophrenia. Claire Balding presents a radio documentary about depression and walking, and a pioneering campaign by Sky Sports sets out to raise awareness of common mental health problems in the lead up to the live Super League games. Mental Health Cop reports from the front line of mental health and policing and the Sunday Express cover everything from mental health in UK workplaces to mental health in prisons, as part of their Campaign for Better Mental Health.

Last night Paul Farmer, Mind’s chief executive, said “discrimination still frames attitudes towards mental health.” And it’s clear that the media can do much more to accurately reflect the lives of people living with mental ill health and to challenge damaging public attitudes towards mental illness.

But it’s getting better. Ten years ago you’d read headlines about ‘nutters’ and ‘schizo’s.’ The reason you don’t now is, in part, because of the people who ‘inform, educate and engage audiences about the real issues at the heart of mental health.’

A lot has changed. Now, as the scope of subjects covered by this year’s awards shows, we are used to seeing (and have come to expect) nuanced, balanced and complex coverage of the issues around mental illness.
Read more about the event here.

Police stations are not the right place for children in crisis

Published November 20, 2012 Children , Criminal Justice , Early intervention Closed

This week a Radio 4 investigation exposed that large numbers of children are being detained in police stations in an emergency under Sections 135 and 136 of the Mental Health Act because of a lack of alternative ‘places of safety’ in a crisis. The investigation, which followed a Freedom of Information request, found that children as young as 11 were being detained, many for more than 20 hours at a time.

This shocking finding shows that emergency care and support in a mental health crisis remains a major problem. This is despite considerable effort since the 2007 Mental Health Act to reduce the use of police stations as ‘places of safety’ and to ensure children are never placed inappropriately in adult psychiatric wards.

There are wide variations in 136 arrangements from one locality to another. Most now have dedicated health-based places of safety (for example in hospital sites) and clear protocols with the police for how to use them. Others might have suites available but are unable to staff them reliably or police officers don’t know how to make use of them. It’s often the relationships between health services and police forces that make the difference. And in all cases arrangements for children and young people will need to bear in mind their particular needs and vulnerabilities.

There are, however, a number of developments in train that should help to reduce the number of children held in police custody as a place of safety. Data about the use of Section 136 is now published alongside other Mental Health Act data by the Health and Social Care Information Centre. This should raise awareness of the use of these provisions and prompt areas that are lagging behind to take action to invest in better places of safety for people of all ages and improved protocols with the police for using them.

The national expansion of liaison and diversion services, for children and adults, can also help to prevent crises from emerging and to ensure that children who are detained get much quicker access to the support they need. Liaison and diversion teams can both respond to individual cases and, over time, raise the awareness and confidence of police officers in dealing with difficult situations.

It is vital, therefore, that we make diversion services available to police forces across the country. In every locality, the NHS and the police need to work in partnership to agree local arrangements for places of safety for children and adults, which staff in both services understand and know how to implement. And with data about the use of Section 136 now being published regularly, it is crucial that local health commissioners are made accountable for achieving improvements through the NHS Outcomes Framework.

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Children in custody have a high risk of poor health and self-harm