Social Perspectives Network AGM 6 April 2006

1. Social Perspectives Network AGM 6 April 2006

2. Social Perspectives Network ‘Future Directions’ Chris Heginbotham Chief Executive Mental Health Act Commission

3. Burning Issues • Service User and Citizen centrality • Equality and Human Rights • Addressing the needs of minority and disadvantaged groups: • ‘Delivering Race Equality in mental health care’ • Women - Gender Duty • Disability and Disadvantage • Mental Health Legislation: • Mental health Act 1983 and the Amendment Bill; • Mental Capacity Act 2005

4. Service User and Citizen Centrality

5. Challenge • Importance of service user involvement in all aspects of care planning • e.g. Service User Reference Panel at MHAC; • Promote social inclusion • e.g. through community engagement; • Develop programmes of ‘connected care’ that are truly person centred • e.g. via commissioning for diversity with local people

6. Equality and Human Rights

7. Challenge • Make an equality and human rights perspective central to all our work • Recognise the extent to which human rights are breached frequently • Develop networks of support to enable a human rights approach to be adopted widely

8. Commission for Equality and Human Rights duties include … • Promoting awareness, understanding and good practice on equality, diversity and human rights, • Promoting equality of opportunity and working towards elimination of unlawful discrimination and harassment • Promoting good relations between different communities • Keeping discrimination and human rights legislation under review • Being a source of expertise on equality and human rights

9. The Equalities review background • An independent investigation of the causes of persistent discrimination and inequality in British society. • Part of the Government’s commitment to creating a society • “… where everyone can achieve their full potential, free from prejudice and discrimination.”

10. Reframing debates about Equality • Equality of Opportunity • Equality of Process • Equality of Outcome • The Capabilities Approach

11. Why the Capabilities approach? • Goes beyond lobbying for competing ‘strands’. • Beyond ‘strands’ means exploring how any individual is affected • Uses vulnerabilities, triggers to disadvantage, and the penalties that affect the person

13. New ways to look at (and for) the evidence of penalty • Vulnerability distinguished by membership of a social group • Specific life events or triggers • Field or context of those triggers • Specific consequences – for groups • Some key questions to ask

14. Diversity and Disadvantage

15. Challenge Delivering Race Equality in mental health care • More appropriate and responsive services • Community engagement • Better information • Purpose: • to achieve 12 key characteristics by 2010 • to tackle 72 action items

16. Delivering race equality (DRE)12 key characteristics¹ (1) • less fear of mental health services amongst BME communities • increased satisfaction with services • reduction in disproportionate admissions from BME communities • reduction in disproportionate rates of compulsory detention from BME communities • fewer violent incidents secondary to inadequate treatment • reduction on the use of seclusion. 1. DRE para 1.32 on page 19

17. Delivering race equality (DRE)12 key characteristics¹ (2) • prevention of deaths in mental health services following physical intervention • increase in proportion of BME service users who feel they have recovered • reduction in the proportion of prisoners from BME communities • balanced range of therapies that are culturally relevant and appropriate • active role for BME communities and service users in professional training • workforce capable of delivering appropriate and responsive services. 1. DRE para 1.32 on page 19

18. Census 2005: Count me in

19. Ethnic groups

20. Admission rates* * Standardised for age and gender ** 3 or more times higher in Black and White-Black Mixed groups

21. Referral routes* • Compared with the average, referrals by: • GPs: lower in some BME groups, particularly in Black Caribbean, Black African, Other Black • Police: higher in Black Caribbean, Black African, Other White and Indian groups • Courts: higher in Black Caribbean group • Social services: higher in Black Caribbean and Bangladeshi groups * Standardised for age and gender

22. Detention rates* • overall, 46% of males and 29% of females detained on admission • detention rates 33-44% higher than average in Black Caribbean, Black African, Other Black groups • detentions under section 37/41 higher in males from the Black Caribbean, Other Black and White-Black African Mixed groups * Standardised for age and gender

23. Cautions and acknowledgments • admission rates:- ONS 2001 census population estimates subject to significant error margins- no allowance for migration, population changes since 2001 • all rates:- no allowance made for socio-economic factors- no allowance made for clinical case-mix • not a review of service quality or patient experience • Dr. Veena Raleigh, Giovanna Polato, and their colleagues at the Healthcare Commission who undertook the data analysis and prepared the core presentation; • The MHAC Team for their work in ensuring an effective data collection

24. Challenge Women • Ensure the new ‘Gender Duty’ is implemented effectively • Tackle continued harassment and abuse of women in care services • Ensure appropriate treatment is available

25. Gender Duty From implementation on 6 April 2007 all public authorities and some private bodies providing public services will be expected to have plans in place to eliminate sex discrimination and harassment and to promote gender equality

26. Challenge Disability and disadvantage • Equalities Review suggests a capabilities approach to disability and disadvantage • What does this mean for disabled people? • How will this work in practice? • Must develop a process for tackling discrimination that recognises and empowers

27. Mental Health Legislation

28. Mental Health Bill • The draft mental health Bill 2004 is dead! but • Some of the key changes will be imported into the draft Mental Health Bill 2006

29. Bill proposals • Simplified single definition of mental disorder • Remove the ‘treatability test’ • Introduce supervised treatment in the community • Expand the skill base of professionals responsible for treatment of patients without consent; • Give MHRTs ‘order making powers’ • Remedy the ECHR incompatibility on nearest relative

30. Simplified single definition of mental disorder Remove the ‘treatability test’ Introduce supervised care in the community Expand the skill base of professionals responsible for treatment of patients without consent; Give MHRTs ‘order making powers’ Remedy the ECHR incompatibility on nearest relative Potentially widens powers of compulsion Extends idea of appropriate treatment availability to all patients Creates a community supervision order – but sanctions? Clinical supervisor can be doctors or other professions; ASW go, replaced by AMHP Unclear on scope except needed to make CSO effective Ensure ECHR/HRA compatible What does this mean?

31. What’s missing? • Advocacy • Speedy access to a tribunal on ‘entry’ – now only on ‘exit’ • Principles on the face of the Bill • Expert Panel (retain SOADs and consent provisions)

32. Mental Capacity Act 2005 • Consultation on the Code of Practice • IMCA Advocacy Pilots being established • ‘Bournewood’ changes will be incorporated into the Mental Health Bill

33. Between the Acts! • Possibly some difficult decisions especially on CSOs • Is a CSO ‘restriction’ rather than ‘deprivation of liberty’ and thus what is the status of a patient on a CSO that does not have capacity for MCA purposes? • How will advocacy cross between the Acts • Will ‘Bournewood’ patients receive the same level of safeguard as mental health Act patients?

34. Some questions 1 • Continuation of formal monitoring of the rights of detained patients? • Will the ‘appropriate treatment is available’ formulation lead to preventive detention? • Role of consent procedures and SOADs – could this be expanded or improved?

35. Some MHAC questions 2 • Will the CSO simply codify s.17/25 leave or be similar to guardianship? • Will the loss of specialised expertise in the AMHP lead to a dilution of protections for patients on admission – introducing the CSO would suggest a strengthened role for ASWs?

36. Some MHAC questions 3 Is this the opportunity to change radically the approach to compulsion and bring in a capacity test?

37. Future Directions

38. Based on the present – what the future holds

39. Future Directions • Challenge discrimination and promote equality and human rights • Encourage social inclusion through community engagement; • Develop and extend patient/service user and citizen centre services through radical commissioning for diversity; • Develop a legal framework that minimises compulsion and achieves culturally appropriate and relevant care

40. Mental Health Act Commission “Safeguarding the interests of all people detained under the Mental Health Act”

41. Mental Health Act Commission “Safeguarding the interests of all people detained under the Mental Health Act”