The Purpose Of Mental Health

Published Date: 02 Nov 2017

PUT CONFINMENT IN INTRO! And about brief history of mental health law in uk

Discuss capacity/incapacity laws how they are all included in ni?????

Discuss four categorise of mental disorder according to Bartlet page 56

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Mental health law according to Bartlett (2003) is as old as law itself, with the earliest classified reference in the English law book as far back as 1324. This law gave the King authority over persons and property of ‘idiots’ and those who lost their ‘wit’. It was not until the late eighteenth and predominantly nineteenth century that the insane gradually became subject to legal authority. Although these statutes were the precursors of the Mental Health Act (MHA) (1983) they were significantly different systems. Much of the nineteenth century saw mental health law in a variety of streams of statutes and each one independent from the other as opposed to a single act. The nineteenth century also saw a structure of laws relating to the clarification, modernising and justifying that related to the Royal Prerogative powers. These powers allowed for control over a person and property once they were admitted to an asylum (Bartlett, 2003). Two significant developments in the first half of the nineteenth century saw another strand of legislation termed the Mental Deficiency Acts that began in (1913). This Thomson (1998) and Walmsley et al, (1999) believe provided a legislative framework for care in the community before the Second World War (Thompson (1998), Walmsley et al, 1999). The second development was the Mental Health Act, (1930) saw the beginning of informal admission, as up to this point there was no distinction between admission to and confinement to a psychiatric facility. It became possible for an individual to be admitted without a compulsory order of admission it also became possible for an individual to leave, this accounts for almost 90% of psychiatric admissions (Bartlett, 2003). The (1959) Mental Health Act moved control from hospital management to General Practioner (GPs) (Fennell, 1968). The (1959) Mental Health Act moved the power of the state to a legislative basis, it also places mental disorder and developmental disorder in the same law, and this continued until Mental Health Act (1983) in which confinement is an enforced treatment is performed on legislative justification and is measured by judicial assessment (Bartlett, 2003). The mental health act (1983) for England and Wales was based on UK ‘Better Services for mentally ill’ white paper (1975); and UK report of the Butler Committee on mentally abnormal offenders (1975), it covers four categories of mental illness:

severe mental impairment,

mental impairment,

psychopathic disorder

mental illness

Under the Mental Health Act (1983) an adult can be admitted, detained and treated in hospital against their wishes, this can be done under a number of different sections within the Mental Health Act (1983). Section 2 and 3 are used when someone’ needs to be assessed or treated and they are not a danger to themselves or the general public; this is termed a civil admission and can last for 28 days. An adult can be detained under section 4 of MHA if they are a danger to themselves or the public, this section allows a person to be admitted to hospital for an assessment of their mental health for a restricted period of time and requires the recommendation of only one doctor. This is dissimilar to section 2 which requires two medical recommendations. However, section 5 (2) and 5 (4) of MHA can be used by a doctor and a nurse respectively to prevent a voluntary patient leaving a psychiatric hospital (http://www.rethink.org). The (1983) act was amended by the Mental Health Act (2007), under this new act a host of professionals such as psychologists, mental health nurses and social workers are charged with overall care and treatment of patients. It also allows professionals who are not a registered medical practitioner to complete medical reports that are vital for detention renewal orders (Mental Health Alliance). A case example of this is Winterwerp v. Netherlands (1979) this case showed that detention application was accompanied by a medical declaration completed by a general practitioner, who had examined Mr Winterwerp for the first time. The court approved the temporary detention and did not pursue expert advice or consult with Mr Winterwerp. The European Court on Human Rights indicated that impartial medical expertise is vital in order to determine whether the patient has a mental disorder that justifies a detention. The EUHR went on to question whether or not this can be legally be achieved by non-medical professionals (Bartlett et al, 2007). Controversially, the new Mental Health Act (2007) for England and Wales allows professionals who are not registered medical practitioners to deliver the medical report required to renew detention orders (REFFFFF).

The Mental Health (Care and Treatment) (Scotland) Act 2003 came into effect in October (2005). It replaced the preceding (1984) Act and developed new measures for the detention, care and treatment of individuals with a mental illness or associated condition, and included brain injury. Principles of the Act are to deliver services to the individual that are suited to their individual needs and limit restrictions on freedom (Appendix 1). (www.headway.org). The Mental Health Order (1986) for Northern Ireland was based on the mental health act (1983), and has not been reformed for over two decades, and is considered outdated. There is also criticism of the MHO (1986) for lacking in human rights approach when using stigmatising language (dhsspsni, 2009).

The need for reforming the MHONI (1986) was recognised by the Bamford Review and the Northern Ireland Executive acknowledges the need for new for legislative reform by delivering the Bamford Vision to include changes to the existing Mental Health (Northern Ireland) Order (1986). This will also include new mental capacity statute and a report on human rights that would be followed by new mental health legislation for (2011) and mental health capacity by (20140. The NI executive also recognises that ideologies that were developed by the Bamford Review should be entrenched in the statute to cover mental health and capacity legislation. The main principle links to autonomy and the rights of the individual to make decisions and act on these decisions. The other central ideologies are:

Justice, to apply the law equally and justly;

Benefit, supporting the health, welfare and safety of the person, whilst having regard to the safety of others;

Least harm, to ensure little harm to other people or persons.

These ideologies according to NI Executive will support an all-inclusive framework which will include all mental health provisions and capacity (dhsspsni, 2009).

The nature of mental health law is complex and contentious and with the existence of different acts within the United Kingdom can lead to confusion and poor service delivery for the service user. In Northern Ireland for example the Mental Health Order (1986) has no stature for dealing with capacity, whilst in Scotland the Mental Health Care and Treatment Act (2003) has capacity-based mental health legislation. A debate regarding the issue of capacity was raised both in Parliament and in the Royal College of Psychiatrists in relation to the provisions for England and Wales. This concern according to Dame Elizabeth Butler-Sloss argued that mental health law should reflect the legal requirements for people with physical illness. Dame Butler-Sloss went on to say that an individual who is capable has the right to refuse treatment even if it leads to their death (Appendix 2). (Zigmond, 2013). The Mental Capacity Act (2005) provides a legal structure supporting people to make decisions for themselves, who may not be able to make these decisions due to illness, injury or disability. It has a far-reaching effect and effects services-users and services-providers, relatives and carers; the Mental Capacity Act (2005) is based on five principles (Appendix 3), and is intended to protect people from decisions made for them that are not in their best interests (www.mentalhealth.org.uk, 2005), capacity is tested using four questions and any professional can test capacity (Appendix 4). By answering yes to all four questions a person is judged to have capacity, safeguards include contacting a family member, friend or care worker. For mental illnesses, the Mental Health Act is used instead, this permits compulsory treatment even if a person is judged still to have capacity, but they are judged to be a risk to their own or others’ safety, or so ill that they need the treatment (Yousif et al, 2012). Scotland has a similar act called the Adults with Incapacity Act (2000), this act is designed for adults who lack capacity when making decisions for themselves as a result of a mental disorder or who lack the ability to communicate. This Act sets out the principles that must be adhered to when making a decision to intervene (Appendix 5) (www.hmso.gov.uk. 2000). In Northern Ireland there is at present no statute on capacity, and medical treatment and care for individuals who lack capacity are made in accordance with common law, and requires decision to be made in the individual’s best interest (http://www.gmc-uk.org).

The Mental Capacity Act are there to protect individuals from making poor decisions either directly or as a result of poor advise, However, these safeguards one of which is liberty safeguard are complex and unclear when bordered with existing mental health law, and could prove to be confusing and challenging to clinical teams.

Where a patient meets criteria for admission under Mental Health Act Sections 2 or 3 and objects to either admission or treatment, the Mental Capacity Act Schedule 1A states that the Mental Health Act should be used. This means that objection becomes an important factor for the patient and clinical staff. However, if the patient object to admission or treatment the clinician needs to balance the Mental Health Act and Mental Capacity Act, the later gives the patient more choice that could be lost in the confusion. In the case of H.L v United Kingdom (Application no. 45508/99), where the person was autistic, unable to speak and his level of understanding was limited was admitted to a psychiatric hospital against his will. The court ruled that he had been unlawfully detained under the mental l disorder (1983) Act (Appendix 6), (Richardson, 2010). There is a balance to be realised between having the means to react to the needs of a person assumed to have a mental disorder and the risk that the use of legislation can pose a risk to a person’s rights to autonomy.

Social Policy

Good mental health according to Gable et al (20///) is an important global concern, and is often ignored and undermined by policymakers and politicians. People living with mental disabilities can face significant difficulties such as discrimination, stigmatisation, humiliation and involuntary confinement without just process. These are according to Gable et ( 1111) human rights violations that persist through the lives of people with mental and intellectual disabilities (Gable et al. 2///). Governments can improve the mental health of it citizens by improving underlying societal conditions such as implementing policies that include former service users in future policy making, and a better understanding of community integration (ref. maybe?????

Although not a new idea phemonoma the purpose of community care is to integrate and provide persons with mental disabilities effective treatment in a community setting, and to maximise opportunities for social integration. To achieve this governments needs to ensure that community mental health services are well-funded and supported Reffff). The Mental Act (1930) England and Wales saw the introduction of informal admissions of mental health patients and the importance of aftercare was directed to community. However, overcrowding in the 1950s saw this fall by the wayside. It was the Percy Report that emphasised the importance of treating patients in the community albeit on the fringes in community housing and day centres (Goodwin, 1990). Community care has been the agenda for successive governments and in 2007 the UK government amended the Mental Health Act (1983) and the Mental Capacity Act (2005) to include Supervised Community Treatment. . This is the new supervision process for patients who are discharged from hospital and placed back in the community. An additional amendment is the redefining of the professional roles, which now means that there are more mental health professionals who take complete care of one patient (http://www.legislation.gov.uk).///////////////////FORGET HOW TO REFERIENCE IT MENTAL HEALTH CAPACITY ACT 2005 ON http://www.legislation.gov.uk/ukpga/2005/9/contents Taking complete care of a patient in the community can have a negative effect on them with effective treatment with pharmaceuticals requiring a strong infrastructure to ensure that medications and other support services are available and affordable. However, underfunding can lead to staff shortages and in turn patients not keeping appointments for medication and according to Gable et al (2///) the sad consequence of these policy changes can result in the number of mentally ill people not receiving their medication. The outcome of this can be agitated patients that can be misunderstood in their community and find themselves homeless and without any access to health services, and in extreme cases patients result in patients been jailed, where they can be isolated and deprived of their human rights (Gable et al 20//).

Human rights are also an important issues for an individual with mental health illness and these was not addressed until 19.. thereafter any acts were mindful of an individual’s human rights.

. Conclusion

Admitting adults to hospital for psychiatric treatment without their consent remains a contentious subject and challenges the very foundation of modern day clinical practice—that of informed consent. However, if it is necessary to confine an individual a legal framework is required to protect them while they receive attention for their illness (refffff). Foucault believed confinement that began in the late eighteenth century under the supervision of the medical profession were both cruel and controlling. These institutions were the only place a person with mental health illness could get treatment (Foucault, 2006)