NSF(S): National Schizophrenia Fellowship (Scotland)

Mental Health Law - a carer's perspective
Janette Gardner, President of NSF (Scotland) 10-minute talk at SDC seminar in Dundee 1/5/01
Introduction
As a carer, I can see that the issues of mental health and the Law have been very thoroughly discussed in the Millan Report and there are very many good things in it. In particular the Principles e.g. that care should be provided informally if at all possible and that service users should be fully involved as far as possible in all aspects of their care and treatment. The reciprocity principle seems logical and fair but of course applies only to detained patients.
Focus is Service Users
For carers, the main focus of our concern is on the service user and getting improvements in treatment and care both for individuals and for service users as a group. That concern will include how best we carers can help and support users, and keep on doing so for as long as possible. That of course means that help and support for the carer is in turn needed.
NSF(S) Survey
When the Millan Committee started its work , NSF(Scotland) carried out a survey on the views of people associated with them, service users, carers and staff. The comments that I make will therefore look at what carers said about the deficiences in the system and whether Millan successfully addresses them.
Access to Help
The first problem is in gaining access to help- from the GP when someone is becoming ill. When a person has already been in the psychiatric system. Millan recommends that carers should have the right to ask for an assessment from the HB or SW and written reasons must be given if that assessment is not done.. That's good.
However, there are a significant number of instances when carers felt let down, especially when the service user first shows signs of mental distress- the service user would not go to see the GP who would therefore not help or the carer is told this is just eccentricity or a psychiatrist has seen the person but does not consider them ill enough to be sectioned.
Millan discusses this and recommends more and better training for GPs. I could wish for something rather stronger.
I would hope that training would happen and that individual GPs would be able to get support from CPNs or othe members of the LHCC.( Many GPs are helpful)
Relationship between SU and C
There are good parts which seem to be helpful to the relationship between users and carers and to reducing anger and bitterness:

the 'nearest relative'. The user is to be able to nominate a 'named person' to take responsibility and to act for them. This would often be the informal carer. The right of the user to choose is important.
Carers often feel cut off and ignored when someone is getting treatment, and would hope that advance statements would allow the user when well enough after the first episode of illness to say how much involvement they wished from their informal carer and how much info they would like the carer to have.
Carers with the present law, can be asked to consent to emergency and short term treatment and this can cause resentment, bitter enough to damage severely the relationship between U and C, often forgiven especially with parents , thinking they were doing the best for son/daughter but difficult and liable to change completely the relationship when the carer is a partner or child of the user . Millan says this should be abolished, though carers would still be consulted.
Respect for Carers
One of the main principles is 'respect for the carer'. This comes through in the recommendation that carers should have a right to information so that they can properly care for the user. This would be on a need-to-know basis and would sometimes mean that the user's wishes were overruled.
Again I would hope that advance statements could help here. Respect is shown again in that Tribunals or Sheriffs who approve compulsory measures ( and hear appeals and approve care plans) are recommended to have carers present i.e. carers will not be discouraged from attending.
Community Treatment Orders
There is to be one new kind of order i.e. the CTO and carers would see this as a a good thing if it meant that someone who was prone to stopping medication, not keeping medical appointments and who at one time would have spent the rest of their lives in hospital could have the chance of a better life in the community.
The majority of carers and users whose opinions we surveyed did see the need for compulsory treatment but had many misgivings about how this would be monitored and how it would come about. Would it for instance be someone the hospital found difficult, didn't want ? Would someone who really needed the safety of hospital be discharged because this would be cheaper?
Mental Welfare Commission
The expansion of the role of the MWC to the community could help with CTOs. and is essential. Millan 's recommendation that MWC should be responsible for upholding the principles is also very welcome and this could be aided by the inclusion of SU and Cs.
Resources
The need for more resources is implicit in much of this report and why not? Compare the treatment and care for MI with the sophistication of treatments for most physical illnesses. For whatever reason MI has fallen very far behind and surely this is a chance for the law to do its part in helping to redress that balance.
JBG 30/4/01

Top of this page | Home page



	Mental Health Law - a carer's perspective Janette Gardner, President of NSF (Scotland) 10-minute talk at SDC seminar in Dundee 1/5/01 Introduction As a carer, I can see that the issues of mental health and the Law have been very thoroughly discussed in the Millan Report and there are very many good things in it. In particular the Principles e.g. that care should be provided informally if at all possible and that service users should be fully involved as far as possible in all aspects of their care and treatment. The reciprocity principle seems logical and fair but of course applies only to detained patients. Focus is Service Users For carers, the main focus of our concern is on the service user and getting improvements in treatment and care both for individuals and for service users as a group. That concern will include how best we carers can help and support users, and keep on doing so for as long as possible. That of course means that help and support for the carer is in turn needed. NSF(S) Survey When the Millan Committee started its work , NSF(Scotland) carried out a survey on the views of people associated with them, service users, carers and staff. The comments that I make will therefore look at what carers said about the deficiences in the system and whether Millan successfully addresses them. Access to Help The first problem is in gaining access to help- from the GP when someone is becoming ill. When a person has already been in the psychiatric system. Millan recommends that carers should have the right to ask for an assessment from the HB or SW and written reasons must be given if that assessment is not done.. That's good. However, there are a significant number of instances when carers felt let down, especially when the service user first shows signs of mental distress- the service user would not go to see the GP who would therefore not help or the carer is told this is just eccentricity or a psychiatrist has seen the person but does not consider them ill enough to be sectioned. Millan discusses this and recommends more and better training for GPs. I could wish for something rather stronger. I would hope that training would happen and that individual GPs would be able to get support from CPNs or othe members of the LHCC.( Many GPs are helpful) Relationship between SU and C There are good parts which seem to be helpful to the relationship between users and carers and to reducing anger and bitterness: the 'nearest relative'. The user is to be able to nominate a 'named person' to take responsibility and to act for them. This would often be the informal carer. The right of the user to choose is important. Carers often feel cut off and ignored when someone is getting treatment, and would hope that advance statements would allow the user when well enough after the first episode of illness to say how much involvement they wished from their informal carer and how much info they would like the carer to have. Carers with the present law, can be asked to consent to emergency and short term treatment and this can cause resentment, bitter enough to damage severely the relationship between U and C, often forgiven especially with parents , thinking they were doing the best for son/daughter but difficult and liable to change completely the relationship when the carer is a partner or child of the user . Millan says this should be abolished, though carers would still be consulted. Respect for Carers One of the main principles is 'respect for the carer'. This comes through in the recommendation that carers should have a right to information so that they can properly care for the user. This would be on a need-to-know basis and would sometimes mean that the user's wishes were overruled. Again I would hope that advance statements could help here. Respect is shown again in that Tribunals or Sheriffs who approve compulsory measures ( and hear appeals and approve care plans) are recommended to have carers present i.e. carers will not be discouraged from attending. Community Treatment Orders There is to be one new kind of order i.e. the CTO and carers would see this as a a good thing if it meant that someone who was prone to stopping medication, not keeping medical appointments and who at one time would have spent the rest of their lives in hospital could have the chance of a better life in the community. The majority of carers and users whose opinions we surveyed did see the need for compulsory treatment but had many misgivings about how this would be monitored and how it would come about. Would it for instance be someone the hospital found difficult, didn't want ? Would someone who really needed the safety of hospital be discharged because this would be cheaper? Mental Welfare Commission The expansion of the role of the MWC to the community could help with CTOs. and is essential. Millan 's recommendation that MWC should be responsible for upholding the principles is also very welcome and this could be aided by the inclusion of SU and Cs. Resources The need for more resources is implicit in much of this report and why not? Compare the treatment and care for MI with the sophistication of treatments for most physical illnesses. For whatever reason MI has fallen very far behind and surely this is a chance for the law to do its part in helping to redress that balance. JBG 30/4/01
	Top of this page \| Home page