Mental Health Act

NSF (SCOTLAND) AND THE NEW MENTAL HEALTH ACT

The new Mental Health (Care and Treatment) (Scotland) Act came into force in October 2005

NSF (Scotland) welcomes the fact that that the new Act is one aspect of the wider commitment from Scottish Executive regarding mental health. This is illustrated by the Scottish Executive�s National Programme to improve the mental health and wellbeing of the people of Scotland. This encompasses the see me anti-stigma stigma campaign (funded by the Executive and managed by the see me anti-stigma alliance), Choose Life, Recovery (funded by the Executive and managed by the Scottish Recovery Network) and initiatives aimed at the prevention of mental ill-health.

WHAT NSF (SCOTLAND) LIKES ABOUT THE NEW ACT
This is the first fundamental change to Scottish mental health law in over forty years. Many aspects of the new Act have been welcomed by a wide and diverse range of organisations in Scotland, including NSF (Scotland). These include:

• Inclusion of a set of Principles on the face of the Act. These are wide-ranging. They will provide a clear context for interpretation of the legislation, and should underpin any intervention under the Act. Implicit in the Principles is the commitment to ensuring that compulsion will truly be used only as a last resort. People engaging with mental health services but not subject to compulsion also have the protection of the Principles, as the Act does not relate only to compulsory measures
  
• An individual right to advocacy for mental health service users
  
• New rights to involvement and information for carers, which will take account of the need to balance carers� rights to information with service users� rights to confidentiality
  
• The right of a service user, when well, to nominate a �named person� with rights to be involved in legal processes
  
• The removal of consent by the �nearest relative� to detention under the Act
  
• The right of service users to make an Advance Statement which must be taken into account when treatments are being considered
  
• Introduction of a new Tribunal to replace the current Sheriff Court system
  
• The right to appeal against being held in conditions of excessive security

• The Principle of �reciprocity� as recommended by the Millan Committee(whereby the obligation on an individual to comply with a programme of treatment and care is paralleled by an obligation to provide safe and appropriate services) now places the obligation to �have regard to the importance of providing services� on individual practitioners, not a duty on public authorities to provide appropriate services
  
• The introduction of Community Based Compulsory Treatment Orders does not restrict their use to the prevention of relapse and deterioration
  
• There is no right of appeal to a Tribunal if an Advance Statement is over-ridden
  
• The right to of a service user to nominate a �named person� does not give that named person a right to assist the service user prior to proceedings being commenced under the Act.

• That services won�t be able to deliver. In any system of mental health care it is possible to have:
  
  • good law/poor services
    
  • poor law/poor services
    
  • poor law/good services
    
  • good law/good services
  
  
  Dr Sandra Grant OBE, in her assessment report �Towards implementation of the Mental Health (Care and Treatment) (Scotland) Act 2003� commented: �The new Act will require a comprehensive range of responses organised on a joint agency basis and involving service users, carers, the voluntary sector and others in the assessment, planning and delivery processes.�
  
  NSF (Scotland) is concerned that the implementation of the new Act as hoped for will be hampered by services being unable to rise to the challenge. Sometimes it also seems that mental health services are at their least effective when responding to the needs of people with very serious mental illness � the very people to whom many aspects of the Act apply.
  
  
• Insufficient resources for services, including resources to develop better services for carers. Dr Sandra Grant expressed concern that �Until it is clear exactly what is being spent, how well and to what effect, an unanswerable case for an increase in resources is difficult to make. The need for resources will become greater in order to implement the new Act�.
  
  Concerns about resources apply to availability of people (psychiatrists, Mental Health Officers) as well as availability of adequate financing.
  
  
• That there won�t be a full and proper understanding of how the Principles should translate into practice, in terms of how people experience how services are delivered (as opposed to what services are delivered)
  
  
• That service users and carers won�t know enough about how the new Act will/should operate, or feel they have had a say/had a chance to express their concerns.

• Membership of the Mental Health Legislation Reference Group (MHLRG) and through that
  
• Membership of the Monitoring, Assessment and Research sub-Group
  
• Membership of the Tribunal sub-Group
  
• Membership of the Guidance, Training and Information sub-Group - and through that
  
• Membership of the NHS Education Scotland Reference Group � which is devising training materials for front-line NHS staff
  
• Membership of the Communication Working Group, which will be devising topic guides for service users and carers about various aspects of the new Act.