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One adult in six in the UK suffers from one or more forms of mental illness at any time. Incidence of mental ailments can as such be considered as prevalent as asthma (Ray et al, 2008, p 2 to 13). Mental ailments range from very common conditions like depression to ailments like schizophrenia, which affect less than 1% of the population. Mental ailments cost the nation approximately 77 billion GBP every year in terms of expenses on health and social care (Ray et al, 2008, p 2 to 13). Such ailments are not really well understood even today and often frighten people and stigmatise people with such ailments (Sheppard, 2002, p 779 to 797). Individuals with long term mental health issues are likely to face discrimination and social exclusion, phenomena that can lead to unemployment or underemployment, poverty, inadequate housing, social isolation and stigmatisation (Sheppard, 2002, p 779 to 797). Whilst UK society is progressively coming to terms with and accept modern day phenomena like homosexuality and same sex marriages, people continue to be very apprehensive about mental disorders and often associate such conditions with lunacy and the need for isolation and detention of people with severe and long term mental health conditions (Angermeyer & Matschinger, 2003, p 304 to 309).
Legislation and social policy towards mentally ill people has however evolved substantially over the course of the 20th century and more so in the last 25 years. I am placed in a residential unit that houses people that both sexes who are over 16 and have mental health issues. This assignment focuses on mental health law and policy in the UK and the various ways in which Ii am using my knowledge and understanding of these issues to inform my practice.
Mental Health Legislation in UK
Poor mental health continues to have substantial economic and personal impact in the UK. Stigma and discrimination increase such impacts (Angermeyer & Matschinger, 2003, p 304 to 309). Social research has consistently found the presence of extremely negative attitudes towards individuals with mental health issues (Angermeyer & Matschinger, 2003, p 304 to 309). There persists the view that such people represent dangers to their communities, perceptions which are also on occasion reinforced by the media. Such negative attitudes do not occur only in the media and the general public but also among mental health workers and professionals (Angermeyer & Matschinger, 2003, p 304 to 309). Such elements increase social distancing, cause social exclusion and reduce the probability of such individuals to gain employment or access social and health care services (Angermeyer & Matschinger, 2003, p 304 to 309).
Whilst discriminatory attitudes towards the mentally ill still exists in substantial measure and adversely affect the life chances and social exclusion of such people, it also needs to be recognised that substantial progress has been made over the course of the 20th century and especially in the last 25 years to improve the physical, mental, economic and social conditions of such people (Mind.Org, 2010, p 1). Such changes have basically been brought about through changes in legislation and in social policy (Mind.Org, 2010, p 1).
People with mental illnesses have traditionally been perceived negatively by society, with attitudes towards them varying from being harmless nuisances to violence prone and dangerous individuals (Mind.Org, 2010, p 1). Families with members with mental illnesses have often tried to hide such conditions for fear of social stigmatisation and the state, right until the end of the 19th century, was comfortable with locking such people up in “lunatic” asylums (Mind.Org, 2010, p 1). The Madhouse Act 1774 led to the creation of a commission with authority to give licences to premises for accommodating lunatics (Mind.Org, 2010, p 1). Succeeding legislation gave mental hospitals the authority to detain people with mental ailments (Mind.Org, 2010, p 1).
The Lunacy Act 1890 was repealed with the passing of the Mental Health Act 1959. The Mental Health Act 1959 strengthened the Mental Treatment Act 1930 and allowed most psychiatric admissions to happen on a voluntary basis (Mind.Org, 2010, p 1). The Act aimed at providing informal treatment for most individuals with mental ailments, even as it created a legal framework for detention of certain people (Mind.Org, 2010, p 1). The recommendations made in the Percy Report led to decisions on compulsory detention of mentally ill persons changing from judicial to administrative prerogatives (Mind.Org, 2010, p 1). The 1959 Act however did not clarify whether legal detention orders for people with mental disorders authorised hospitals to treat such people without their consent (Mind.Org, 2010, p 1). The passing of the Mental Health Act 1983 provided a range of safeguards for people in hospitals. The act also imposed a duty on the district health authorities and social service departments to provide after care services to the people discharged from hospital (Mind.Org, 2010, p 1). The Mental Health Act 1983 covered the assessment, treatment and the rights of people with mental health conditions and specified that people could be detained only if the strict criteria specified in the act were met (Mind.Org, 2010, p 1).
The Mental Health Act 2007 aimed to modernise the Mental Health Act 1983 and incorporated changes that widened the definition of mental disorder and gave greater say to patients about who their nearest relatives were (Ray et al, 2008, p 2 to 13). The act also decreased the situations where electroconvulsive therapy could be given without permission, gave detained patients rights to independent mental health advocates, gave 16 and 17 year olds rights to agree or refuse admission to hospital without such decisions being superseded by parents and introduced supervised community treatment (Ray et al, 2008, p 2 to 13). The amendment of the Mental Health Act was followed by the publication of a code of practice that provides guidance to health care professionals on the interpretation of the law on a regular basis (Ray et al, 2008, p 2 to 13). The code of practice has five important additions to guiding principles, which deal with purpose, least restriction, participation, and effectiveness, efficiency and equity (Ray et al, 2008, p 2 to 13). The code importantly states that the specific needs of patients need to be recognised and patients should be involved to the greatest possible extent in the planning of their treatment (Ray et al, 2008, p 2 to 13).
Whilst The Mental Health Act 1983, as amended in 2007, constitutes the most important mental health legislation in the country, the rights of people with mental health ailments is also governed by other acts like The Mental Capacity Act 2005, The Disability Discrimination Act 1995, The Health and Social Care Act 2008, The Care Standards Act 2007, The Mental Health (Patients in the Community) Act 1995, The Carers (Recognition and Services) Act 1996 and The Community Care (Direct Payment) Act 1996. All of these acts by way of certain provisions provide for the rights and entitlements of young and old individuals with mental ailments (Mind.Org, 2010, p 1).
Progressive legislation in areas of mental health has been accompanied by changes in social care policy for people with such ailments (Brand et al, 2008, p 3 to 7). The beginning of social work in the area of mental health commenced with the engagement of a social worker by the Tavistock Clinic in 1920 (Brand et al, 2008, p 3 to 7). Whilst social work in the area of mental health was subdued until the 1950s, it subsequently assumed larger dimensions and led to the realisation of the utility of non medical social interventions for treatment of medical health issues (Brand et al, 2008, p 3 to 7). The publication of the Beverage Report in 1942 was instrumental in altering government policy and shifting the treatment of people with mental disorders from hospitals to the community (Brand et al, 2008, p 3 to 7).
The 1950s saw the establishment of day hospitals, greater flexibility in provisioning of psychiatric services and reduction in hospital beds (Brand et al, 2008, p 3 to 7). The introduction of advanced drugs, the establishment of therapeutic bodies and development of greater outpatient services led to the decrease of numbers of psychiatric inpatients from 1955 (Brand et al, 2008, p 3 to 7). Much of such decrease was prompted by the introduction of social rehabilitation and resettlement methods, introduction of anti psychotic medication and availability of welfare benefits (Brand et al, 2008, p 3 to 7).Intensive debate and discussion in the media and among the community on the need to improve the conditions of people with mental health issues led to the introduction of specific programmes like the Care Programme Approach (CPA) in 1991 and other government initiatives (Ray et al, 2008, p 2 to 13). The guidance on “Modernising Mental Health Services” stressed upon the need for providing care at all times of the day and night and access to a comprehensive array of services (Ray et al, 2008, p 2 to 13).The introduction of the “National Service Framework for Mental Health” in 1999 elaborated the national standards for mental health, their objectives, how they were to be developed and delivered and the methods for measuring performance in different parts of the country (Sheppard, 2002, p 779 to 797).Social workers are now playing important roles in the treatment of people with mental health disorders and their greater inclusion in the community (Brand et al, 2008, p 3 to 7. Social work theory and practice has always espoused the use of the social model for dealing with people with mental health problems and have contributed to the development of a range of approaches that are holistic, empowering and community based in approach (Brand et al, 2008, p 3 to 7.Apart from being responsible for the introduction of numerous new person centred and community oriented approaches dealing with mental health issues, mental health legislation, by way of The Mental Health Acts of 1983 and 2007 empowered appropriately trained social workers with a range of powers for assessment and intervention of people with mental health disorders (Ray et al, 2008, p 2 to 13).
Application of Disability Knowledge in Practice Setting
I am currently placed for my social work practice in a residential unit for people with mental health problems, who are furthermore homeless, more than 16 years of age, and fall under the purview of the Care Programme Approach (CPA). The CPA, which was introduced in 1991 for people with mental illnesses, requires health authorities, along with social service departments, to make specific arrangements for the care and medical treatment of people in the community with mental ailments (Care Programme…, 2010, p 1). The CPA requires that all individuals who receive treatment, care and support from mental health services should receive high quality care, which should furthermore be based upon individual assessment of their choices and needs. The needs of service users and their carers should essentially be central to delivery of services (Care Programme…, 2010, p 1).
Mentally ill and homeless people are liable to pose special challenges to health and social care workers.
“The majority of those who suffer major mental illness live in impoverished circumstances somewhere along the continuum of poverty. Homelessness, however defined, is the extreme and most marginalised end of this continuum, and it is here that we find disproportionate numbers of the mentally ill.” (Timms, 1996, P 159)
It is very possible that the levels of cooperation and motivation of the mentally ill, who are also homeless, could be lesser than that of other patients (Net Industries, 2010, p 1). Whilst their limited resources often result in difficulties in their obtaining transportation to treatment centres, such people often forget to keep appointments or take their medications. Frequently unkempt in dress and appearance, their engagement in drug abuse can render them unresponsive and unruly (Net Industries, 2010, p 1).
My practice setting provides specialised and supported residences for people with severe and long lasting mental health problems. Each resident has his or her own bedroom and is required to share the use of kitchens and bathrooms. Some of the residents have histories of multiple admissions in hospitals, combined with lack of compliance with medication and disengagement with services. Some of them also have histories of alcohol and substance abuse.
Our organisation provides residents with a helpful and supportive environment for the carrying out of comprehensive assessment of needs (Timms, 1996, p 158 to 165). Assessments and care plans of our residents need to consider a range of requirements. These include assessing the requirements of parents with regard to physical health, housing, vocation and employment, dual diagnosis, history of abuse and violence, carers and medication (Timms, 1996, p 158 to 165). Assessment and care plans for such users need to essentially address risk management and plan for crises and contingencies (Timms, 1996, p 158 to 165).
I, along with the other staff of the residential unit, work with mental health services for carrying out of detailed need assessments and for helping residents in development of independent living skills. My academic training and my knowledge of legislation and policy, whilst substantial, has not really provided me with the wherewithal to meet the practical challenges of my current position. It is still not widely recognised that social and economic disadvantages can lead to mental health problems (Timms, 1996, p 158 to 165). It is clear from my interaction with the residents that many of them come from disturbed and abused backgrounds and feel insecure about the social exclusion and stigma attached with mental ailments. They often have a multiplicity of needs that includes dual diagnosis as well as physical and mental health issues. I have to constantly refresh my knowledge of anti-oppressive and anti-discriminatory theory and ensure that personalised, cultural and socialised biases do not affect my responses towards the inmates of the residential unit and that I am able to help them with their social service needs.
My work includes involvement and help in assessments, assisting residents in finding educational agencies that can help them in improving their skills and earning ability, arranging for medical appointments and counselling sessions in line with their intervention requirements, making them aware of their various social services benefits and entitlements, and helping them to access such benefits. I am aware of the need to adopt a person-centred approach, and take care to ascertain the needs of service users as also their opinions on what they feel is best for them before I make suggestions. I try to adopt a uniformly cheerful and cooperative approach that is based upon respect and helpfulness in my routine interaction with them and strive to ensure that my responses are free of condescension and patronage.
I find that some members of the health and social care professions, despite such significant progress in legislation and policy, approach the mental health and other problems of our residents in traditional and bureaucratic ways, (much in the manner of Dominelli’s portrayal of the current state of social services), and appear to be constrained by resources as well as entrenched attitudes (Dominelli, 2004, p 18 to 95). I am doing my best to ensure that the opinions of the residents are taken into account in the satisfaction of their needs, that they are helped to overcome their mental health issues, and are made more self sufficient to look after their needs.
Conclusion
Significant changes have occurred in the last 40 years in the ways in which disabled people are perceived in society. Whilst many of these changes are outcomes of legislative and policy action by UK governments, the growing awareness of (a) the relevance of the social model, and (b) the fundamental flaws of the medical model, in dealing with disabled people has driven both legislative and policy changes.
Social workers, with their commitment towards bringing about of social inclusion of excluded and disadvantaged segments of society, their specialised education and training, and the resources and authority at their disposal, are particularly well placed to bring about attitudinal changes among the members of health and social services, as well as among members of the community. My practice experience has convinced me that much more will have to be done in the application of legislative provisions and social policy at the ground level, especially so by the people responsible for delivery of social and health care, before the disabled can truly be integrated into mainstream society.
