Capacity Issues

Mental Capacity

The Mental Capacity Act (MCA) is designed to protect and empower people who may lack the mental capacity to make their own decisions about their care and treatment. It applies to people aged 16 and over.

It covers decisions about day-to-day things like what to wear or what to buy for the weekly shop, or serious life-changing decisions like whether to move into a care home or have major surgery.

But just because a person has one of these health conditions doesn’t necessarily mean they lack the capacity to make a specific decision.

Someone can lack capacity to make some decisions (for example, to decide on complex financial issues) but still have the capacity to make other decisions (for example, to decide what items to buy at the local shop).

The MCA says:

  1. assume a person has the capacity to make a decision themselves, unless it’s proved otherwise
  2. wherever possible, help people to make their own decisions
  3. don’t treat a person as lacking the capacity to make a decision just because they make an unwise decision
  4. if you make a decision for someone who doesn’t have capacity, it must be in their best interests
  5. treatment and care provided to someone who lacks capacity should be the least restrictive of their basic rights and freedoms

The MCA also allows people to express their preferences for care and treatment, and to appoint a trusted person to make a decision on their behalf should they lack capacity in the future.

People should also be provided with an independent advocate who will support them to make decisions in certain situations, such as serious treatment or where the individual might have significant restrictions placed on their freedom and rights in their best interests.

How is mental capacity assessed?

The MCA sets out a 2-stage test of capacity:

1) Does the person have an impairment of their mind or brain, whether as a result of an illness, or external factors such as alcohol or drug use?

2) Does the impairment mean the person is unable to make a specific decision when they need to? People can lack capacity to make some decisions, but have capacity to make others. Mental capacity can also fluctuate with time – someone may lack capacity at one point in time, but may be able to make the same decision at a later point in time.

Where appropriate, people should be allowed the time to make a decision themselves.

The MCA says a person is unable to make a decision if they can’t:

  1. understand the information relevant to the decision
  2. retain that information
  3. use or weigh up that information as part of the process of making the decision

Helping people make their own decisions

Before deciding a person lacks capacity, it’s important to take steps to enable them to try to make the decision themselves.

For example:

  1. does the person have all the relevant information they need?
  2. have they been given information on any alternatives?
  3. could information be explained or presented in a way that’s easier for them to understand (for example, by using simple language or visual aids)?
  4. have different methods of communication been explored, such as non-verbal communication?
  5. could anyone else help with communication, such as a family member, carer or advocate?
  6. are there particular times of day when the person’s understanding is better?
  7. are there particular locations where the person may feel more at ease?
  8. could the decision be delayed until they might be better able to make the decision?

Is the decision in their best interests?

If someone lacks the capacity to make a decision and the decision needs to be made for them, the MCA states the decision must be made in their best interests.

The MCA sets out a checklist to consider when deciding what’s in a person’s best interests.

It says you should:

  1. encourage participation – do whatever’s possible to permit or encourage the person to take part
  2. identify all relevant circumstances – try to identify the things the individual lacking capacity would take into account if they were making the decision themselves
  3. find out the person’s views – including their past and present wishes and feelings, and any beliefs or values
  4. avoid discrimination – don’t make assumptions on the basis of age, appearance, condition or behaviour
  5. assess whether the person might regain capacity – if they might, could the decision be postponed?

It’s vital to consult with others for their views about the person’s best interests.

In particular, try to consult:

  1. anyone previously named by the individual
  2. anyone engaged in caring for them
  3. close relatives and friends
  4. any attorney appointed under a Lasting Power of Attorney or Enduring Power of Attorney
  5. any deputy appointed by the Court of Protection to make decisions for the person

Finding the least restrictive option

Before you make a decision or act on behalf of someone who lacks capacity, always question if you can do something else that would interfere less with their basic rights and freedoms.

This is called finding the “least restrictive alternative”. It includes considering whether there’s a need to act or make a decision at all.

Where there’s more than one option, it’s important to explore ways that would be less restrictive or allow the most freedom for a person who lacks capacity.

But the final decision must always allow the original purpose of the decision or act to be achieved.

Any decision or action must still be in the best interests of the person who lacks capacity.

So sometimes it may be necessary to choose an option that isn’t the least restrictive alternative if that option is in the person’s best interests.

Deprivation of liberty

In certain cases, the restrictions placed upon a person who lacks capacity may amount to “deprivation of liberty”. This must be judged on a case-by-case basis.

Where it appears a deprivation of liberty might happen, the provider of care (usually a hospital or a care home) has to apply to their local authority.

They’ll then arrange an assessment of the person’s care and treatment to decide if the deprivation of liberty is in the best interests of the individual concerned.

If it is, the local authority will grant a legal authorisation. If it isn’t, the care and treatment package must be changed – otherwise, an unlawful deprivation of liberty will occur. This system is known as the Deprivation of Liberty Safeguards.

If you suspect a deprivation of liberty may happen, talk to the care provider and then possibly the local authority.

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BASW – your chance to air your views

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Voices from social work in a pandemic

Call from Professional Social Work magazine to share your thoughts, feelings and experiences in writing, images or video during the corona-virus crisis.

These are unprecedented times for those working in social work and other caring professions. Professional Social Work magazine wants to hear what it’s like for you as you endeavour to continue to provide vital services to those who most need it during the COVID-19 pandemic. How are you managing to do your job, study, or teach? Is there anything you have learned? Things that have inspired – or frustrated – you? Do you have a message, an insight, some advice or simply a need to express yourself and bear witness to the current situation?

Whether it’s a short anecdote or a longer reflective article, a poem, video, photo or drawing that creatively captures your thoughts, feelings and experiences – we would love to receive it and share with others online or through Professional Social Work magazine.

BASW know you’re likely to be busier than ever, but sharing experiences in creative ways can be therapeutic – and it will also serve as testimony to a unique time in social work history.

Please email contributions to: editor@basw.co.uk

This has been shared from BASW website.As BASW turns 50 in 2020, they are planning a range of activities to explore the past, present and future of social work from 1920 to the present day.   The project will raise the profile and understanding of the profession and reveal the diverse voices of social workers and people who experience, work with and care about the profession. Please check out the BASW site if you want further information. Equally, Service Users should also share their own views on their own experiences in working together with social work authorities.

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South West London and St George’s Mental Health NHS Trust (SWLSTG)

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South West London and St George’s Mental Health NHS Trust (SWLSTG) has gained approval to begin work on its two new mental health facilities for south west Londoners

This £150m development will see the construction of two new mental health facilities set to open in 2022 on its largest site in Tooting, south London.

Eight new inpatient wards will be boosted by the modernisation of the NHS trust’s community services. They have already commenced construction work on this programme, which will include new housing and a 32-acre public park, receiving government approval for its Full Business Case for the development following extensive engagement with the Department of Health and Social Care, NHS Improvement, NHS England and Her Majesty’s Treasury.

At the moment the Trust have these hospitals and is the main provider of NHS mental health services to a population of over 1 million people of all ages in the London boroughs of Kingston, Merton, Richmond, Sutton and Wandsworth. It also provides a broad range of specialist services to people from all over the UK.  

They provide services from a number of sites, including the following hospitals.

Barnes Hospital

South Worple Way
Barnes
London
SW14 8SU
Tel:
0203 513 5000

Kingston Hospital

Galsworthy Road
Kingston-upon-Thames
Surrey
KT2 7QB
Tel:
020 8546 7711
Email:
enquiries@kingstonhospital.nhs.uk

Queen Mary Hospital

Roehampton Lane
London
SW15 5PN
Tel:
020 8487 6000

Richmond Royal Hospital

Kew Foot Road
Richmond
TW9 2TE
Tel:
020 3513 3200

Springfield University Hospital

61 Glenburnie Road
London
SW17 7DJ
Tel:
0203 513 5000

St. Helier Hospital

Wrythe Lane
Carshalton
Surrey
SM5 1AA

Tolworth Hospital

Red Lion Road
Red Lion Road
Surbiton
Surrey
KT6 7QU
Tel:
020 3513 5000
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Just some Questions to Consider

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Why have people with Schizophrenia been the victims of mistreatment (eg lobotomy,de-institutionalisation) more often than those with other disorders?

Should companies in the private sector have so much control over the cost and distribution of a critical breakthrough drug, one which could improve millions of lives?

How might patients react when they find themselves back in the same place where they were confined years earlier, under totally different circumstances?

Why are people so fascinated by the savant syndrome (a person with a major mental disorder or intellectual handicap who has some spectacular ability or brilliance) and might their fascination predispose them to glamorise it?

Must individuals already be anti-social in order to be influenced by films such as A Clockwork Orange or Natural Born Killers or Joker), or do the films confuse them by glorifying criminal and violent behaviour? Should film makers and writers consider the possible psychological influence of their work on certain individuals before they undertake such projects?

Why might people actively pursue drugs that are known to endanger their lives?

Who has the greater impact on the drug behaviours of teenagers and young adults: rock performers who speak out against drugs or rock performers who praise the virtues of drugs?

Do works of Art reveal more about the artists who produce them or about the Art Lovers who interpret their meaning?

If Mental Illness diagnosis is based on science how can a set of symptoms in one person be interpreted in many different ways by many differing Psychiatrists?

 

 

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FINDING URGENT PSYCHIATRIC HELP

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For those who need urgent psychiatric care, or are experiencing a mental health crisis, during this lockdown period there are still options to see NHS staff face-to-face (albeit with extra measures in place). You can find your local NHS urgent mental health 24-hour helpline here.

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Cefn Coed Hospital Swansea

Address Cockett, Sketty, Swansea  SA2 0GH cefn coed

The first Welsh asylum for the mentally ill was opened in Swansea at May Hill in 1815, followed in 1844 by Vernon House in Briton Ferry. The Glamorgan County Asylum in Bridgend opened twenty years later to serve the whole of the county of Glamorgan. But with the 1891 Public Health Act required each County Borough to build its own asylum . This took a long time to implement, for initially Townhill was thought to be the place to build an asylum, until in 1908 the Cefn Coed site was considered. Nearly 250 mentally ill persons from the Swansea area were being treated elsewhere. Eventually land was purchased, and the foundations were nearly complete when during the First World War shortage of labour and materials caused a halt. Building work began in 1928, utilising Unemployment Relief schemes, as with the erection of the Guildhall and Tir John Power Station. The Swansea Mental Hospital was opened in December 1932 by the then Princess Royal.

Work started in 2009 to build modern replacement mental health accommodation and facilities, including Ysbryd y Coed in the grounds of Cefn Coed, which is purpose-built for patients with dementia. Other new builds in the Cefn Coed grounds are the 18-bed Gwelfor Rehabilitation Unit, a pub featuring non-alcoholic beer called “The Derwen Arms” and two supported houses for recovering patients preparing to move back home.

In March 2015 the health board’s new low-secure mental health unit, Taith Newydd, opened in Bridgend, replacing some of the old wards at Cefn Coed. Other new mental health builds include the ARC Centre and Angelton Clinic in Bridgend, and Ty Einon in Swansea. In 2015 the NHS announced that the phased closure of Cefn Coed Hospital would continue for the next three to five years, with several decommissioned wards planned for demolition that year.

The Tawe Clinic provides assessment, therapeutic interventions and support for individuals experiencing an acute mental health episode where inpatient care is necessary. There are two wards, Fendrod providing care for men and Clyne providing care for women.

Two new facilities have been built at Cefn Coed Hospital.

  1. Gwelfor: Adult Mental Health Services

The 18-bed slow stream rehabilitation and two, four-bedroom step down houses at Cefn Coed Hospital are phase 1 of the reshaping mental health Services in Swansea project.

2. Ysbryd y Coed: Older People Mental Health Services

This 60 bed unit across three wards provides care for older people with dementia in purpose-built, modern surroundings which support our dedicated staff in providing effective care.

 

 

 

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mental health awareness week 18-24 May 2020.

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Mental Health Awareness Week takes place from 18-24 May 2020. The theme is kindness. Overall, kindness, to ourselves and others, has important benefits for our mental health and well-being, but kindness goes beyond individual action. It is important for our communities, organisations, and political institutions. Kindness has a critical role to play in policy, and policies rooted in the values of kindness, empathy, dignity, and respect have great potential to reduce inequality and discrimination, and strengthen relationships and trust between governments, citizens, and society. As part of this week, the Mental Health Foundation is calling on central and local governments across the UK to take preventative action rooted in justice and kindness to protect people’s mental health. 

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COVID-19 SECURE UNIT GUIDANCE

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Every secure hospital setting should have a simple social distancing policy in place which is compliant with public health guidance and preferably drafted with the knowledge and acceptance of the patients and preferably co produced.

In secure forensic hospital settings the responsible clinician (or deputy) should ensure that there is a review of each patient’s pre-existing physical health vulnerability and consider any particular vulnerabilities for the circumstances as a result of their mental disorder. This will help to make patient level decisions when required. An example of the risk assessment is as follows:

  • Does the patient have an underlying physical illness or anything causing them to be immunocompromised? If so, there should be a clear plan in place to provide extra protections and contingencies for that patient as far as possible.
  • If the patient’s discharge were pending, is it still safe to send them home, taking account of the risks of covid-19 being in the secure hospital setting and risks of transmitting this at home/next placement and the potential risks of the next placement to the patient. If there is to be any deferral of discharge, this will have to be discussed sensitively with the patient and their family or significant others.
  • If a patient’s discharge were not pending, is there any case for bringing this forward? This is unlikely, but should be formally considered in the interests of everyone’s physical health safety
  • Should the patient require isolating, to what extent will s/he be able to cooperate voluntarily? What measures are in place to ensure cooperation for the few cases where there are difficulties in this respect?
  • Is the patient on clozapine? What is the frequency of blood tests? When is the next one due? Which service can do clozapine blood tests in house?
  • Can the patient have visits with family by Skype or by other interactive media? Can patients make free (or cheap) phone calls to family and friends? Where such communication possibilities do not exist, units must prioritise setting up facilities for such communication as soon as basic safety precautions have been implemented.
  • It is really important that patients continue to have activities to occupy and divert them, and to stay fit or improve their physical fitness. It is unlikely that off-ward activities like OT can continue, but, as far as possible, occupational therapists should ensure an on-ward activity plan is available for each patient, which includes minimisation of any interpersonal interactions. Access to secure gardens must be planned to be compliant with public health guidance.
  • All leave outside the secure perimeter must be reviewed with each patient who already has permissions for this in place, and a new plan formulated to ensure patient and unit safety. Any decisions about leave will need to be taken based on latest government advice at the time and analysis of benefits and risks for that individual patient’s recover.

Please check within your own settings with regard to this guidance which is taken directly from https://www.rcpsych.ac.uk/about-us/responding-to-covid-19/responding-to-covid-19-guidance-for-clinicians/community-and-inpatient-services/secure-hospital-and-criminal-justice-settings

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Deaths of detained mental health patients double due to “covid 19”

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  • Deaths of patients detained under the Mental Health Act have doubled in 2020 compared to last year
  •  To date 122 people have died whilst under section, of these 56 patients died from either confirmed or suspected covid-19
  • The CQC has written to providers highlighting its concern over the deaths

Deaths of patients detained under the Mental Health Act are running at twice the rate of 2019, with half of the fatalities down to covid-19, new data has revealed.

The Care Quality Commission have said 112 patients detained under the Mental Health Act had died between 1 March and 1 May. This compares to a total of 56 deaths during the same period of 2019, 61 deaths in 2018, and 70 deaths in 2017.

These figures include both people who are detained in hospital and people subject to the Mental Health Act, but who are still in the community.

Since 1 March, 56 detained patients have died from either suspected or confirmed covid-19 said the CQC. 54 of these were under the care of a mental health provider, and two of a non-mental health providers.

However, it is likely that the number of detained patients who have died with coronavirus is higher.

According to NHS England’s latest data there have been 65 such deaths recorded within stand alone mental health providers. What is more, NHS England’s data also does not capture the number of patients transferred from mental health trusts to acute trusts for treatment who may have subsequently died. HSJ has previously asked the national commissioner if it is able to share any data regarding this, but it did not respond.

The Office for National Statistics also confirmed to HSJ it could not supply a breakdown of its data on deaths within care homes by those with a psychiatric condition.

Last week the CQC wrote to providers asking them to continue reporting the deaths of patients under the Mental Health Act regardless of whether they are transferred to an acute trust for treatment. HSJ understands some providers had taken patients off their section when transferring them. 

Dr Kevin Cleary, deputy chief inspector of hospitals and lead for mental health said: “This increase of death notifications is due to coronavirus related deaths and while this mirrors a rise in notifications from other sectors and includes deaths from confirmed or suspected coronavirus cases, it is obviously of concern.

“That a number of people detained under the Mental Health Act have died from suspected or confirmed coronavirus is a particular worry as these are some of the most vulnerable people in society.”

He added mental health providers should continue to notify the CQC of the deaths of people subject to the Mental Health Act in a “timely way”.

“We want to be clear what we expect from providers in term of their management of coronavirus and we will be asking some providers to urgently confirm the action they are taking to manage coronavirus outbreaks.”

Deborah Coles director of charity Inquest said: ”There has been considerable delay in getting any scrutiny of the impact of this pandemic on mental health and learning disability settings. Finally some data has been disclosed but it is incomplete. People in detention are reliant on others for their care and there have been well documented concerns about ill treatment and abuse.

”At a time when there is no external scrutiny and family visits are suspended openness and transparency is essential to ensure the human rights of detained people are protected. This should not have to be fought for. We need to know how this pandemic is impacting on therapeutic services, staffing levels and the use of seclusion, restraint and medication.”

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Earth Day April 22nd 2020

earth day

pic c/o THE GUARDIAN

Earth Day was a unified response to an environment in crisis — oil spills, smog, rivers so polluted they literally caught fire.
On April 22, 1970, 20 million Americans — 10% of the U.S. population at the time — took to the streets, college campuses and hundreds of cities to protest environmental ignorance and demand a new way forward for our planet.The first Earth Day is credited with launching the modern environmental movement, and is now recognised as the planet’s largest civic event. Over the 24 hours of Earth Day, the 50th anniversary of Earth Day will fill the digital landscape with global conversations, calls to action, performances, video teach-ins and more.

Earth Day will educate and mobilise more than one billion people to grow and support the next generation of environmental activists. It’s time to re=imagine what we can collectively do for our global environment with activities and events. Remember that the benefits to our own mental health is immense. The more we care for the Earth the more we take care of ourselves.

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