Independent Review =are we moving forward on implementation?

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Following the final report of the Independent Review of the Mental Health Act 1983 last year the government has, so far, accepted two of its recommendations:

  • to replace the nearest relative role, in which a patient is allocated a relative to be involved in decisions about their care, with that of a nominated person that they would choose;
  • to allow people to make statutory advance choice documents setting out their preferences for inpatient treatment, which clinicians must honour unless there are compelling reasons not to.

Ministers accepted two of its 154 recommendations straight away and promised to respond more fully in the New Year. In June of this year, it promised a white paper before the end of 2019 setting out its plans for legislation.However, as a new act was an idea strongly associated with Theresa May, it is unclear whether the plan will survive now that there is a new prime minister.

AMHPs (approved mental health professionals), the vast majority of whom are social workers, have a critical role under the existing Mental Health Act, co-ordinating assessments for admission to hospital or for community treatment orders, and ensuring that safeguards for people’s rights are upheld, including that restrictions on them are minimised.

The inquiry report said that the role required practitioners to have the “time to make the appropriate, least restrictive decision for an individual; time to get to know them, to explain their options to them, to talk to family members and to come to a collaborative decision”.

There are an estimated 3,900 AMHPs practising in England, according to a Skills for Care briefing issued last year.However, the Association of Directors of Adult Social Services reported, also last year, that ratios of AMHPs to population  – 1:16,000 in November 2017 – were much lower than previous recommendations set out in 1991 (1:7,600 for inner city areas and 1:11,800 for other areas).The inquiry said the situation meant that the existing statutory provisions needed to be strengthened to require a statutory minimum number of AMHPs per head of population.

“The introduction of ratios with statutory force would support local authorities in gaining resources to meet need and ensure provision of more rights protective and consistent service. It would assist in workload management and staff recruitment and retention. It would also help to underpin successful partnership with NHS colleagues and organisations.”

The UK Social Workers: Working Conditions and Wellbeing research, co-commissioned by Social Workers Union (SWU) and the British Association of Social Workers (BASW) found that almost two-thirds (61%) of social work practitioners and managers surveyed were looking to leave their current position in the next 16 months. This compared to 52% in last year’s study. We seem to be in a state of paralysis watching all this happen whilst politicians generally seem to be so heavily involved in the Brexit process that they appear unable to appreciate the enormity of the problems facing everyday members of the public. When they wake from this slumber it may all  be too late!!

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