It is therefore to the governments credit that
it took the decision in 1999 to give Mental Health the same priority as coronary heart
disease in the programme of national service frameworks. These are being developed to lay
down models of treatment and care which people will be entitled to expect in every part of
the country. For mental health there are standards in five areas. I was particularly
pleased that Standard One addresses Mental Health Promotion and states that health and
social services should combat discrimination against individuals and groups with mental
health problems and promote their social inclusion. An extra £700million was allocated
over three years. It was acknowledged that implementing the National Service Framework
fully across the NHS and social services and throughout other agencies could take up to 10
years. The need to reform the Mental Health Act to reflect modern treatments and care was
So how are we doing three years on?
Sadly the debate on reform of mental health
legislation has concentrated primarily on the issue of compulsion (as a result of the
government proposal to extend compulsory treatment to community settings and to detain
people with a severe personality disorder) though, to be fair, government ministers have
stated that they want to see the use of compulsory treatment decline. This will not happen
whilst services remain fragmented and crisis-driven and professional workloads remain
unwieldy. Expectations raised by pledges of extra funding for Mental Health Services have
not been met. According to parliamentary answers I received, only about half of the £700
million has been allocated and the proportion of NHS funding spent on Mental Health
Services has risen from only 12.2 per cent in 1996/7 to 12.5 per cent in 1999/00.
Furthermore the lack of joined-up government is evident from the decision of social
security ministers to introduce compulsory interviews for claimants of disability
benefits. Worry about benefits is a major contributory factor in psychiatric morbidity.
Despite good intentions there is a danger that
pressures from more popular causes will mean the momentum for reform and improvement may
be lost. The All-Party Group on Mental Health is working with mental health charities,
professional workers and service users and their carers to try to ensure the government
keeps on track.
If the quality of all mental health services is to
reach that of the best, there must be greater respect for the contribution that people
with mental health problems and their carers can make. Public perceptions will not be
changed nor stigma overcome unless more service users are able to openly discuss their
Every family in the land is touched in some way by
mental illness and yet the overwhelming public perception is that mentally ill people are
dangerous and their problems self-inflicted. The only logical interpretation of this
inconsistency is that people bottle up their own experiences, whether as a sufferer or as
a relative or carer, because of the stigma that continues to be associated with mental
illness. Thus is the low priority given to mental illness perpetuated.
We must break out of this cycle. Urgently-needed
reform in legislation must put at its heart the need to treat people with respect. Those
subject to compulsion should be seen as victims of inadequate services rather than treated
as convicts. Respect requires that service users should have a say in their treatment
they are usually the greatest experts in their condition! Advance treatment
directives should be given statutory status and people with capacity should not be treated
against their will.
We must end the use of "confidentiality"
as the excuse for preventing relatives and carers from being involved. Service users
should be encouraged to include their close family in discussions about their treatment,
which should not just be about doling out medication. Mentally ill people and, indeed,
people suffering from "personality disorder" (the difference is usually
artificial), have often experienced some trauma in their lives, which needs to be
understood. Except in exceptional circumstances, family members are vital to this process
and their continued support must be nurtured. Only if a patient specifically wants to
maintain confidentiality, should next of kin be excluded. Measures need to be introduced
to positively review such exclusion.
One day there will be no more shame attached to a
visit to a psychiatrist than to any other type of medical practitioner and people will
seek help when they need it. We are a long way from that day but we are responsible for
putting in place the changes that are needed to ensure that that day comes as soon as