Critical Appraisal of Recent Mental Health Legislation and its Effect Upon Service Users and Carers
In recent years, we have seen a renewed government interest in public health. The everyday coming amendments and suggestions show that achievement of a healthy individual in society is not just related to medical treatment. It also shows that social, environmental and economic surroundings play an important part to determine levels of illness and disease (DoH, 1999). Before mid-twentieth century, majority of the moderate mental disorders were not taken seriously to treat and only people get assistance from their general physician and from family, friends, and clergy
." The care of people with serious mental illness was a state responsibility, provided in custodial mental hospitals for people who could not safely be cared for by themselves or their families...the segregation of such people in isolated custodial institutions probably contributed to the stigma associated with disorders of mental functioning. In addition, psychiatrists were separate from physicians in other medical specialties and commonly were held in low regard by their physician colleagues" (Mechanic D, 2003, p15).
This essay is aimed at exploring the impact recent mental health legislation has on carers and service users. Legislation has the potential to shape professional attitudes which can then be translated into positive or negative policy decision. For example, therapeutic jurisprudence is a relatively new approach to mental health law policy that envisions the construction of law as a therapeutic agent which positively impacts the emotional life and psychological well-being of individuals (Winick & Wexler, 2003). When mental health law policies are drafted in the context of a framework such as therapeutic jurisprudence, mental health consumers are more likely to assume an active and meaningful role in negotiating and designing treatment programs, collaborating with mental health and legal professionals, feeling are more likely to assume an active and meaningful role in negotiating and designing treatment programs, collaborating with mental health and legal professionals, feeling empowered, and having a more active role in their recovery process (O'Connell & Stein, 2005)
Medical model has been a contentious issue for some time and which therefore the autonomy takes account of service user's experiences. Cited in Barnes (2010, p1) "mental illness discourses linked to stigma and loss of rights, passive receipt of services, and interventions addressing biological rather than social causation, are viewed as presenting potential barriers to recovery and social inclusion" (Bailey, 2002; Rusch, 2005; Beecher, 2009). Their experience can be criticised to the point to significant of mental helath problems, "especially among people who encounter inequality" (Barnes, 2010, p1) and stigmatisation. Related to this, Barnes (2010, p2) claims that "people facing inequalities and disadvantage experience mental health issues at high rates" (Warner, 2003).
As Walton (1999, cited in Adams, 2002) states that the MHA 1983 provides the legislation for intervention but it does not assist the social worker as it is embedded with the psychiatry model of illness and medical treatment. Primarily medical support is given to patients as this can be far more cost effective than psychosocial models such as counselling or cognitive behavioural therapy. In most serious case reviews that have taken place a lack of joined working has been criticised heavily. Nevertheless, sole treatment does not always necessary give effective outcome, such as medication treatment often associated with the side effects and therefore many reviews claim that the effectiveness of the treatment for psychiatric patients could be possibly combined with psychosocial therapy, such as Cognitive Behaviour Therapy (CBT).
Related to underpinning influences and characteristics of the modernising health policy context within the models, Duggan et al. (2003) suggest that it should include; "the policy emphasis on partnership and collaboration, developments in service user involvement, the multi-factorial nature of the public health agenda, and evidence for the effectiveness of holistic interventions aimed at the root causes of ill health and health inequality" (p5). The reason is they (see Duggan et al., 2004) claim because of the complexity of health and illness within individual and communities increase inequality or unfairness to people who suffer with health in their everyday life. The government therefore try to support this combine process that has committed to make the links clear. Although these agreements may not adequate to the political, organisation, and culture barriers restrain to make it effective, however Maddock (2000) believes that the surroundings may carry on to be non-favourable to develop a partnership while national frameworks are determined at supervising the performance somewhat than progress, and where the dimension of partnership achievement is short-term. For example want for share considerate about the social nature of health itself, the roots of sickness and disability and a changeable promise to avoidance in addition to treatment can yet show the new strategy stress on partnership to be an unattainable delusion in practice (Duggan, 2003,). Consequently, the practice could make available the range of responses from both models to individual or community health needs that they require (Duggan et al., 2003).
2. The perspectives of mental health service users and their carers
The mental health service users and carers have their own concerning regarding services. Laws are created to reflect the beliefs and attitudes individuals hold regarding specific conduct. These laws can have major effects on the practice of psychiatry, the level of social control over the mentally ill (Gove, Tovo, & Hughes, 1985), and whether potential barriers in implementing these laws may be overcome (Fleishner, 1998). When legislation allows individuals to voluntarily and actively take part in their treatment choices and reduce potential coercion, attitudes can become a catalyst to legislative change (Wallsten & Kjellin, 2004).
Service users and carers have run-ins in with the civil and criminal justice system for numerous reasons including disagreement of treatment decisions made on their behalf under a doctor's recommendation (Starson v. Swayze, 2003), denial of having a mental illness, and drug induced states or paranoia which can impair judgement (Roth, Appelbaum, Salle, & Huber, 1982). Diversion practices encouraging appropriate medical treatment require collaborative dialogue across medical and legal disciplines.
In the United Kingdom (UK), patients have right to express their treatment preferences outside of the legal framework through 'crisis cards' (patients state their preferences without reference to the service provider) or 'joint crisis plans' (a discussion between the patient, service provider, friends, care coordinator and an independent facilitator regarding acceptable forms of treatment in the event of relapse) (Szmukler & Dawson, 2006). As in the U.K. case of Bournewood (N. Eastman and G. Peay, 1998) which drew attention to the widespread practice of admitting to psychiatric hospitals as voluntary patients people with autism, learning disabilities or Alzheimer's disease who are incapable of giving consent.
According to census results 2010 (Neighbourhood Statistic, 2011), around 62 million population in the United Kingdom (UK), and according to Carers UK (2011) there are around six million people in the UK provide unpaid supportive care for a friend, relative, or neighbour due to old age, disability, or illness, from this result they also tells us that the carers have saved £119 billion a year of the economic value contribution. This saving is a beneficial for the government budget, however the contribution of value gives the impact to the carers as individual whom have to give it up of work, social life and even many of them according to Carers UK (2011) "likely to suffer ill health (p.2)."
Consequently, this affects an individual in many ways, including financial burdens, exclusion and discrimination at work, interference with the ability to work, to seek higher education, and to participate in leisure activities. Considering the amount of the population that engages in caring, it is vital to account for the experience of the carer as well when formulating policy and drafting legislation that concerns service users.
Similarly there is mental capacity act (2007) for carers in which cares can make decision for patients with lack of mental capacity but making sure that the decisions are in their best interest. This is a new act that was introduced in 2007. There are many people who have mental problem like, dementia, learning disability, stroke, substance misuse, confusion, drowsiness and unconsciousness because of any illness. They cannot make decisions at their own. Under this law the mentally ill persons can chose a person as their attorney (one who is eligible by law to make decision for them) or in case they are unable to make a choice the court of protection will appoint an attorney for them. (Mental Capacity Act, 2007)
Carers have legal right that social services while assessing a community case must ask if there is a carer attached to the mentally ill and if yes they must consult with them and try to reach an agreement with the carers (Community Care Assessment Directions, 2004). In this regard, Department of Health issued a policy guidance in 1990 which advises that while assessing a community case the views and preferences of mentally ill and their carer's must be considered. It clearly states that the care plan for…