news analysis of delays to mental health legislation and girls` school exclusions

Charities use delay in drafting bill to scrutinise white
paper proposals.

Charities and professionals have used the past year to
discuss proposed mental health reforms, but are now wondering when
they will be implemented. Katie Leason
reports.

It’s all quiet on the Westminster front as far as mental
health reform is concerned. Since the Reforming Mental Health Act
white paper¹ was published in December 2000 very little
progress has been made publicly towards a draft bill. Yet mental
health organisations are keen that the reforms remain at the top of
the political agenda.

The Mental Health Alliance is a coalition of more than 50
organisations that share concerns about the government’s
proposals to reform the Mental Health Act 1983. It sent out
Christmas cards to MPs asking them to make mental health a priority
for their new year’s resolutions and back calls for reforms.
This follows a report highlighting a lack of mental health
awareness by the main political parties.

The report, ‘Pledge Your Party to Mental Health’,² is
based on surveys carried out with party delegates and visitors at
the Labour, Conservative and Liberal Democrat party conferences in
2001. It shows that the majority of respondents recognised that one
in three people who ask for help from a mental health service are
turned away. Only a third of party activists knew the date of the
present Mental Health Act and most believed incorrectly that people
have access to an independent specialist advocate to help them
negotiate with mental health services.

Despite the absence of a bill in last year’s Queen’s
speech, the government has shown a commitment to improving mental
health services. Only last month it announced the establishment of
77 crisis resolution teams over the next two years to support
people with severe mental illness and it has also published a
five-year strategy aimed at improving mental health services for
prisoners.

MHA chairperson Paul Farmer takes a positive view towards the
delay in drafting the bill, explaining that the time lapse has
provided a chance to discuss issues and think about the practical
implications of the proposals.

“Our view initially was that while on one hand it was a little
disappointing, it does give us a very real opportunity to consider
in more detail, other than in a parliamentary environment, the
issues identified as being of concern,” he says.

The delay has also given the MHA time to work with the
department of health, with both sides meeting this week to discuss
the progress of the legislation.

Farmer thinks that it is unlikely that the legislation will be
implemented before 2004 and says there will need to be a time delay
between the passing of the law and its implementation. In spite of
his optimism over the delay, Farmer says the MHA is keen to ensure
that the reform does take place.

“We want to make sure it does not fall off the agenda, that the
debate continues, and that the recognition that a new act is very
much needed doesn’t get lost,” he says.

However, there are others who are less eager for the reform to
be hurried through. At independent think-tank, the Sainsbury Centre
for Mental Health, director of policy Andrew McCulloch believes the
government is justified in delaying reform and putting emphasis on
other areas of mental health, such as implementing the NHS Plan,
the national service framework and setting up the National
Institute for Mental Health.

“I don’t think it is an urgent issue and I don’t
think resources and effort should be focused on it,” he adds.

He considers the 1983 act to be an adequate piece of
legislation. While he sees reasons for reforming it, he feels
priority should be given to improving services.

When the white paper was first published it was greeted with a
mixed response. McCulloch considers it to be good, with only a few
points that needed rethinking. He describes the proposed tribunal
system made up of a psychiatrist, a lawyer and a lay person as
unworkable.

“The idea of a tribunal with a seven-day deadline is
unrealistic,” he says, explaining that with 44,000 detentions a
year such a system would be a “huge logistical exercise” needing
around 100 psychiatrists, lawyers and lay people at hand.

Paul Jewitt has other concerns. As a forensic social worker in
an assertive outreach team, he has been campaigning for the act to
remain as it is and is particularly concerned about changes in the
role of the approved social worker.

“The role of the ASW is the only independent arbiter role in
mental health services for people placed on sections,” he says.

He says that any replacement of the ASW role is likely to be by
a member of the nursing staff, who may not feel comfortable
opposing the opinion of the consultant.

Jewitt describes the 1983 act as “an elegant piece of
legislation” that protects rights more than taking them away, and
makes it difficult to section people under the act. He believes
that further consultation is necessary and fears that the bill
“might be sneaked through” by the government.

“I would like them to go into a proper consultative programme
similar to what they did with the National Service Framework for
Mental Health, then the changes would be constructive rather than
dangerous to civil liberties,” he adds.

The Mental Health Foundation hopes that any new act will give
some legal force to advance statements, so that mental health
sufferers will be able to have more control over the help they
receive in a crisis. While the white paper recognises advance
statements can play a part in making decisions around care and
support, it does not propose making them legally enforceable. Last
summer, MHF was awarded £66,000 by the DoH to evaluate the use
of mental health advance statements, and is carrying out a
three-year project in conjunction with a home treatment team in
Bradford.

MHF director of research and development Nigel Duerdoth says he
hopes to see significant changes in the bill from what was in the
white paper.

“I think the government has understood our concerns that there
is too much emphasis on compulsion. I would expect and hope the
bill would go some way to shifting the balance between consent and
compulsion,” he says.

But he admits he would be surprised if the government concedes
on rights to services by granting a legal entitlement for anyone
assessed as needing services to receive them.

Yet when the government will take the next steps to reform the
act is anyone’s guess. In reply to a parliamentary question
from Paul Burstow in December, health minister Jacqui Smith said
the white paper “made clear our intention to reform mental health
legislation and bring it in line with the contemporary patterns of
care and treatment”. She added: “This is a high priority for the
government. New legislation will be introduced as soon as
parliamentary time allows.”

The DoH is still waiting for a parliamentary slot, according to
a spokesperson, but there is no indication as to when this may be.
It remains committed to mental health reform, in addition to
implementing the National Service Framework for Mental Health
throughout the country, and carrying out pilot projects for people
with dangerous and severe personality disorders in Broadmoor and
Rampton special hospitals and Whitemoor prison.

So, while government waits for an appropriate parliamentary
slot, the rest of us will have to hope for a bill in this
year’s Queen’s speech. Meanwhile, in Scotland, there
are plans to bring forward a bill to parliament in the next few
months.

No doubt ministers here are aware that procrastination is the
thief of time, but delay does them few favours. The MHA’s
report shows that almost two-thirds of party activists realise that
with one in four voters in every constituency likely to experience
a mental health problem, service users have the potential to become
a powerful lobby capable of affecting the outcome of elections.
Making mental health a priority is one new year’s resolution
that ministers would be wise to keep.

¹ Department of health, Reforming Mental Health Act,
DoH, 2000 at www.doh.gov.uk/mentalhealth/whitepaper2000.htm

² Mental Health Alliance, Pledge Your Party to Mental
Health, MHA, 2001 from 020 8215 2282

White Paper proposals

– An independent tribunal to determine all longer-term use of
compulsory powers.

– A right to independent advocacy.

– Safeguards for people with long-term mental incapacity.

– A Commission for Mental Health.

– A statutory requirement to develop care plans.

——————————————————————————————-

Gender gap at schools leaves girls needs unmet, claims
new report

Girls make up a small minority of school exclusions. But
could this be because boys’ behavioural problems often mask those
of girls? Anabel Unity Sale reports.

A typical mixed-sex secondary school classroom. A boy at the
front is giving the teacher some lip and refusing to do his work, a
girl at the back stares out the window.

Which one is more likely to be excluded? The boy, of course. But
that is not to say the girl does not have a problem. Research
published by the Joseph Rowntree Foundation last week says girls
often have behavioural problems that go unacknowledged because boys
are more likely to gain attention.

The report says that although around 1,800 girls – 17 per cent
of all exclusions – were permanently excluded in 1998-9, official
statistics disguise the extent of the problem.

“While girls account for just one in five of the students
permanently excluded from secondary school, they are particularly
vulnerable to other forms of exclusion,” it says.

The research found that girls were not a priority in schools’
thinking about the problems of behaviour management and school
exclusion. Consequently, resources to tackle exclusion were
targeted at boys, even when schemes were said to be for both
sexes.

Everyday around 400,000 pupils are not in school. Of these at
least 10 per cent are absent without school permission; 3,000 are
in short, fixed-term exclusions; and around 6,000 have been or are
being permanently excluded.¹

Report co-author Kerry Vincent, a research fellow at Leicester
University’s school of education, says when schools define
disruptive behaviour worthy of permanent exclusion only as “in your
face behaviour” it is going to be more applicable to boys than
girls.

“The narrow focus on permanent exclusion means that the needs of
some girls are being overlooked,” she adds.

Vincent believes greater work needs to be done between schools,
social services and other relevant agencies on making sure that the
needs of girls are met, whether they are excluded by the school or
through their own choice. “There is a willingness [among agencies]
to do this but it is quite challenging,” she says.

So how can social services help tackle the problem? Warwickshire
Council is just one council involved in joint working to tackle
this, with a local public service agreement (PSA) commitment to
have “fewer unauthorised absences from schools”.

Warwickshire’s assistant county education officer Beryl Lockwood
says while the education department is taking the lead on the PSA
pledge, it works with the Connexions service, social services and
the youth offending team when necessary.

She adds: “If a child is involved with lots of agencies it makes
sense for us to talk to each other.”

Newcastle Council’s PSA target is to reduce school truancies by
a further 10 per cent from the level expected this year.
Newcastle’s head of education Myra Robinson says social services
can help achieve this.

“Exclusion from school often indicates a crisis point in the
family and we in education cannot always help those families tackle
their problems so help from social services is often useful,” she
says.

The target is pretty tough, says Duncan Nicholson, head of
access and inclusion at Newcastle Local Education Authority,
adding: “There is no extra funding from the PSA to help us achieve
this – we only access funding when we have achieved the target
set.”

Tameside Council has a PSA target of halving truancy levels in
its secondary schools. Principal education welfare officer Cherry
Platt says doing so will require a new approach to joint working.
“Joint working is about accepting what professionals say to one
another without having to prove it blow by blow. There needs to be
more professional trust between us.”

* Joseph Rowntree Foundation, Not a Problem? Girls and Social
Exclusion; from 020 7843 6000.

¹ Audit Commission, Missing Out: LEA Management of
School Attendance and Exclusion, 1999