Swine flu: Charities concerned over Mental Health Act plans

Mental health charities have outlined concerns on proposed temporary changes to the detention of patients under the Mental Health Act in the event of a pandemic flu outbreak.

Rethink and Mind warned that patient safeguards could be compromised after the Department of Health yesterday issued consultative proposals to ensure Mental Health Act functions could be maintained should a flu outbreak trigger severe staff shortages.

The consultation, which is unusually short, closes on 7 October and would lead to the introduction of emergency legislation in the early autumn.

Proposed changes

The proposed amendments fall into three areas:-

• Reducing from two to one the number of doctors required to comply with a number of actions under the act, including detention for assessment or treatment if the approved mental health professional making the application believes there would otherwise be an undesirable delay.
  
• Extending or suspending time limits that apply to certain provisions – for instance suspending the requirement for a second opinion appointed doctor (SOAD) to approve giving a patient medication without consent if they have been in hospital for three months or more.
  
• Allowing certain additional people to be approved to undertake some specific functions – for example some recently retired approved social workers may be temporarily approved to undertake the role of the approved mental health professional.

‘Fair and reasonable’

The consultation asks whether the overall package of proposed amendments to the act is “fair and reasonable” and whether it will be “effective and helpful” during staff shortages.

The DH said its intention was for the contingency measures to be used “only be used if local circumstances make it necessary to do so”, while it would also ask regulator the Care Quality Commission to convene a group including service user representation to advice on the need to retain the measures.

Inappropriate detention warning

However, Mind’s chief executive, Paul Farmer, said: “Any proposals that will reduce the number of professionals involved in the sectioning process are concerning. Sectioning effectively deprives people of their liberty, and the reason that a number of professionals are involved is to ensure that the best decision is made for the patient, and no one is detained inappropriately. We have to be clear that these are serious changes, and should only be used as a last resort.”

Rethink chief executive Paul Jenkins said it was right to plan for an outbreak, but added: “The act is very carefully balanced, ensuring that there are significant protections and safeguards for individuals faced with losing their liberty and being forced to accept treatment for an illness.

 “We will be looking closely at the proposals and measuring them against the need for people to access services early even during a pandemic crisis and be protected at the same time.”

Those with schizophrenia ‘need vaccine access’

He added that the DH should be offering people with schizophrenia early access to the swine flu vaccine because of their high rates of respiratory illnesses. 

The current planning assumptions are for a 10-12% rate of absence from work in the general population in the peak weeks of the pandemic, but this could reach up to 25% in some health and social care organisations where there are a high number of staff with childcare and other caring responsibilities.

National director of mental health services Louis Appleby said it was important to find out if temporary changes in the act would help professionals and protect patients.

‘Exceptional circumstances’

He added: “We will also consider in what kind of exceptional circumstances we might need to use them. It would only be in exceptional circumstances and strong safeguards would remain in place.

“We are determined to make sure we have a sensible, proportionate approach that ensures that vulnerable mental health patients continue to get the treatment they need, when they need it, even in the event of staff absences. It is only sensible to be prepared for every eventuality.”  

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