There is a lot going on this month, in the NHS and in the news, affecting mental health issues and the overlap with criminal justice. A whistle-stop tour follows! –
This month there is a lot of business commencing that will change the way the mental health care is given – so a short summary seems in order. At the start of this month, Primary Care Trusts (PCTs) in England ceased to exist and they have been replaced by GP-led Clinical Commissioning Groups. There are 211 CCGs in England and taken they together they will control £65bn of the £95bn NHS Commissioning budget. This will affect decisions around the commissioning of mental health care in ways we do not yet fully understand.
One challenge for this area of business is the overlap with criminal justice: secure-mental health services and specialist offender health services will continue to be commissioned seperately and directly by the Commissioning Board of NHS England and each police force area will have an offender health commissioner whose role it is to ensure, amongst other things, that issues affecting the police are not lost in the distinction between local CCG commissioning and that directly arranged by the NHS Commissioning Board. As of 1st April 2013, Strategic Health Authorities ceased to exist – their responsibilities are now transferred to the NHS CB about which more information is available on the NHS England website.
Also coming into effect in April 2013 are Health and Wellbeing Boards – run by local authorities who take over responsibility for the public health agenda, these bodies aim to bring together on a statutory basis health and social care leaders to improve the health of their population and reduce inequalities in healthcare. Interesting point about these bodies: the police are not involved in them by right, but only by local invitation or as and when required. Given the vast amount of information the police have about health issues, including mental health issues as well as drug and alcohol abuse, it strikes me that the police should be right in there as active participants. Areas are making their own decisions about this, as these boards get up and running.
ROYAL COLLEGE STANDARDS
This month the Royal College of Psychiatrists has published new guidance to NHS Commissioners – in the new CCGs! – on s136 Places of Safety. It mostly echoes the “s136 Standards” that were published in 2011, although with a new aspiration that police officers should be able to hand over patients to PoS staff and leave within 30 minutes of arrival. This is fantasy-land in many parts of the UK, but I truly welcome yet another document which allows police officers to arm themselves with argument ahead of meetings with NHS colleagues about the provision of these services.
Can it really be 30 years since the MHA was enacted and we still don’t have PoS provision in every county of England? – North Yorkshire remains the only one and quite unsurprisingly they are now wrestling with this after a death in custody incident in York in June 2011.
The Care Quality Commission this month published their new strategy for 2013-2016 and within it, they stress a new emphasis on MHA, MCA and DoLS processes in their inspection regime: I truly hope that CQC inspectors use these nationally agreed guidelines and standards as a benchmark against which to assess PoS provision. Actually, I hope that commissioners will already be doing this for themselves without having to be asked – in particular I draw their attention to pages 11 and 13 which provide highlights about what “good PoS provision” looks like.
DIAGNOSITC AND STATISTICS MANUAL – 5th EDITION
This month, the American Psychiatric Association will publish the 5th Edition of the DSM – this is textbook which classifies mental disorders. I am not going to say too much about this because I am writing a full post on the DSM for next month. Suffice to say for now, that it is a controversial publication, not least because some clinicians argue that the whole classification system is scientifically invalid per se. Many aspects of its production and content are opposed by, amongst other prominent psychiatrists, Dr Allen FRANCIS and Dr Robert SPITZER – they were heads, respectively, of the task forces that put together DSM-III and DSM-IV. Chief amongst criticisms is the fact that this fifth edition has been produced in secret, with members of the task force signing non-disclosure contracts. There are also clinical objections:
DSM-5 introduces disorders not included in previous editions, such as “paraphillic coercive disorder” – a disorder in men who become sexually aroused by the coercive dimension of rape. Highly controversial – is this a medicalisation of what is simply criminal conduct? Some would say. Whole research papers by psychiatrists have sprung up to debate and oppose the validity of this particular suggested disorder. But one can forsee how its inclusion in a scientific textbook of mental disorders like the DSM will mean it is mentioned in criminal rape trial at some point in our future. There has also been controversy about the decision not to specify Asperger’s Syndrome as a distinct condition, but to include it within the broader autistic spectrum.
Such debates have been part of the DSM’s evolution since the earliest stages: originally, homosexuality was listed within the tables of disorders in DSM-I and II, but it was removed after protests at psychiatric conferences when DSM-II was reprinted in 1974. Psychiatrists in the United Kingdom and many other countries, often prefer the classification system ICD-10, published by the World Health Organisation, but the DSM-5 debate will extend to Europe, not least because those involved in its conception will be undertaking conference tours and debates across the world later in 2013. Nice work if you can get it.
A very difficult case for the Sussex Coroner, arising from tragic events at Gatwick Airport – Ernestas ANIKINAS was a 33 year Lithuanian-speaking man who was in contact with Sussex Police at Gatwick Airport after becoming agitated. Having used a telephone translation service to establish why he was at the airport and why he was agitated or upset, it emerged that he had gone to the Airport in the hope of returning to his family in Lithuania. During converstations he was advised by his family to go to Victoria Station in London so officers escorted him from the Airport to the railway station. On the platform, Mr ANIKINAS suddenly took a bottle, broke it and stabbed himself in the neck causing fatal injuries and blood loss. The Coroner and Mr ANIKINAS’s family praised the officers involved for efforts to save his life after the self-inflicted wound.
The IPCC were required to investigate the death, given it occured following police contact and they concluded that the restraint, involving the use of a taser, has been appropriate in the circumstnaces and that all efforts had been focussed upon saving his life. However, their report suggested that “more could have been done” to establish during the Airport encounter why Mr ANIKINAS was agitated. I admit, I’d like to know more about the case, not least because – if there are lessons to be learned for future encounters, let’s learn them nationally. Chief Inspector Chris BALL from Sussex Police is on record as saying the officers had no powers to detain the man the man at their first point of contact. I infer from the comment by the IPCC that “more could have been done” and them raising section 136 in their press release when it was never used by Sussex officers, that think he may have been detainable. Many IPCC reports are made public: I wonder whether there are issues to be considered that mean this one should be?
MENTAL HEALTH GIGS
I’m being asked to speak at various events at the moment – I like doing these things and do as many as I can, bearing in mind it’s all in my own time. Upcoming in May is me going “home” – I’ve been asked the Northumbria University to speak at their AMHP training for local authorities in the North-East so I intend to get my accent back and enjoy the first event I’ve spoken to in Newcastle. I’m speaking at an AMHP event in Manchester later in the year. I’m sharpening my “Section 135” input for the inevitable debate about warrants, with my best case study yet at the ready!
It’s good to talk.
KEEP AN EYE OUT!
- 24th April 2013: the trial of two police officers for wilful neglect in public office arising from the re-detention of Colin HOLT, an AWOL patient from a mental health unit in Kent. Without the outcome of the trial yet being known, if offers learning for why restraint after detention needs to be carefully done and why it should be accompanied by calling ambulances to ALL MHA detentions and re-detentions.
- 09th May 2013: the publication of the Adebowale Independent Commission report on policing and mental health in the Metropolitan Police. I had a chance to express views to the Commission along with many others and it will be interesting to see what they say. They had also come to a view that mental health issues contribute to around twenty percent of police demand.
Winner of the Mind Digital Media Award.