Tuesday, 26 February 2013

Review: The Pocketbook Guide to MHA Assessments

Claire Barcham is an AMHP who has been closely involved for a long time with the development of AMHP practice, including involvement with The College of Social Work as a professional practice development advisor. Based on her own experience, she has written a clear and concise guide to Mental Health Act Assessments.
The book is very easy to navigate (take note, Richard Jones). Of course, it is not purporting to be as painstaking and detailed as the Mental Health Act Manual, but is more designed to provide a practical guide to the basic process of assessing people under the MHA.
The book is in five parts: The Legal Landscape; Setting up Mental Health Act assessments; Managing MHA assessments and making decisions; Implementing decisions and admission to hospital; and rounding off with the newest addition to the MHA, Community Treatment Orders, in a section on Working with Compulsion in the Community.
The first section places the MHA within the wider legal context, including the Human Rights Act and the Mental Capacity Act. It also usefully looks at the interface between the Children Act 1989 and the MHA when considering detaining a child.
The second section concentrates on the process of setting up assessments, including the gathering of relevant information, making assessments of risk and urgency, and looking at alternatives. She then reviews the different sorts of situations in which MHA assessments arise, eg following Sec.5(2) and Sec.136, whether the assessment is in hospital or in the community, and also looks at Sec.135. There is a good analysis of issues relating to the Nearest Relative, including identification and displacement.
The third section concentrates on the actual assessment. This includes interviewing in a suitable manner, a breakdown of each individual section that involves detention, and the necessary criteria for admission under the MHA.
The fourth section looks at the process once a decision has been made. This importantly includes what needs to go on the section papers in order to ensure that they are legal and valid. Guidance on conveyance to hospital is included, as well as a helpful guidance for nurses and staff who receive the patient and the paperwork.
The final section compares and contrasts the various methods by which patients can be maintained in the community. This includes appropriate use of Sec.17 leave, guardianship, and of course, Community Treatment Orders.
Each section is heavily interspersed with examples from practice, as well as explicit references to legal issues, and also helpful reminders about other relevant legislation to bear in mind in certain situations, in particular, where the Mental Capacity Act may be considered, as well as checklists to guide one through each part of the overall process.

While experienced AMHP’s would probably not need to dip into this book that often, I would wholeheartedly recommend it as a very useful resource for AMHP trainees, social work and mental health nursing students, nurses, police, service users, and indeed anyone with a personal or professional interest in mental health  and the Mental Health Act.

Saturday, 9 February 2013

They Don’t Give ATOS: Public Accounts Committee Criticises Work Capability Assessments

It was reported yesterday (8th February 2013) that the Parliamentary Public Affairs Committee has severely criticised the Department of Work & Pensions for their handling of assessments of the sick and disabled claimants for their capability to work. Responsibility for conducting these assessments has been delegated to ATOS, which was paid £112.4m to carry out 738,000 assessments in 2011/12.

In a report published yesterday, it was stated:

The Work Capability Assessment process is designed to support a fair and objective decision by the department about whether a claimant is fit for work, but in far too many cases the department is getting these decisions wrong at considerable cost to both the taxpayer and the claimant.

The department's decisions were overturned in 38% of appeals, casting doubt on the accuracy of its decision-making.

Poor decision-making causes claimants considerable distress, and the position appears to be getting worse, with Citizens Advice reporting an 83% increase in the number of people asking for support on appeals in the last year alone.

We found the department to be unduly complacent about the number of decisions upheld by the tribunal and believe that the department should ensure that its processes are delivering accurate decision-making and minimising distress to claimants,

The report also stated: "The one-size-fits-all approach fails to account adequately for mental health conditions or those which are rare or fluctuating."

This is something I have written about on more than one occasion (two actually, and now three) in relation to those with mental health disabilities.

Increasing amounts of my time as a worker in a community mental health team are spent attending work capability assessments with mentally ill service users at the local ATOS centre (“local” is a relative term, as the centre is actually 30 miles away from my CMHT). I feel it is incumbent on me to attend these assessments as I know from bitter experience that if I do not, service users will frequently be taken off Employment Support Allowance and placed on Jobseeker’s Allowance, even though they also been assessed, separately, and by the DWP, as being entitled to high levels of Disability Living Allowance.

I have never understood why a service user who has already been through an assessment of their disability, then has to go through a further assessment of their capability to work. Actually, I’m being disingenuous here: I think it is very likely that the reason for being put through these continuous assessment processes (they often seem to occur on an annual basis) is in order to remove them from ESA and hence to reduce their benefits.

The statement in the report that the assessments fail to account adequately for people with mental health conditions certainly chimes with my own experience of these assessments.

If you had a problem with your kidneys, for example, you might expect to see a specialist urologist. But when you go as someone with a mental illness to an ATOS assessment, it has been my experience that the assessors, who usually appear to be general nurses, have woefully little knowledge of the nature of the person’s psychiatric diagnosis, or how that disorder might affect their ability to work.

Their assessments are entirely geared up to assessing physical mobility, or the ability to bend or lift or stand for periods of time. They do not know how to assess the capacity for someone with chronic paranoid schizophrenia to hold down a job, or how to assess someone with agoraphobia, or depression, or even chronic fatigue syndrome.

Unless such people have a representative, who can describe in more detail how their condition affects them on a day to day basis, they inevitably find themselves on Jobseeker’s Allowance, having to attend work focused interviews – and also inevitably failing at these, and therefore risking being removed from benefits entirely.

It is therefore no surprise that the report finds that CAB’s have encountered an 83% increase in assisting with appeals, nor that over a third of those appeals are found in favour of the service user.

I am glad that that the committee have highlighted these scandalous issues. I hope that the Government will take heed.