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Guardianship under the Mental Health Act 1983, England: 2013
- Author:
- HEALTH AND SOCIAL CARE INFORMATION CENTRE
- Publisher:
- Health and Social Care Information Centre
- Publication year:
- 2013
- Pagination:
- 16
- Place of publication:
- Leeds
Statistical report providing information about cases of guardianship under Sections 7 and 37 of the Mental Health Act 1983 in England. It contains information at national, regional and local authority level. Of relevance to anyone with responsibility for handling applications for guardianship or who is involved in monitoring uses of the Mental Health Act and the rights of people with mental problems. (Edited publisher abstract)
Implementation of the care programme approach across health and social services for dual diagnosis clients
- Authors:
- KELLY Michael, HUMPHREY Charlotte
- Journal article citation:
- Journal of Intellectual Disabilities, 17(4), 2013, pp.314-328.
- Publisher:
- Sage
- Place of publication:
- London
Care for clients with mental health problems and concurrent intellectual disability (dual diagnosis) is currently expected to be provided through the care programme approach (CPA), an approach to provide care to people with mental health problems in secondary mental health services. When CPA was originally introduced into UK mental health services in the 1990s, its implementation was slow and problematic, being hampered in part by problems occurring at a strategic level as health and social service organizations attempted to integrate complex systems. This article reports on a more recent attempt to implement CPA for dual diagnosis clients in one mental health foundation trust in a large English city. The Trust was implementing a joint mental health and intellectual disability CPA policy across five of its constituent boroughs. Semi-structured interviews with key informants at Trust and borough levels focused on the Trust’s overall strategy for implementing CPA and on how it was being put into practice at the front line. Documentary analysis and the administration of the Partnership Assessment Tool were also undertaken. Data were analysed using a framework approach. Progress in implementing CPA varied but overall was extremely limited in all the boroughs. The study identified six key contextual challenges that significantly hindered the implementation progress. These included organizational complexity; arrangements for governance and accountability; competing priorities; financial constraints; high staff turnover and complex information and IT systems. The only element of policy linked to CPA that had been widely taken up was the Greenlight Framework and Audit Toolkit (GLTK). The fact that the toolkit had targets and penalties associated with its implementation appeared to have given it priority. None of the contextual challenges identified in this study were specifically related to CPA as a policy or to the needs and circumstances of dual diagnosis clients. Nevertheless, they inhibited the types of organizational change and partnership working that implementing CPA for a client group of this kind required. Unless these more generic factors are acknowledged and addressed when introducing policies such as CPA, the chances of effective implementation will inevitably be compromised. (Edited publisher abstract)
Using the Mental Capacity Act in complex cases
- Authors:
- BROWN Hilary, MARCHANT Liz
- Journal article citation:
- Tizard Learning Disability Review, 18(2), 2013, pp.60-69.
- Publisher:
- Emerald
Purpose – The purpose of this paper is to explore the way that practitioners apply the 2005 Mental Capacity Act (MCA) in complex cases involving people with learning disabilities who cannot make some key decisions by themselves. Like many qualitative studies it began with a felt sense that practitioners were struggling to apply the clear framework set out in the Act to real life situations, and that some of the decisions they were faced with did not fit neatly into the linear, cognitive model of decision making set out in the MCA and its accompanying guidance. Design/methodology/approach – The study was conducted under the aegis of the Office of the Public Guardian (OPG) during 2010-2011. A number of “complex” cases were obtained from Social Services, Primary Care Trusts and other organisations and subjected to thematic analysis. The current paper focuses on the 16 cases that involved people with learning disabilities. Findings – A number of issues were identified that underlay the complexity of the cases examined. The cases drew attention, in particular, to the way in which practitioners were confronted with mounting concerns as opposed to single, discrete decisions, with the risk that decisions could be delayed until positive choices were much less available. Originality/value – The aim of the study was to support the use of the Act in these situations and to give practitioners confidence in applying its principles across a wide range of diverse circumstances. Although the original study specifically related to the English legislation, the factors that led people to consider a case “complex” would apply equally in other jurisdictions. The study also shed light on difficulties that arise when intervening in less formal ways. (Publisher abstract)
Commentary on “Using the Mental Capacity Act in complex cases”
- Author:
- DUNN Michael
- Journal article citation:
- Tizard Learning Disability Review, 18(2), 2013, pp.70-73.
- Publisher:
- Emerald
Purpose – The purpose of this paper is to comment on Brown and Marchant's analysis of the complexity that can arise when applying the Mental Capacity Act 2005 (MCA) to the care and support provided to people with learning disabilities. Design/methodology/approach – A theoretical approach to explore the implications of Brown and Marchant's paper for the relationship between the law and practice in this area. Findings – The complexity accounted for by Brown and Marchant lies in the tension between the procedural requirements of the MCA and the practical realities of the support provided to individuals with complex and long-term needs. This tension cannot be addressed simply by focusing on improving training or better implementing the law in practice. Originality/value – It is important to further examine and explore the relationship between new legal principles to govern decision making and the complex ways in which people with learning disabilities and other individuals need to be supported in practical situations. (Publisher abstract)