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Devastating HealthEast consultation: NSFT is breaking the law and ignoring NICE and Department of Health guidance

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The Outlaw

“Managers are in the impossible situation of holding medical recommendations for admission to hospital, but unable to comply with their duty under section 13 MH Act 1983. We have reached a point where Approved Mental Health Professionals (AMHPs) are no longer able to operate on a legal basis. Patients’ safety is being placed at risk, and their legal rights infringed. The Clinical Commissioning Group is in breach of its statutory duty under Section 140 of the 1983 Mental Health Act (as amended, 2007).”

“We would also like to draw the CCG’s attention to the following recent reports which – in our view need to be taken into account when evaluating NSFT’s service strategy:

1) The 2013 report of the National Inquiry into Suicide and Homicide in Mentally Ill People and – in particular – how it highlights the need for assertive outreach teams in order to reduce suicide rates: a service not mentioned in the Trust’s proposals.

2) The Care Quality Commission report ‘Monitoring the Mental Health Act 2012/2013, which highlights the shortage of acute psychiatric beds and the impact on both CCGs and Approved Mental Health Professionals (AMHPs) in relation to their ability to fulfil statutory duties.

3) The Government’s report ‘Mental Health Crisis Care Concordat’, 18 February 2014, and consider whether reducing two locally based CRHTs to one larger CRHT will enable the Concordat’s standards to be achieved.”

“In the absence of local beds, patients when detained under the Mental Health Act, are being sent hundreds of miles from their home in clear contravention of Article 8 of the Human Rights Act (right to family life).”

“The Mental Health Act 1983 code of practice (4.75) states “Primary Care Trusts (now CCG’s) are responsible for commissioning mental health services to meet the needs of their areas. They should ensure that procedures are in place through which beds can be identified where required”.

“In our view, the Clinical Commissioning Group is in breach of its statutory duty under Section 140 of the 1983 Mental Health Act (as amended, 2007):

It shall be the duty of every Clinical Commissioning Group (England) and of every Local Health Board (Wales) to give notice to every local social services authority for an area wholly or partly comprised within the area of the CCG or LHB specifying the hospital or hospitals administered by or otherwise available to the CCG or LHB in which arrangements are from time to time in force –
a) For the reception of patients in case of special urgency;
b) For the provision of accommodation or facilities designed so as to be specially suitable for patients who have not attained the age of 18 years.’

“Work under the mental health act has doubled in frequency of referral and length of time since 2 years ago. The reality is that last year a record number of people were assessed under the Mental Health Act (2012/13).”

“The failure of the CCG to ensure that beds are available for urgent cases is preventing AMHPs from carrying out their legal duty under Section 13, 1983 Mental Health Act to make an application when it is considered ‘necessary and Proper to do so.'”

“The Mental Health Act,1983, is predicated on the assumption that only 10% of the inpatient population will be detained. This premise is reinforced by the 5 guiding principles underpinning the 2007 reform of that act. In 2007, those principles were being upheld by NSFT: bed occupancy was lower than 80%, most of those patients were informal. This was enabled by properly functioning community teams. Now bed occupancy is constantly 100% or higher. The number of detained patients is always above 50%, usually running around 70-80%. Those principles have effectively been discarded and ignored by NSFT.”

“There is a miss-match between what NICE guidelines recommend is provided and the resources available to put guidance into practice.”

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