ITEM
SOCIAL SERVICES COMMITTEE
5TH JULY 1991
MENTAL HEALTH POLICY
REPORT OF THE DIRECTOR OF SOCIAL SERVICES
INTRODUCTION
VALUES
We believe that people with mental health problems, regardless of
the level of their disability have the same rights, and, as far as
possible, the same responsibilities as other citizens. They have a
right to and a need for a lifestyle similar to other people in
society.
We aim to ensure that people with mental health problems have access
to a range of high quality community based services which are local,
accessible, responsive to individual and carer needs, which as far
as possible allow people to live an ordinary life of their own
choosing.
PURPOSE OF OUR SERVICES
Our aim is to ameliorate the effects of people's mental health
problems by providing social care or enabling it to happen.
WHO ARE THE SERVICES FOR?
Many people will at some time in their lives have a significant
mental health problem. This usually resolves itself but help may be
required; support from a friend, counselling from a local voluntary
group, treatment from a GP, contacting local psychiatric services,
or the Social Services Department.
Up to one-third of the people in contact with us may have a
significant mental health problem. We are committed to ensuring
that staff in our Areas have sufficient skills and knowledge to
assess the needs of these people, to know when and where to refer
them on to another organisation, or to offer appropriate assistance.
However, this document focuses on people with serious mental health
problems who may be especially vulnerable and require specialist
mental health services.
This policy has implications for people using other departmental
services including those for elderly people or people with
disabilities. Whilst acknowledging this, the main focus for this
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policy is those people aged between 18 and 65 with a serious mental
health problem.
Services for people with drug or alcohol problems will be addressed
in another policy document.
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CARE IN THE COMMUNITY
For community care under the 1990 National Health Service and
Community Care Act to become a reality a strong network of community
based social and health care services will have to be developed to
meet users' and carers' needs. The national move away from
providing hospital centred mental health services is going to affect
these services in Hampshire to an increasing extent over the next
five years. 90% of the expenditure on mental health services in
this country is channelled through District Health Authorities and
most of this this is spent on hospital based services. This pattern
of expenditure is reflected in Hampshire.
NEW SERVICES, NEW SOLUTIONS
The kinds of social care services that we provide, or secure, must
reflect local need. In the past our expenditure on services for
people with mental health problems has been low compared to other
similar sized local authorities. To create new solutions to old
problems will require new types of service. We will be creative and
energetic in seeking all opportunities for funding.
This policy outlines the strategic ambitions of the Department in
this field for the next five years. It will be reviewed in
September 1992.
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PRINCIPLES
CONSUMER ORIENTATION
Services will be sensitive and will respond to the needs of
individuals and carers. The process for planning services, whether
for individuals or groups of people, will include the active
participation of people who use the service. They will respect the
dignity and the individual rights of users and carers, and will be
designed to increase the choices available to people locally.
QUALITY
We are committed to the highest standards. These standards will be
made known publicly, monitored and evaluated. Service agreements
will be made with provider organisations, and programmes of care
will be agreed with individuals. We will be open and responsive to
criticism. Standards will be consistent. Services will be
evaluated every year, and any changes made as required. A strong
commitment will be made to training. We will make public our
practice and procedures.
SENSE OF DIRECTION
All services will operate within the broad policy framework set out
in this document but each Area Manager will design and develop them
locally taking account of differing local needs, opportunities and
constraints. Policies and plans will be published, users and carers
will be given information about the service they will receive
including; the purpose, type, timescale and cost.
INTEGRITY AND EQUALITY
Whether planning, providing or evaluating services, certain values
must underpin the activities of our staff and other service
providers. These values will include honesty, respect, openness,
and an awareness on the part of the professionals involved of the
power they have compared with users and carers. This power must be
tempered by services which are enabling and empowering to users.
Services will represent the differing needs of people in terms of
their race, ethnic background, gender, and location. We will aim to
allocate resources fairly. This aim will be reflected in the
planning, staffing and delivery of services.
AN OPEN SERVICE
We will communicate the nature, extent and purpose of our services.
All care planning will involve users and carers. The accountability
for decisions and services will be clear. Procedures for making
complaints will be made available.
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CONSUMERS
POLICY
People with mental health problems and their carers will be
encouraged to participate in the planning and development of
services both at an individual and a service level. Advocacy and
self advocacy will be encouraged.
ISSUES
Together with our health colleagues we are committed to increasing
the participation of users and carers in the planning of new
services, the development of joint strategies and the planning and
programming of individual packages of care.
We recognise that there are obstacles to this. We need to avoid
`tokenism' and will discuss and agree ways of achieving meaningful
consumer participation with consumers and consumer groups.
STRATEGY
. We will plan to ensure that all users will have access to
advocates and are encouraged to advocate for themselves.
This will require training, information support and
resources.
. Each of our Areas will set up a mechanism for consultation
with individuals with mental health problems and their
carers. This will involve voluntary organisations and
representatives from user groups but we recognise that these
arrangements are not sufficient to ensure full consumer
participation.
. Each Area will be responsible in its Area Plan for stating
how it has taken issues regarding mental health services to
the users and carers in its area.
. Areas will ensure that a separate assessment of user and
carer needs is undertaken and used in planning and delivery
of services.
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RANGE OF SERVICES
POLICY
A balance of services will be provided which reflect the different
needs of a person with mental health problems at different times of
their life, at different times of day and at different points in the
week. We will work with District Health Authorities, voluntary
organisations and the private sector to ensure an appropriate
balance between hospital treatment, community treatment, housing
opportunities and social care.
ISSUES
We recognise that currently, social care services in Hampshire are
scarce. However, this provides an opportunity, with others, to
develop an effective range of new services.
All new services must be needs led rather than service led. They
will be flexible, adaptable, changeable, local and responsive to
individuals' social care and treatment needs.
By delivering the right sorts of social care, the need for
admissions to hospital or medical treatment can be reduced.
STRATEGIES
. High quality services currently being delivered will be
maintained but new services will be developed bearing in mind
the need to shift the balance of services towards social care
of a practical/ supportive/enabling nature.
. These new services will include home support services,
respite services, access to real work opportunities, day
services and care management.
. We will aim to secure a wider range of services by
encouraging voluntary organisations and the private sector to
create new social care services.
. We will continue to work with District and Regional Health
Authorities to `unlock' resources currently tied up in
hospital centred services in order to provide an appropriate
balance of hospital treatment, community treatment, housing
and social care.
. To ensure that training and information is provided for our
staff to facilitate the development, management and
evaluation of new services.
. All services will be accessible in terms of their location,
opening times, design, and how people can get there.
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. In identifying need, special attention will be paid to those
who have traditionally been unable or reluctant to use
services such as homeless people or people from other
cultures.
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WHERE PEOPLE LIVE
POLICY
People want to live in circumstances that are as ordinary as
possible where they may require different levels of service. People
will be encouraged to stay in, or move into, their own homes. A
range of accommodation and support will be developed with others to
reflect the needs and choices of individuals.
ISSUES
Appropriately supported housing is the cornerstone of high quality
community care. Poor housing contributes to mental health problems
while inadequate or inappropriate support compounds it.
This can result in people with mental health problems living in
inappropriate `accommodation' such as hospitals or prisons. Many
homless people also have mental health problems.
The funding of housing is complicated and ways of maximising access
to available monies need to be addressed.
STRATEGIES
. Each Area will review current provision and need with
district and city councils, voluntary organisations and the
private sector, health authorities and housing associations.
. From these they will develop a locality accommodation plan.
This will include stated partnership arrangements for the
development of new housing and associated services to meet
local needs at a local level.
. Links with our Independent Inspection Unit will be developed
to influence and contribute to the development of quality
care standards.
. Clear management arrangements for projects based on service
agreements will be developed with housing associations or
other organisations involved in this field.
. The department will not be a direct provider of housing but
will work with others to provide a range of housing and
associated services.
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RESOURCES
POLICY
Services will be promoted which shift the balance of provision from
hospital centred services to community based services.
ISSUES
In our department the budget for 1991/92 for all mental health
services is £2.5M. Across the six Hampshire District Health
Authorities the equivalent expenditure is approximately £30M.
Within available funding we are committed, with health colleagues,
to find ways of providing more high quality community services so as
to reduce the need for hospital admission.
In distributing new resources there is a need to ensure equality of
provision, reflecting local needs and demographic factors.
Given the number of people using our services who have a significant
mental health problem we must continue to increase Departmental
expenditure in this area.
STRATEGIES
. Actual costs will be identified and agreed for both social
care and health care services.
. We will develop a Departmental view on the distribution of
resources including the balance of services between urban and
rural areas.
. Local managers will identify and agree with the District
Health Authorities the social care element required within
the overall balance of local services.
. Current levels and types of service, service gaps and plans
to meet those gaps will be published annually in local Area
plans. This planning process will identify resources needed
in different localities.
. A high priority will be given to increasing significantly our
expenditure on mental health services by 1996.
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JOINT STRATEGIES WITH HEALTH AUTHORITIES
POLICY
We will be the lead agency in ensuring, though not necessarily
providing all social care. The voluntary sector will make a
substantial contribution. The department will work with District
Health Authorities and Family Health Service Authorities at
different levels to clarify our respective roles, to transfer social
care from health services and enable them to provide good quality
health care in community settings.
ISSUES
The District Health Authorities have separated into purchasers and
providers. It is clear that service planning arrangements need to
be developed with both the purchaser and provider sides. Agreements
with purchasers will be of a strategic nature, whereas agreements
with providers, endorsed by purchasers, will reflect agency
accountabilities for specific services.
STRATEGY
. Health and social services strategies for meeting identified
needs will be agreed with purchasers, within realistic
timescales for implementation.
. Local managers will clarify the respective roles of health
and social care services, management arrangements within
those services and accountability for those services with
providers.
. Decisions will be reached on whether a particular service is
principally a health or social care service with both
purchasers and providers.
. We will work with others to establish local forums within
which local service users, carers, voluntary organisations
and the private sector and the statutory agencies can discuss
and promote service development based on local needs.
. A local manager will be responsible for ensuring that the
Social Services contribution to the Care Programme Approach
works effectively in each District.
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CARE MANAGEMENT
POLICY
Our care management will be based on the separate assessment of
individuals' and carers' needs, the design of packages to meet those
needs, and the identification of gaps in services. Care management
will form the basis of all our services and will target people with
serious mental health problems.
ISSUES
There has been much discussion on how services can best meet the
needs of individuals. Care management is a process which seeks to
make services flexible to ensure these needs have the best chance of
being met. It links assessment of a client's strengths and needs
with the capacity to purchase a tailor made `packages' of care.
From April 1991, District Health Authorities have had to introduce a
system of assessment and review for patients using their mental
health services who are assessed as being vulnerable. This system
is called the Care Programme Approach. Care management will need to
follow on from, and be linked to, this approach.
By identifying services which are needed, but not yet provided, this
individual assessment, linked with the ability of managers to buy
services on a block or individual basis, will be the key in
unlocking the monies tied up in existing services.
STRATEGY
. People subject to the Care Programme Approach will be
targeted as the focus for social care which may be provided
through care management.
. All Areas will be expected to develop care management
"potential" involving training, staff, health colleagues and
colleagues in the voluntary sector in order to develop new
skills such as service costings, budgetary control systems,
and assessment methods.
. IT resources will be developed to enable improved data
collection, costing, review and assessment processes.
. Care management will be needs led, will involve users, carers
and advocates in an open process.
. An assertive co-ordinated approach to user follow up in the
community will be adopted.
. All vulnerable people discharged into the community will be
offered co-ordinated follow up.
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. Areas will promote the use of the Care Programme Approach in
individual cases and use the information it produces in
planning services.
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MENTAL HEALTH ACT
POLICY
In providing a high quality service for assessing people under the
Mental Health Act, we will seek actively to provide alternatives to
admission into hospital, where appropriate, and develop the
protective functions under the Act by the active management of
resources, clear practice policies and a commitment to continuing
training and support for all staff.
ISSUES
Our responsibilities under mental health legislation include the
assessment of people who may need to be detained in hospital for
further assessment or treatment. Our aim is the development of
alternatives to admission to hospital. We must also pursue the
least restrictive alternative, compatible with treatment and care
needs, when considering a compulsory admission to hospital. To
ensure this, we will manage approved social workers' (ASWs) practice
and, with others, develop services which provide real alternatives
to hospital admission where appropriate.
STRATEGIES
. Clear practice guidance for all statutory duties under the
Mental Health Act 1983 will be given. This will establish
clear standards on competent practice for all ASWs, duty
social workers and managers.
. All Areas or groupings of Areas providing ASW cover will
produce an annual workforce and training plan.
. Each Area will identify one manager to be responsible for the
provision of its ASW service.
. All ASWs will undertake substantial current planned work with
people with mental health problems.
. Quality assurance systems for activities in this area will be
designed and implemented.
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INFORMATION
POLICY
The Department will develop information systems to assist the
planning of services which will reflect the varying needs of the
communities we serve. This will include the translation of
publicity material into other languages and when needed, or
requested, the explanation of any material, process or fact.
Departmental policies and procedures on client access to records
will be followed at all times.
ISSUES
High quality service planning requires good information on needs to
be available to people who plan the services. Good quality
information on services which are available must be given to the
users of the service and their carers to ensure they are able to
make informed choices on services they need.
As there are other organisations involved in the planning and
delivery of services,compatible systems of data collection and
information dissemination must be devised to ensure the development
of effective and appropriate services.
STRATEGY
. All our records, wherever possible, will be open for people
to whom they relate.
. Where possible, joint recording with health authority and
voluntary organisation colleagues will take place.
. Representation for users and carers will be encouraged,
particularly in the process of agreeing particular care
programme approaches. How users are involved will be
monitored.
. District based assessment of needs will be generated to form
the basis of planning for social care provision with health
colleagues.
. Where we are working in multidisciplinary teams we will share
information as appropriate with colleagues from other
disciplines.
. Information on services will be translated into other
languages, clarified and made available.
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PREVENTION
POLICY
We will work with others to develop services which will prevent
mental health problems arising which would otherwise lead to the
need for specialist psychiatric services and social care within the
Care Programme Approach.
ISSUES
Some individuals with mental health problems may not need specialist
psychiatric services or social care if they have ready access to
appropiate advice, information and counselling. People having
recovered from a serious mental health problem may also need such
assistance.
STRATEGY
. Areas will develop plans in conjunction with District Health
Authorities, District Councils, Family Health Service
Authorities and others to create realistic and appropriate
services which will diminish the need for social care and
intervention by the specialist psychiatric services within
the Care Programme Approach.
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OFFENDERS WITH MENTAL HEALTH PROBLEMS
POLICY
We will work with other agencies to develop effective services which
divert people with mental health problems away from the criminal
justice system, where appropriate.
ISSUES
There are widespread anxieties about the number of offenders in
prisons with mental health problems. Without an agreed
"gatekeeping" policy between the agencies concerned, including the
police, the District Health Authorities, the Crown Prosecution
Service, Social Services and Probation, many such individuals will
continue to be imprisoned unnecessarily.
STRATEGY
. A manager in each Social Services District will undertake a
responsibility to appraise the need, with headquarters and
other agencies, for diversion policies and services within
the District.
RECOMMENDATION
That the report be noted and that the Mental Health Policy be
approved.
B085CR91
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