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Contact: Neil Lovell 02380-241336 [email protected]

1. Summary

This report summarises the work undertaken by Approved Social Workers (ASWs) in relation to assessments under the Mental Health Act 1983. It includes the County Council's use of Guardianship under the Mental Health Act and a summary of the last visit of the Mental Health Act Commission on 20 March 2003. This report also meets local requirements for an annual progress report on the use of Guardianship and a National Service Framework expectation that information on the operation of the Mental Health Act is reported to Boards.

2. Introduction

2.1 The County Council has a duty under section 114 of the Mental Health Act 1983 to appoint a "sufficient number of Approved Social Workers (ASWs)" to carry out its responsibilities under the Act, namely to assess those suffering from mental disorder (as defined by the Act) for possible admission and if necessary, detention to a psychiatric hospital. Section 3 of this report summarises the number of ASWs working for the Council, the work undertaken by ASWs and the current issues affecting recruitment and retention.

2.2 The majority of Hampshire's ASWs are based in adult Community Mental Health Teams (CMHTs) which are integrated services between Hampshire Social Services and Hampshire Partnership NHS Trust (for the most of the County) and Surrey Hampshire Borders NHS Trust for North-East Hampshire.

2.3 ASWs also assess clients for possible reception into guardianship under section 7 of the Mental Health Act 1983. Guardianship provides a statutory framework to support a client's care in the community. Sections 4-7 of this report provide a summary of the powers provided by Guardianship and the number of current Guardianship orders together with the number of new orders accepted by the Council between 1 January 2002 and 31 March 2004.

2.4. The final section of this report summarises the last visit of the Mental Health Act Commission to Hampshire Social Services on 20 March 2003 together with progress against the recommendations made by the Commission.

2.5 The Council's duties under the Mental Health Act support Aims 4 and 6 of the Corporate Strategy (Building Strong and Safe Communities and Developing Councillors and Staff). ASWs assess clients at a time when they are most vulnerable and most at risk of suicide or other self harm, exploitation, neglect or harm to others. ASWs assess risks to both clients, family, carers and the wider community and act to reduce that risk (by compulsory admission to hospital if necessary).

2.6 The impact of Mental Health policy and practice on ethnic minorities is a major concern of the National Service Framework. Research shows that nationally there is a disproportionately high use of the Mental Health Act to detain people from Black and Minority Ethnic Groups. The Hampshire data for Mental Health Assessment and for Guardianship Orders is shown in Tables 2, 5 and 7.

2.7 The Government is planning to publish a new Mental Health Bill in the Autumn. The proposals are likely to include Approved Mental Health Practitioners (instead of just Social Workers), community treatment orders, and measures to comply more fully with human rights legislation. Implications of the Bill will be considered by the County Council and a response will be made on the draft Bill to a Joint Committee appointed by Parliament.

3. Approved Social Workers & Mental Health Act Data

3.1. The statistics in this report present the number of Mental Health Act assessments carried out in each area of Hampshire together with the number of ASW staff operating within each locality. Figures are also provided to demonstrate the number of assessments undertaken by the County's Out of Hours Service which provides an ASW service in the evenings, weekends and bank holidays across all localities within Hampshire County Council.

3.2 Table 1 in the Appendix provides a breakdown of the number of Mental Health Act assessments by locality and the care group of the client being assessed. It should be noted that the number of assessments on adult clients includes those with mental health problems as well as clients with a learning disability. The number of learning disability assessments is in the region of one or two per year per locality.

3.3 On average eighty per cent of assessments are on adults of working age, eighteen per cent on older people, and two per cent on children. There are currently two localities (Eastleigh and New Forest) who employ ASWs within older persons' teams. Plans to improve services for older people with mental health problems have recently been reported to the Executive Member and include proposals regarding the role of ASWs. There are significant differences between localities in the use of the Act with older people and adults. Explanations will require more detailed analysis, including trends over several years.

3.4 Table 2 gives a breakdown of assessments by Ethnicity. Overall, five per cent of assessments under the Mental Health Act were on people from black and minority ethnic groups. This compares favourably with a 4.6 per cent black and minority population in Hampshire, except in North East Hampshire, where the proportion of assessments on black and minority ethnic groups was twenty per cent. The majority of these were "other ethnic groups" and further investigations are in hand to identify this group.

3.5 Table 3 shows the number of practicing ASWs in Hampshire as of 31 March 2003 and 31 March 2004 to allow comparison. Table 4 shows the number of ASWs by locality and by care group as of 31 March and 1 July 2004. Figures are presented for 1 July to illustrate the change in the number of ASWs in some localities in this short space of time.

3.6 The New Forest in particular has lost a significant number of ASWs since March of this year due to moves internally within the Council, reducing from full time to part time work, or leaving to work for other authorities.

3.7 Since March two ASWs from other areas of the County have left the Council to work for a neighbouring authority. In both cases pay was one of the factors influencing the move to a higher paying local authority.

3.8 Although the results of Hampshire's Pay & Benefits review are awaited, the work on role profiling the ASW role is complete and Cabinet have agreed an interim pay award to ASWs with effect from 1 July 2004. ASWs within the County will now receive a market supplement payment of £3000 per year to ensure that the County remains a competitive employer for ASWs.

4. Use of Guardianship under the Mental Health Act 1983.

4.1 Adults' Services Sub-Committee 25 July 1997 agreed that the reporting of guardianship activity should be an annual summary report rather than the reporting of each individual guardianship case, as had previously been the format. The Committee also delegated its functions in relation to the acceptances into, renewals and transfer of guardianship under the Mental Health Act 1983 to the Director of Social Services (or nominated officer).

5. The Powers and Purpose of Guardianship

5.1 Section 7 of the Mental Health Act 1983 provides for guardianship with the local social services authority (or a named individual) on the recommendation of two doctors and an application by an approved social worker or nearest relative. Under section 37 a Crown Court can also make a guardianship order as a sentencing option for mentally disordered offenders.

5.2 Section 8 of the Act sets out three guardianship powers:

5.2.1 the power to require residence

5.2.2 the power to require attendance at a specified time for the purpose of medical treatment, occupation, education or training

5.2.3 the power to require access by a doctor, approved social worker or other person specified by the guardian.

5.3 Guardianship is used for a number of purposes e.g.:

5.3.1 Ensuring that there is a proper legal framework within which to make care decisions where a person lacks mental capacity (particularly older persons with dementia requiring residential care);

5.3.2 Encouraging younger persons with severe mental illness to stay in one place and not drop out of services;

5.3.3 Enabling access to be given to socially withdrawn individuals who would otherwise refuse services at home leading to neglect;

5.3.4 Preventing exploitation by relatives or other carers.

5.4 Guardianship does not, however, provide any powers in relation to financial affairs. There are several measures that could be taken if someone subject to Guardianship needed assistance and/or protection in dealing with their own finances:

5.4.1 If they did not have the mental capacity to manage their own finances an application could be made to the Court of Protection to appoint a Receiver to manage their finances. The responsible social worker would receive advice and assistance in this regard from the Receivership Unit.

5.4.2 If they had capacity but needed assistance with their benefits, the Benefits Agency could authorise a third party to act as Appointee in order to claim and collect welfare benefits to which the client was entitled.

5.4.3 Finally they could give Enduring Power of Attorney to the person or persons they wished to manage their financial affairs. If they then became mentally incapable of dealing with their own finances the Attorney would apply to the Court of Protection to register the Power as Enduring and take over the financial management.

6. Guardianship Orders in Hampshire County Council

6.1 In the period 2002-2004 a total of sixteen new guardianship orders were accepted by the County Council (eight each year). A breakdown of these orders by care group, gender, age, ethnicity, type of mental disorder, is found in Table 5.

6.2 As at 31 March 2004 there were nineteen guardianship orders in Hampshire (Table 6). Table 7 provides a breakdown of the total number of orders by care group, gender, age, and ethnicity as at 31 March 2004. The use of Guardianship has remained fairly stable over the last three years. There has been a slight decline from a high of twenty five in 2000-2001 to nineteen at end of March 2004. This is mostly due to a number of long standing Guardianship orders being discharged as the clients were settled and no longer in need of a statutory framework for their care.

6.3 The information in Table 7 summarises all current Guardianship orders as at 31 March 2004. Four of the clients subject to Guardianship under the learning disability category are allocated to a social worker within the adult mental health service due to their special needs.

7. Guardianship - The National Perspective

7.1 The annual figures from the Department of Health for the most up to date figures available are for the year ending 31 March 2003. In 1994 there were 487 ongoing guardianship cases, however the number had risen to 997 by 2001 although falling slightly in 2002 with 990 open cases at the end of the financial year. In the year to 31 March 2003 the national figures show another decrease with the total number of open cases falling to 975.

7.2 The national figures however continue to illustrate Hampshire County Council's positive and pro-active use of guardianship. In the South East Shire Counties and Unitary Authorities, Hampshire had the second highest number of open cases (seventeen) at 31st March 2003.

8. Mental Health Act Commission Visit

8.1 The Mental Health Act Commission last visited Hampshire Social Services on 20 March 2003. The purpose of the Commission's bi-annual visits is to review the provision of statutory services provided by Social Services in relation to clients assessed and detained under the Mental Health Act 1983 and to check on the progress of any recommendations for improvements to services made at their last visit.

8.2 The Mental Health Act Commissions visit concentrates on a number of key areas:

8.2.1 The provision of a sufficient number of Approved Social Workers (ASWs) to carry out the Departments responsibilities under the Mental Health Act 1983.

8.2.2 Issues relating to the training, development and support of Approved Social Workers.

8.2.3 Issues which may be impeding Approved Social Workers from efficiently carrying out their duties. (For example problems encountered with the Police or Ambulance Services).

8.3 The Commission's last report following their visit in March 2003 was overall very positive, highlighting only two recommendations which are listed below.

8.4 Recommendation One: "Consistent, regular and high quality professional development and training should be accessible to all ASW's."

8.5 Recommendation Two: "It may be useful for some additional time to be given to mutual negotiations between Social Services and Ambulance Services as overall the impression the Commission gained was that the obvious good-will and co-operation between services is becoming worryingly strained."

9. Action Plan

9.1 In response to the Commission's recommendations an action plan was devised to address issues of training and development for Approved Social Workers and to develop a forum in which issues relating to the interface between ASWs and the Ambulance and Police services could be discussed.

9.2 In response to recommendation one to improve the training and development of Approved Social Workers the Department agreed to achieve the following:

9.2.1 Review the current ASW Pathway, Appointment & Re-appointment policy relating the preparation and ongoing training and development of the County's Approved Social Workers.

9.2.2 Closer links to be developed with Bournemouth University in relation to the provision of Approved Social Worker training. The Commission highlighted concerns from ASWs around the organisation of the ASW training course from the previous year (2002).

9.2.3 Practice Development training days to be remodelled to more effectively meet the

9.2.4 Supervision and support of Approved Social Workers to be improved and given greater focus and attention through the appointment of Senior Practitioner Social Workers in every Community Mental Health Team; and the creation of a County wide Mental Health Senior Practitioner Network.

9.2.5 Changes to the commissioning arrangements for mental health training bringing it under the direct control of the mental health management team.

9.3 In response to recommendation two, liaison meetings with the Police and Ambulance Services to be restarted with senior management representation from those agencies.

10. Progress

10.1 The following progress has been made on each of the action points listed in section 9.2 and 9.3:

10.1.1 The new ASW Pathway, Appointment & Re-appointment Policy is currently out for consultation with the County's Approved Social Workers and Mental Health Senior Practitioners. The final version will be completed by end of August 2004.

10.1.2 Senior Management representation from Hampshire Social Services has now been achieved on the ASW Programme Management and Monitoring Boards for Bournemouth University. There has been positive feedback from the course participants this year about the quality of the training.

10.1.3 Practice Development days have been revised to ensure relevance to Approved Social Workers. Changes have also been made to the commissioning of legal update training for ASWs to ensure that they received yearly update training on developments in mental health legislation. The Department has also become a member of the Institute of Mental Health Law who provide monthly updates on developments in mental health law.

10.1.4 The Department has successfully recruited to fifteen out of the sixteen Senior Practitioner Social Worker posts. Arrangements are in place for all ASWs to receive regular supervision for their Mental Health Act work and the Senior Practitioner Network had its first meeting in January 2004. Senior Practitioners receive professional support and supervision from the Mental Health Practice Development Manager.

10.1.5 The commissioning arrangements for all mental health training courses within Hampshire are now under the direct control of the Project Manager for Mental Health Training and the Mental Health Practice Development Manager (for courses relating to Approved Social Workers).

10.1.6 Hampshire Partnership Trust's Criminal Justice Liaison Group provides a regular forum for liaison with Hampshire Police, Courts and Probation. This meeting is chaired by the Trust's Chief Executive and attended by senior representatives of the various Criminal Justice organisations and Hampshire Social Services. A sub-group of this meeting will provide a forum for Police and Ambulance services to discuss issues relating to Mental Health Act assessments. This sub-group will be established by September 2004. The Ambulance Service have recently been consulted and report that there is good cooperation between Social Services and the Ambulance service on matters relating to functions carried out under the Mental Health Act 1983.

11. Recommendations

That the Social Care Policy Review Committee:

1. Notes the activity information regarding ASWs and the steps taken by the County Council to strengthen Recruitment and Retention.

2. Notes the number of new Guardianship orders accepted by the Council since 1 January 2002 and the number of orders that continue to support clients in the community as of 31 March 2004.

3. Notes the action plan in response to the Mental Health Act Commission visit in March 2003 and the progress to date in addressing the Commissions recommendations.

4. Comments on the report and the County Council's response to its duties under the Mental Health Act 1983.

Background Papers

Section 100D - Local Government Act 1972 - Background Documents

The following documents disclose facts or matter in which this report or an important part of it, is based and has been relied upon to a material extent in the preparation of the report.

N.B The list excludes:

1 Published works.

2 Documents which disclose exempts or confidential information as defined in the Act.

Report of Mental Health Act Commission visit to Hampshire County Council Social Services on 20 March 2003.

Appendix - Mental Health Act Activity

Table 1: Number of Mental Health Act Assessments 1 April 2003 to 31 March 2004 by Locality and Care Group of client

Table 2: Number of Mental Health Act Assessments on Black and Minority Ethnic (BME) Clients 1 April 2003 to 31 March 2004

Table 3: Number of practicing Approved Social Workers per locality from 1 April 2002 to 31 March 2003

* Figures include 1 team manager still practising as an ASW

Table 4: Number of Practicing ASWs by locality and care group at 31 March 2004 and 1 July 2004

* Figures include 1 team manager still practising as an ASW

Table 5: New Orders - Acceptance into Guardianship in Hampshire

* Care group based on which team the client is allocated to

Table 6: All Guardianships in Hampshire

Table 7: All Current Guardianships in Hampshire as at 31 March 2004

Table 8: Use of Guardianship in South-East England