Hampshire County Council

Adult Social Care Policy Review Committee Item 10

29 March 2006

Use of the Mental Health Act 1983 2004/2005

Report by the Director of Adult Services

How the conclusion in this report fits with the Corporate Strategy

This scheme will impact on the delivery of the following Corporate Aims

Aim 4 - Building strong and safe communities is achieved through service developments described in the report that reduce risk to individuals with mental health problems, and in some cases to other people.

1.

Summary

1.1

This report summarises the work undertaken by Approved Social Workers (ASWs) in relation to assessments under the Mental Health Act 1983. including the County Council's use of Guardianship under the Mental Health Act. 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.

Impact Assessment

2.1

In compiling this report account has been taken of the requirements of the Corporate Equalities Plan and Race Scheme. An assessment of the requirements of black and minority ethnic communities under the National Service Framework was made in November 2004 and reported to the Policy Review Committee in January 2005. Since then Hampshire has been identified as a `Focused Implementation Site' for early implementation of Delivering Race Equalities in Mental Health, and this is included in the Local Area Agreement.

3

Introduction

3.1

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 4 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.

3.2

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

3.3

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 5-8 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 April 2004 and 31 March 2005.

3.4

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 ethnicity data for Mental Health Assessment and for Guardianship Orders is shown in Tables 2, 5 and 7.

3.5

The Government is currently preparing to present a new Mental Health Bill to this session of Parliament. This Bill will make provision for Approved Mental Health Professionals, extending the role currently undertaken by ASWs to other professions. It would also bring an end to Guardianship in its current form.

4

Approved Social Workers and Mental Health Act Data

4.1

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 in 2004/05. 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. It should be noted that since these statistics were collected the number of ASWs is planned to increase by twelve as a result of plans to establish new crisis resolution and home treatment teams, and an early intervention in psychosis team.

4.2

Table 1a 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. Data is available for the first time this year on the number of learning disability clients assessed. Table 1b contains the previous years data while Table 1c provides a comparison in the number of assessments by locality between the two years. There were 1272 assessments in 2004/05, an increase of 157 (fourteen per cent) over 2003/04. There are increases in all care groups, including children (an eighty nine per cent increase, from nineteen to thirty six ). For the financial year ending 31 March 2005 - 79% of all Mental Health Act assessments were on adults with mental health problems of working age (18 to 65). 18% were on clients aged 65 or over; 3% on children under the age of 18 and 1% on clients with learning disabilities.

4.3

Table 3 describes the number of ASWs in 2004/05. Overall the number of ASWs within the County has increased from 51 full time equivalent (FTE) ASWs to 55.6 FTE ASWs - an increase of 4.6. These are not new posts but represents recruitment into vacancies of appropriately qualified staff from other authorities and existing staff graduating from the Hampshire ASW training programme. The mental health social worker establishment has remained relatively static until very recent investment in social work posts from health. On 28 February 2006 there were 58 ASWs and 12 vacant posts.

4.4

Table 4 summarises the number of ASWs by care group at 31 March 2004 and 31 March 2005. Eastleigh & Test Valley South saw a reduction in the number of ASWs working in Older Persons due to the retirement of one of the workers. East Hampshire has seen an increase of 2 ASWs in Older Persons ASWs who graduated ASW training during the last financial year. East Hampshire also gained an ASW in Learning Disability services who was an ASW from another local authority appointed into a staff vacancy. As of 31 March 2005 there were 5 ASWs in Older Persons Services and 1 in Learning Disability services with the remaining 49.6 (full time equivalent) ASWs being based in adult mental health services.

4.5

Table 2a provides the details of the number of assessments of clients from ethnic minority communities being assessed under the Mental Health Act. Table 2b provides the data for the previous financial year while Table 2c provides a comparison between the two years. Overall 5.3% of all assessments were on Black and Minority Ethnic (BME) clients compared to 4.6% of Hampshire's population being from BME communities. Most localities number of assessments on BME clients are in line with their local populations - however the following stand out as being statistically significant differences:-

4.6

Eastleigh & Test Valley South has a local BME population of 5.9% compared to 8% of all assessments being on this community.

4.7

North East Hampshire has a BME population of 6.3% while the number of assessments on BME clients accounted for 17% of all Mental Health Act assessments.

4.8

The data for Eastleigh Test Valley South while appearing to be significantly higher (2.1% variance) is in reality only 6 assessments on BME clients during the 12 month period out of a total number of 71 assessments. The figures are too small to consider there to be any concerns for this locality.

4.9

The variance between 6.3% BME population and 17% BME assessments is far more significant in North East Hampshire. Investigations into the causes of such a large variance (10.7%) concluded that while the number of assessments on BME clients was much higher than would be expected compared to the local BME population figures - the actual number of individuals assessed was lower than the percentage figure suggests. Investigations concluded that a number of very unwell BME clients had been repeatedly assessed under the Mental Health Act during this 12 month period. The ethnicity of the clients assessed is also very broad with very few being from Black African ethnicity.

4.10

17 non White British clients were assessed in North East Hampshire during the 2004/2005 financial year. Their ethnicities are as follows:

4.10.1

1 refused to give information on their ethnicity.

4.10.2

4 Other European clients (1 Spanish, 1 Italian, 1 Portuguese and 1 Madeiran who was assessed several times)

4.10.3

2 Pakistani clients (1 admitted informally and one detained)

4.10.4

1 Black African client (assessed and detained twice during the year)

4.10.5

8 "Other" ethnicity which comprised of: 1 Algerian, 1 Thai, 1 Phillipino, 1 Burmese, 1 Tibetan, 1 African-Asian and 1 Asian-German.

4.11

Further research is being carried out to discover whether the client base of the community mental health teams and other specialist teams (eg. Assertive Outreach) have a higher proportion of ethnic minority clients compared to the population as a whole. Clients detained under the Mental Health Act represent a small percentage of the clients known to mental health teams. It stands to reason however that if the teams have a higher proportion of ethnic minority clients then the numbers being assessed under the Act will also be proportionally higher.

5

The Use of Guardianship under the Mental Health Act 1983

5.1

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).

6

The Powers and Purpose of Guardianship

6.1

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.

6.2

Section 8 of the Act sets out three guardianship powers:

6.2.1

the power to require residence

6.2.2

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

6.2.3

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

6.3

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

6.3.1

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);

6.3.2

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

6.3.3

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

6.3.4

Preventing exploitation by relatives or other carers.

6.4

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:

6.4.1

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.

6.4.2

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.

6.4.3

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.

7

Guardianship orders in Hampshire County Council

7.1

In the period 1 April 2004 to 31 March 2005 the County Council accepted ten new guardianship orders. A breakdown of these orders by care group, gender, age, ethnicity and type of mental disorder is found in Table 5.

7.2

Table 6 shows that at 31 March 2005 there were a total of nineteen people subject to the guardianship of the County Council. The total number of guardianship orders has remained constant over the year. Table 7 provides a breakdown of the clients by type of order, type of mental disorder, gender, age, care group and ethnicity.

7.3

The care group of the clients as at 31 March 2005 were as follows:

7.3.1

Older Persons: 4

7.3.2

Mental Health: 7

7.3.3

Learning Disability: 7

7.3.4

Children: 1 (sixteen year old client)

7.4

The ethnicity of the clients subject to guardianship as of 31 March 2005 were as follows:

7.4.1

White British: 18

7.4.2

Refused Information: 1

8

Guardianship - The National Perspective

8.1

The number of on-going guardianship cases in England and Wales in 1994 was 487. By 1997 this had risen to 997. At 31 March 2002 this was 990, for 2003 the figure was 975, 916 in 2004 and the most up-to-date data for the number of ongoing cases at end of March 2005 is 966. 966 open cases at the end of March 2005 represents a slight decrease of 3% from the previous year.

8.2

In almost all cases (99%) guardianship was conferred on the local authority, with the remaining 1% conferred on a named individual or organisation.

8.3

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 continues to have the

second highest number of open cases (19) at 31st March 2005. Kent

remains the highest user with 38 open cases at the end of the reporting

period.

Recommendation(s)

That

Members

1

Note the number of new Guardianship orders accepted by the Council since 1 April 2004 and the number of orders that continue to support clients in the community as of 31 March 2005.

2

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

Locality/ Service

No. of Mental Health Act Assessments

Adults

Learning Disability

Children Under 18

Older Persons

Total

No.

%

No.

%

No.

%

No.

%

No.

%

North East Hants

85

83.3

0

0

2

2

15

14.7

102

8

North Hants

134

73.6

0

0

0

0

48

26.4

182

14.3

Mid Hants

128

80.5

0

0

6

3.8

25

15.7

159

12.5

Eastleigh/TVS

54

76

1

1.5

3

4.2

13

18.3

71

5.6

New Forest

121

70.3

0

0

3

1.7

48

28

172

13.5

East Hants

78

68.4

0

0

4

3.5

32

28.1

114

9

Fareham & Gosport

107

77.5

5

3.6

2

1.5

24

17.4

138

10.8

Out of Hours Service

291

87.1

0

0

16

4.8

27

8.1

334

26.3

TOTAL

998

78

6

1

36

3

232

18

1272

100

Locality / Service

No. of Mental Health Act Assessments

ADULTS

(incl. LD)

OLDER PERSONS

CHILD < 18

TOTAL

No

% of locality

No

% of locality

No

% of locality

No

% of total

North East Hants

58

83

12

17

0

0

70

6

North Hants

115

67

54

31

4

2

173

16

Mid Hants

129

87

18

12

2

1

149

13

Eastleigh/TVS

75

88

10

12

0

0

85

8

New Forest

109

80

23

17

4

3

136

12

East Hants

125

79

30

19

3

2

158

14

Fareham & Gosport

81

66

41

33

1

1

123

11

Out of Hours Service

201

91

15

7

5

2

221

20

TOTAL

893

80

203

18

19

2

1115

100

Locality / Service

Total Assessments 03/04

Total Assessments 04/05

Variance between 03/04 and 04/05

% increase or decrease in assessments

North East Hants

70

102

+32

+45.7 %

North Hants

173

182

+9

+5.2 %

Mid Hants

149

159

+10

+6.7 %

Eastleigh/TVS

85

71

-14

-16.5 %

New Forest

136

172

+36

+26.47 %

East Hants

158

114

-44

-27.8 %

Fareham & Gosport

123

138

+15

+12.2 %

Out of Hours Service

221

334

+113

+51.1 %

TOTAL

1115

1272

+157

+14.08 %

Locality / Service

Ethnicity

Ban

BA

BC

BO

I

WI

W E/E

W O/E

O

R

RI

Total by locality

% of assess-ments on BME in locality

% of BME population in the locality

Gender

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

ALL

North East Hants

3

2

2

2

3

5

7

10

17

17.00 %

6.3 %

North Hants

1

1

1

1

1

1

2

1

1

6

4

10

5.00 %

6.2 %

Mid Hants

1

1

1

1

1

5

0

5

3.00 %

4.8 %

Eastleigh / TVS

1

1

2

1

1

2

4

6

8.00 %

5.9 %

New Forest

1

3

3

4

3

7

4.00 %

2.9 %

East Hants

1

1

1

2

1

3

3.00 %

3.0 %

Fareham & Gosport

1

2

1

4

0

4

3.00 %

3.3 %

Out of Hours Service

3

3

1

1

1

1

1

2

1

2

12

4

16

5.00 %

4.6 %

Total (by ethnic group)

1

0

5

3

4

0

4

0

4

3

3

2

3

3

7

5

11

10

42

26

68

5.00 %

4.6 %

Locality / Service

Ethnicity

Ban

BA

BC

BO

I

WI

W E/E

W O/E

O

R

RI

Total by locality

% of assess-ments on BME in locality

% of BME population in the locality

Gender

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

ALL

North East Hants

1

2

1

4

3

1

1

1

9

5

14

20.00%

6.3

North Hants

2

1

2

1

4

2

6

3.00%

6.2

Mid Hants

1

1

4

3

6

3

9

6.00%

4.8

Eastleigh / TVS

1

1

1

1

2

3

4.00%

5.9

New Forest

1

1

1

1

2

1.00%

2.9

East Hants

3

3

1

1

1

7

2

9

6.00%

3.0

Fareham & Gosport

1

1

0

1

1.00%

3.3

Out of Hours Service

2

1

2

1

5

1

6

3.00%

4.6

Total (by ethnic group)

9

1

3

1

1

3

4

1

1

2

1

6

4

7

5

1

34

16

50

4.00%

4.6

Ban: Bangladeshi

BA: Black African

BC: Black Caribbean

BO: Black Other

I: Indian

WI: White Irish

WE/E: White Eastern Europe

WO/E: White Other European

O: Other

R: Requested & unable to provide

RI: Refused information

Locality / Service

Total Assessments on BME clients 03/04

% of assessments on BME clients in locality 03/04

Total Assessments on BME clients in 04/05

% of assessments on BME clients in locality 04/05

Variance in total number of assessments between 03/04 and 04/05

Variance in % of assessments on BME clients between 03/04 and 04/05

North East Hants

17

17.00 %

14

20.00%

-3

+3%

North Hants

10

5.00 %

6

3.00%

-4

-2%

Mid Hants

5

3.00 %

9

6.00%

+4

+3%

Eastleigh / TVS

6

8.00 %

3

4.00%

-3

-4%

New Forest

7

4.00 %

2

1.00%

-5

-3%

East Hants

3

3.00 %

9

6.00%

+6

+3%

Fareham & Gosport

4

3.00 %

1

1.00%

-3

-2%

Out of Hours Service

16

5.00 %

6

3.00%

-10

-2%

Total

68

5.00 %

50

4.00%

-18

-1%

Locality

No. of ASWs at

31 March 2004

No. of ASWs at

31 March 2005

Changes to no. of ASWs

North East Hants

3.5

4

+0.5

North Hants

6

8.6

+2.6

Mid Hants

7.5 *

10.5

+3

Eastleigh & TVS

8

7

-1

New Forest

11

8.5

-2.5

Fareham & Gosport

6

6

0

East Hants

5

7

+2

Out of Hours Service

4

4

0

TOTALS

51

55.60

+4.6

Locality / Service

CARE GROUP

Adult Mental Health (AMH)

Older People
(OP)

Learning Disabilities (LD)

31/03/04

31/03/05

31/03/04

31/03/05

31/03/04

31/03/05

North East Hants

3.5

4

0

0

0

0

North Hants

6

8.6

0

0

0

0

Mid Hants

7.5*

10.5*

0

0

0

0

Eastleigh & TVS

6

6

2

1

0

0

New Forest

9

6.5

2

2

0

0

Fareham & Gosport

6

6

0

0

0

0

East Hants

5

4

0

2

0

1

Out of Hours Service.

4

4

0

0

0

0

TOTAL

47

49.6

4

5

0

1

1 Jan 2003

to

31 Mar 2004

1 Apr 2004

to

31 Mar 2005

No. of applications

accepted

8

10

Breakdown of Orders by:

1: Type of order

section 7

6

8

section 37

1

1

transfer from section 3

1

1

transfer from other LA

0

0

2: Mental disorder

mental illness

4

9

mental impairment

3

1

severe mental impairment

1

0

psychopathic disorder

0

0

3: Gender

female

3

7

male

5

3

4: Age

over 65

5

7

under 65

3

3

5: Care Group*

Older Persons

5

7

Mental Health

1

2

Learning Disabilities

2

1

6: Ethnicity

white British

7

8

white Irish

1

0

Black African

0

0

Black Caribbean

0

0

Black Other

0

0

Other ethnicity

0

2

No. renewed in period

2

2

No. discharged by

Responsible Medical Officer

1

2

No. lapsed

0

1

No. deceased

0

1

1 Jan 2003

to

31 Mar 2004

1 Apr 2004

to

31 Mar 2005

No. of orders renewed

18

15

No. of orders discharged by Responsible Medical Officer

4

7

No. of orders ended by section 3 admission

0

0

No. of people deceased

0

1

No. of orders allowed to lapse

0

4

No. applying to Mental Health Review Tribunal

1

2

Total number of people under guardianship at end of period

19

19

No. of orders as at 31 March 2005

Breakdown of Orders by:

1: Type of order

section 7

16

section 37

2

transfer from section 3

1

transfer from other LA

0

2: Mental disorder

mental illness

10*

mental impairment

9*

severe mental impairment

1

psychopathic disorder

1

3: Gender

female

11

male

8

4: Age

over 65

11

under 65

8

5: Care Group

Older Persons

4

Mental Health

7

Learning Disabilities

7

Physical Disability

0

Child & Adolescent Mental Health

1

6: Ethnicity

white British

18

white Irish

0

Black African

0

Black Caribbean

0

Black Other

0

Other ethnicity

0

Refused Information

1

Total number of people under guardianship at end of period

19