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CHAPTER 6: IMPACT ON OTHER SERVICES
6.1 There have been significant impacts on other services because of MHCT Act work. It was suggested that: 'inevitably there have been casualties as the time pressures have begun to bite' ( MHO, Highland). The majority of respondents were able to identify impacts on their time because of MHCT Act work.
6.2 A shared concern of both psychiatrists and MHOs was the danger of a two-tier system developing for those with mental health problems. For those requiring the support and protection of the compulsory powers of the MHCT Act there would be an immediate response. For those requiring more informal support, longer waiting times appeared to be becoming commonplace.
6.3 Only those staff in dedicated posts were unable to say whether or not there had been an impact on the broader population, the majority felt there had been some impact, although levels of impact varied. One respondent felt they could not comment accurately on the impact on other groups of patients without more time to assess the situation.
PSYCHIATRISTS
6.4 As psychiatrists have had to focus more on the work surrounding detention applications other work was being cancelled, disrupted or rescheduled. For a number of professionals face-to-face patient interaction had been reduced. It was commonly cited by psychiatrists that clinics were being cancelled or re-scheduled, particularly because of the need to attend a tribunal hearing. For some this meant that more clinical and administrative work was being displaced into their own personal time/unpaid overtime (one consultant in Tayside estimated an average of 4-6 hours per CTO). It was argued that no allowances have been made for the extra time involved in following procedures under the MHCT Act. Other areas affected included multi-disciplinary meetings e.g.CPA, ward rounds, reviews, and contact with the broader mental health population.
6.5 Longer waiting times for clinic appointments and the cancellation of clinics had raised concerns as having the most impact on other patients, specifically non-detained patients.
'There has very definitely been an impact on the non-detained population. I tell people that the detained population gets the champagne service and the non-detained population gets the white cider service. If you were to ask folk who are serviced through our out-patient clinics what kind of service they have had over the last 12 months they would tell you not a particularly good one, they can wait ages for an out-patient appointment then have it cancelled at the last minute. We are just adding to waiting times with this kind of approach and not helping the general mental health of the client group' (Consultant Psychiatrist, Tayside).
MENTAL HEALTH OFFICERS
6.6 MHOs raised concerns about the long-term effect of working almost entirely on statutory work and the impact this may have on their ability to work closely with clients. It was noted that:
'Due to the volume of paperwork involved in completing statutory applications/reports a larger proportion of time is spent completing these than is spent in contact with clients/service users and their carers' ( MHO, Edinburgh).
'Direct and indirect contact time with patients, particularly those with informal status in hospital and in the community has been necessarily reduced. Impact on preventative work, undertaking social work/care management role is placed on the backburner when involved in MHO work. The role within the CMHT has changed as a result' ( MHO, Aberdeenshire).
6.7 This was compounded by the complexity of dealing with the demands of the MHCT Act as well as the Adults with Incapacity (Scotland) Act 2000.
6.8 For MHOs outwith dedicated posts broader social work tasks were not being undertaken and were given a much lower priority.
'Our responsibilities and workloads have increased so much with AWIA and the 2003 Act that this has outstripped our capacity. For example, my workload has gone from 20% MHO/80% SW to 80% MHO/20% SW. I think people too often forget about AWIA when thinking about workload impact' ( MHO, Argyll and Bute).
'Workload in terms of MHO duties has increased under the new Act. Under the old Act, MHO duties took up 25% of my time. Now more time is spent compiling SCR reports, attending one or two ward meetings to discuss CTO. More time is spent speaking to families regarding the use of STD and/or CTO. Now 80% of the time is MHO duty, including AWIA which takes up a lot of my time. I am now no longer able to take on community care cases as I need to be flexible to respond to requests for detention. All new [Act] work is a priority and other clients have to come second' ( MHO, Glasgow).
6.9 There were a small number of examples where social workers who were also MHOs had been taken out of general social work within their team to focus solely on their MHO function. This was as a consequence of the amount of work generated around the compulsory powers available under the MHCT Act. In these and other instances work not carried out by the MHOs was allocated to other staff within the team or clients were put on a waiting list to receive services.
6.10 For MHOs in non-dedicated posts it was noted that often they were unable to provide the general social work function to individuals either because of lack of time or specific service re-design in response to the implementation of the MHCT Act. This meant that often service users had two social work staff working with them, one to perform the MHO function and one to perform other social work tasks.
MEDICAL RECORDS STAFF
6.11 Medical records/administrative staff reported that there had been a significant impact both on their workload and on other activities. Administration of the MHCT Act was seen as being very time consuming. While no official figures are available (although in some cases audits were to be carried out to estimate extra workloads) staff stated that MHCT Act work was taking between 20% (Grampian) to 50% (Glasgow) more of their time. This was because the paperwork was more extensive and needed to be completed very quickly. While in a few areas additional hours had been allocated to accommodate the extra work or individuals were seconded to work full time on MHCT Act work, in a number of instances it was reported that other tasks had been affected.
'No longer give back-up within department for absenteeism. Existing staff must absorb the extra work. Other commitments now worked around the Act and take longer to be dealt with' (Medical records, Lothian).
'The time has to be found because of the tight timescale, other duties have been re-arranged and some tasks re-allocated through the other staff in the department adding pressure to their workload' (Medical records, Glasgow).
USING UNPAID TIME TO COVER WORKLOADS
6.12 The majority of psychiatric and MHO respondents indicated that while they had always had to use their own time to cover the workload, this had increased since October 2005. While some were able to access time-off in lieu arrangements to cover their time, others reported that this practice had proven impossible due to the day-to-day demands of the job. A number of psychiatrists reported using their own time to, for example, carry out ward rounds or complete paperwork after normal working hours.
6.13 Only two areas, Fife and Grampian, indicated that MHO staff were paid for any work undertaken outwith their normal working week. A number of staff indicated that they ensured that they never took work home with them as a matter of principle. The remainder of respondents felt that they had not had to use their own time. Some of this group worked within out-of-hour services, while the remainder were psychiatrists who had either not had significant detention experience or had the support of other staff, e.g. specialist registrars covering work that they personally could not undertake.
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