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Introduction
This document offers aspirational guidance on the implementation of the duties of local authorities under Sections 25-31 of the Mental Health (Care and Treatment) (Scotland) Act 2003. These Sections concern provision of care and support services as well as services to promote wellbeing and social development; the latter is often referred to, in shorthand, as 'Section 26'.
These duties have implications for many services delivered by local authorities, not only those directly concerned with social care.
Under Sections 25-31, local authorities are required to promote the wellbeing of, and provide services for, individuals who have or have had a mental disorder. The term 'mental disorder' includes mental illness, learning disability and personality disorder. Section 26, by promoting wellbeing, addresses mental health and not just mental disorder. This reaches every aspect of life that promotes wellbeing, rather than merely the alleviation of symptoms.
There is clear evidence that people with a mental illness, learning disability or personality disorder have missed out in the past, and ending this inequality will benefit everyone. The Act avoids categorising people by diagnosis. Through its use of the term 'mental disorder' it has broad reaching applicability. At any one time, one in six people has mental health problems, one in 200 has a psychotic disorder, whilst one in 25 has a personality disorder 3 and another 3% have a learning disability 4. Health and social care services have a duty toward family and informal carers to support people with mental illness 5. In fact, every single member of the population has an interest in positive mental health and wellbeing and social development.
Although the Mental Health Act does not use the term inclusion, Sections 25-31 create the need to move away from segregated services and to strengthen inclusive opportunities. For example, providing a service in a hospital for current inpatients will fail to reach all the people who 'have had' a 'mental disorder'. Thus, the most efficient way to reach all the people included under the Act is to focus upon universal services, rather than just specialist mental health provision. Further, the Scottish Government believes that the best way to implement the requirements under Sections 25-31 of the Mental Health Act is through the provision of integrated and inclusive services.
In order to fulfil these duties, changes are needed across the whole community and throughout the local authority. This aspirational guidance can help. It suggests some underpinning values for developing a coherent response, and indicates a practical way forward. It provides loose leaf ideas sheets for dissemination to the relevant departments and suggests ways of reviewing subsequent changes.
The changes needed involve a long-term process that must be multi-layered and tailored to each community. It cannot be achieved by simply requiring compliance with a rigid set of standards and that is why this guidance does not lay them down. Instead, it sets out a process that local authorities and other organisations can use together and over time to measure performance, agree goals and actions, and monitor progress.
It is important to recognise from the outset that this is designed to achieve much more than a single set of adjustments in policy and practice to meet the needs of a minority of citizens. On the contrary, it is intended to contribute to a long-term process of change, which will benefit the whole community. As such, it fits with the local authority's broad-ranging Power to advance wellbeing6 which enables local authorities to do anything they consider likely to promote or improve the wellbeing of their area and the people within it.
The Role of Mental Welfare Commission
The Mental Welfare Commission has a duty to monitor the Mental Health (Care and Treatment) (Scotland) Act 2003 and to promote best practice in its use. It does this through a number of mechanisms including meeting with people in the community who have a mental illness, learning disability, or personality disorder, to determine the types and quality of services that they are assessing. Feedback from people to the Mental Welfare Commission may help inform the knowledege base of the ways in which local authorities are meeting their duties under the Act.
Examples of good practice
Throughout the guidance, there are boxed texts which illustrate examples of good practice to provide real-world examples of services and actions that potentially would meet the duties under Sections 25-31.
Background to the document
There are several reasons why action is needed under these Sections of the Mental Health Act:
- There is an opportunity gap between the general public and people with mental illness, personality disorder or learning disabilities. This is unjust 7.
- Removing barriers to participation often leads to changes that make life better for us all.
- Scottish society will be enriched if everyone contributes.
- A diverse community with high levels of participation will enhance the positive mental health and wellbeing of the whole population.
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