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CONSULTATION PAPER ON THE MENTAL HEALTH LAW RESEARCH PROGRAMME

2. POLICY AND RESEARCH CONTEXT

2.1 Reforming mental health law

The new Mental Health (Care and Treatment) (Scotland) Act is the product of the first fundamental reform of mental health law in Scotland for more than 40 years. If it meets its aims, the Act will:

• promote more appropriate use of compulsory measures
• improve the treatment of patients subject to compulsory measures, without negatively affecting the provision of services for others
• promote greater respect for the human rights of patients
• increase the participation of users and carers in mental health care
• improve protection for vulnerable adults with mental disorder
• improve public safety and rehabilitation of offenders with mental disorder
• make the operation of mental health law more efficient, effective and robust

The process of reforming Scotland’s mental health law began with the work of the Millan Committee, set up in 1999 to carry out a detailed review of the Mental Health (Scotland) Act 1984. The Committee used a range of methods to gather information from as many different sources as possible, and made detailed recommendations for reform in their report New Directions¹ in January 2001. The Committee’s recommendations reflected the major changes to the context of mental health law in recent years:

• advances in patterns of treatment and care for people with mental health problems
• moves towards the greater involvement of service users and carers in all aspects of planning, treatment and care
• greater emphasis on the human rights of the individual

Importantly, the Committee also set out a series of principles which they stressed should underpin the development, implementation and operation of mental health law (Box 1, page 6).

2.2 The new Act

The Executive responded to the Millan Committee’s recommendations with the Policy Statement, Renewing Mental Health Law², which set out proposals for a new Mental Health Bill. The Bill was introduced in the Scottish Parliament in September 2002 and is expected to be enacted in April 2003. No target date has yet been set for the Act to be brought into effect, but this is likely to be sometime in 2004.

The new Act will introduce changes in the following areas of law concerning people with mental disorders:

• compulsory treatment
• the system for making decisions about compulsory treatment
• powers and duties of the Mental Welfare Commission
• duties of local authorities towards people with mental disorder
• arrangements for people with mental disorder within the criminal justice system
• patient representation
• safeguards for special medical treatments

A Mental Health Law Implementation Team has been set up within the Scottish Executive to prepare for the new Act. The team’s work includes:

• establishment of the new tribunal system which will make decisions about compulsory treatment
• development of guidance, training arrangements and information
• development of arrangements for monitoring, assessment and research

Information on the team’s work is available from the Executive’s mental health law website: http://www.scotland.gov.uk/health/mentalhealthlaw.

2.3 Mental health policy context

These major developments in mental health law are part of the more general priority given by the Executive to mental health issues. In recent years, the Executive (working with the statutory agencies, the voluntary sector and others) has introduced and developed a number of policies and initiatives to improve the planning, delivery and accountability of mental health services.

A Framework for Mental Health Services in Scotland³, launched in September 1997, laid out the principles and values that should inform the organisation of comprehensive mental health services. In 2000, Our National Health⁴ advanced and evolved the Framework agenda for change to reflect an added concentration on community based services and on attention to be paid to care responses and support for mild to moderate mental ill health. Our National Health also set the agenda for more effective partnerships between sectors, organisations and individuals.

Partnership for Care⁵ (2003) advances these objectives further, not least by the announced plans for mental health to be a client group for the Joint Future initiative (from April 2004) and the active promotion of care networks for the organisation of seamless care for users of mental health services. Partnership for Care also confirms steps to be taken to address a variety of workforce issues and recognises the important role for primary care in the organisation of seamless mental health care.

Mental health problems affect not only individuals, but families, communities and society as a whole. Achieving the goal of improving Scotland’s health therefore means addressing not just physical health, but also the mental health and well being of people and the communities within which they live. Commitments to health improvement made in Our National Health saw the beginning of an ambitious National Programme aimed at improving mental health in Scotland. The National Programme, further endorsed within Partnership for Care aims to:

• raise awareness of mental health issues
• promote positive mental health and well being
• promote effective prevention of mental health problems
• encourage and support action for early identification, and intervention when mental health problems occur

For more details, visit the National Programme’s website: http://www.show.scot.nhs.uk/sehd/mentalwellbeing/home.htm

A strategy for a separate research programme around the National Programme will be published and work will begin during the coming year.

While this research programme focuses on mental health law, the interaction between the various strands of mental health policy, and relevant research associated with them, will be important to its continued development.

2.4 The need for information and research

The Millan Committee noted that statistical information about the 1984 Act was inadequate to provide detail about how well the Act was working and recommended that the Executive should look at arrangements for the collection of statistics. The Information and Statistics Division of the Common Services Agency (ISD) collects, collates and distributes a wide range of National Health Service data sets. Since 2001 ISD has been carrying out a comprehensive review and analysis of the data on national mental health it assembles and processes. For more details of the Improving Mental Health Information Project, visit the website: http://www.show.scot.nhs.uk/isd/mental_health/mhipbase.htm

The Mental Welfare Commission has a statutory duty to be informed on various matters related to the detention of people with mental disorder. As part of the provisions of the new Act, the Commission will have a new duty to collect and publish statistical information, and is developing its information technology to make better use of the information it holds. For more details of the work of the Commission, visit the website: http://www.mwcscot.org.uk/.

The Millan Committee also suggested that the introduction of a new Act would be an ideal opportunity to begin a programme of targeted research. This would help to show how the new law was working and whether the aims of introducing it were being met.

It is intended that the research programme that is the subject of this consultation paper should be an integral part of comprehensive arrangements for monitoring and evaluating the operation of the new Act. The implementation team is therefore working with a range of interested parties to develop a coherent strategy for monitoring, assessment and research. The strategy, which proposes the development of an assessment framework for the operation of the new Act, is expected to be published in May 2003.

2.5 The research programme

The mental health law research programme is being developed and managed by the Executive’s Health and Community Care Research Team⁶.

The aims of the research programme are to:

• provide information to support the implementation of the new Act
• contribute baseline information to build understanding of the operation of the 1984 Act
• evaluate the operation and impact of the new Act
• evaluate whether the aims of introducing the new Act have been achieved, taking account of the expectations of all stakeholders

Development of the research programme began during Parliament’s consideration of the Act so that information could feed into the implementation process. It was also important to collect and analyse accurate information about the operation of the 1984 Act, once work was under way to improve the quality and range of statistical data available.

The research programme will continue until 2008, by which time the new Act will have been implemented, had the opportunity to bed down, and been the subject of evaluation. At different stages of the implementation process, different issues are likely to be relevant but, in the main, the monitoring, evaluation and dissemination of information will be an ongoing and organic process.

2.6 Introduction to the content of the research programme

Our starting point for evaluating the operation of the new Act is the Millan principles (Box 1, page 6). These principles provide a picture of an effective and fair system of mental health law and, as such, they will inform the design and analyses of all research relating to people with mental disorder and those who care for them.

The measures of the new Act will affect people in many of the professions engaging with people with mental disorder. New systems and service arrangements, and new and enhanced responsibilities for staff will all change practice. This has implications for recruitment and training, as well as for caseload and working patterns. The research programme will be looking to trace the effects of the new law on service structures and on service professionals, as well as on those who use mental health services.

We are fortunate to have a dedicated budget for research for several years as mental health law changes in Scotland. We must make sure that the money is used wisely. Mental health covers a wide range of issues and service arrangements and impinges on a spectrum of policy areas. Ideally, we would make the remit of the research programme as broad as possible to include all the factors that influence the way the law is used. The budget available will not permit us to do this, so we need to make sure that we cover the most important issues, and include the perspectives of all stakeholders. Where possible, links will be made with other programmes of research and assessment activities. (See Section 5 for examples of areas where this might happen.)

We hope that this consultation exercise will help us to set up relationships with stakeholders. A full research programme will be published after the consultation process is over and the responses have been analysed. However, this will only be the first edition: the programme will remain flexible and responsive, so we want to keep in touch with your views about the areas in which research might be helpful and the issues that should be covered. We also hope that individual people will want to be involved more closely: by providing particular perspectives to the research commissioning process, for example, or by participating in research advisory groups for individual projects.

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