Friday 20 August 2010

Measure for Measure

Dr Dai Lloyd's visit to Hafal Neath-Port Talbot reminds us that the deadline for getting amendments organised for the Mental Health Measure (Welsh law) looms (Dai chairs the Legislation Committee responsible for the Measure at this stage though we can't usefully lobby him on this one because as Chair he has to remain neutral). You can see some of Hafal's thoughts on amendments in this post but I wanted to support another point being put forward by the Mental Health Foundation - shouldn't there be a requirement in preparing care and treatment plans (under Part 2 of the Measure) for advance directives and similar expressions of wish to be properly taken into account?

(Advance directives - sort of living wills - are written documents which describe what patients want to happen if at some time in the future they are judged to be suffering from a mental disorder in such a way that they are deemed unable to decide for themselves or to communicate effectively. They can inform others about what treatment they want or don't want from psychiatrists or other mental health professionals, and they can identify a person to whom they have given the authority to make decisions on their behalf).

This sounds right to me and the suggestion should not scare the Assembly Government as it is wholly reasonable and does not have significant cost implications. Advance directives do not just provide a practical way to plan for crisis or relapse; they can also provide an important means for the patient to feel in control of their lives even if the directive is not required; and interestingly directives can actually authorise more assertive action where otherwise professionals and carers might have held back - if that is what the patient wants. I have met several patients who report regaining insight following a bad episode, making sense of what has gone on, and wishing their supporters had "gone in harder": they can set that out in a directive.

The idea that people with a mental illness may be better placed to work things out is not new. In Measure for Measure (geddit?) Duke Vincentio reminds us Many that are not mad / Have, sure, more lack of reason.

If we can only get this Measure right it could really make a difference...