Wednesday 19 October 2011

Talk of the Devil

As fast as I pressed the button to publish yesterday's blog we received the draft Code of Practice that I was talking about (follow this link). A quick read suggests that the Government has done a good job on most of this, including welcome detail on the 8 "life areas" and clarity about these being systematically considered in assessments of need. Two bits in particular need improvement I think...

(1) The guidance as drafted on completing a client's Care and Treatment Plan would lead some practitioners to believe that in many cases it would be sufficient to address just two or three of the "life areas" in the Plan. In fact clients need a plan for all the life areas (except, in some cases, clients' parenting or caring responsibilities). That is not to say that mental health services have to take action in all the areas - in many cases other agencies will be involved or indeed the clients may address areas of their Plan by themselves.

One example: if a client is comfortable that they can manage their own housing needs that does not mean the "Accommodation" life area should be left out of the Plan - because the client definitely needs a plan for where they are going to live in the coming months! Rather there should be a simple statement such as "x lives in a Housing Association flat and is confident that he/she can manage rent and services payments, general maintenance of the flat, and relationships with their landlord without support but will contact the Care Coordinator if problems arise". Job done.

A statement of this sort ensures that the "life area" is covered, recognises the responsibility of the client (which is appropriate and in itself therapeutic), and incidentally covers the practitioner very effectively if problems should arise.

By contrast if there is no mention of accommodation in the Plan it will be unclear whether this means (i) there is in fact no action required by mental health services or (ii) another agency's help is needed or (iii) indeed the client can manage for them self or (iv) the matter has just been overlooked or gone unrecorded. This is deeply unsatisfactory and unsafe considering a few words could have transparently cleared the matter up for everybody's benefit.

(2) The advice on the treatments for mental illness "life area" does not specify that both medical and other treatments (including psychological treatments) should be covered in the Plan. Otherwise, frankly, the common practice of not even considering non-medical treatments will persist for many or most clients.

If indeed either medical or non-medical treatments are not appropriate it would be good to read in the Plan words such as "It is agreed that psychological therapies are not appropriate at present". I know it can be argued that this will have been covered at the assessment stage but in practice it is vital to have this clarified in black and white in the ongoing Plan, not least so that at review the matter will be reconsidered.

Hafal's view originally was that there should be quite separate consideration of the two sorts of treatment in Plans rather than dealing with them together. Apparently the amalgamation came as a result of well-meaning people not wanting to dignify medical treatment too much as a distinct area. Understandable perhaps but in practice we risk losing due cosideration of non-medical treatments unless this matter is very clearly addressed in the Code.

I hope the Government, which should take great credit for painstakingly bringing forward this radical and ground-breaking legislation, will go the extra mile and improve the Code in order to prescribe without ambiguity a truly holistic approach to mental health which embraces the responsibilities of patients as well as of professionals and modern talking therapies as well as medicine.

Anyway, enough from me. I'm delighted to report that Lee McCabe, veteran campaigner for the Measure (indeed he's actually the person who instigated it as acknowledged by Jonathan Morgan, the former AM who got the ball rolling with the LCO) has agreed to dust off his armour like Cincinnatus and take the lead in a public campaign on the Code - watch this space...

Here's Lee chatting to the Minister last week: apparently she suggested he puts his role in initiating the Measure in his CV - good advice!