Social Work and Mental Health in Scotland
Since the inception of the Scottish Parliament in 1999, mental health law, policy, practice and ethos have changed dramatically in Scotland. This book provides a thorough grounding in the key issues in mental health and presents a clear picture of the current Scottish mental health scene. By highlighting the skills and values that are necessary for contemporary practice, it helps students to develop their knowledge and understanding to enable them to deliver an appropriate and responsive service for people facing mental health challenges.
- Front Matter
- Back Matter
- Subject Index
- Chapter 1: Perspectives, Ethics and Values in Mental Health Social Work
- Chapter 2: The Legal and Policy Context (I): The Mental Health (Care and Treatment) (Scotland) Act 2003
- Chapter 3: The Legal and Policy Context (II): Support and Protection of Vulnerable Adults
- Chapter 4: The Legal and Policy Context (III): The Law Relating to Mentally Disordered Offenders
- Chapter 5: Working with Vulnerable People: Mental Health and Disorder in Children and Young People
- Chapter 6: Working with Vulnerable People: Adults Who are Short-Term Service Users
- Chapter 7: Working with Vulnerable People: Adults who are Long-Term Service Users
- Chapter 8: Working across Organisational and Professional Boundaries
Transforming Social Work Practice – Titles in the Series
Applied Psychology for Social Work ISBN 978 1 84445 071 8 Collaborative Social Work Practice ISBN 978 1 84445 014 5 Communication and Interpersonal Skills in Social Work ISBN 978 1 84445 019 0 Courtroom Skills for Social Workers ISBN 978 1 84445 123 4 Effective Practice Learning in Social Work ISBN 978 1 84445 015 2 Groupwork Practice in Social Work ISBN 978 1 84445 086 2 Loss and Social Work ISBN 978 1 84445 088 6 Management and Organisations in Social Work ISBN 978 1 84445 044 2 New Directions in Social Work ISBN 978 1 84445 079 4 Practical Computer Skills for Social Work ISBN 978 1 84445 031 2 Reflective Practice in Social Work ISBN 978 1 84445 082 4 Service User and Carer Participation in Social Work ISBN 978 1 84445 074 9 Sexuality and Social Work ISBN 978 1 84445 085 5 Social Work and Human Development (second edition) ISBN 978 1 84445 112 8 Social Work and Mental Health (third edition) ISBN 978 1 84445 154 8 Social Work in Education and Children's Services ISBN 978 1 84445 045 9 Social Work Practice: Assessment, Planning, Intervention and Review (second edition) ISBN 978 1 84445 113 5 Social Work with Children and Families (secon edition) ISBN 978 1 84445 144 9 Social Work with Children, Young People and their Families in Scotland (second edition) ISBN 978 1 84445 156 2 Social Work with Drug and Substance Misusers ISBN 978 1 84445 058 9 Social Work with Looked After Children ISBN 978 1 84445 103 6 Social Work with Older People (second edition) ISBN 978 1 84445 155 5 Social Work with People with Learning Difficulties ISBN 978 1 84445 042 8 Sociology and Social Work ISBN 978 1 84445 087 9 Studying for Your Social Work Degree ISBN 978 1 84445 174 6 Thriving and Surviving in Social Work ISBN 978 1 84445 080 0 Using the Law in Social Work (third edition) ISBN 978 1 84445 114 2 Values and Ethics in Social Work ISBN 978 1 84445 067 1 What is Social Work? Context and Perspectives (second edition) ISBN 978 1 84445 055 1 Youth Justice and Social Work ISBN 978 1 84445 066 4
To order, please contact our distributor: BEBC Distribution, Albion Close, Parkstone, Poole, BH12 3LL. Telephone: 0845 230 9000, email: email@example.com. You can also find more information on each of these titles and our other learning resources at http://www.learningmatters.co.uk.
First published in 2008 by Learning Matters Ltd.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior permission in writing from Learning Matters.
© 2008 Steve Hothersall, Mike Maas-Lowit and Malcolm Golightley
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ISBN: 978 1 84445 130 2
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List of Abbreviations[Page vii]
ACVO Aberdeen Council of Voluntary Organisations AMP approved medical practitioner BASW British Association of Social Workers BMA British Medical Association BPS British Psychological Society CAMHS child and adolescent mental health services CBT cognitive behavioural therapy CFI Camberwell Family Interview CIPFA Chartered Institute of Public Finance and Accountancy CORO compulsion order with a restriction order CPA Care Programme Approach CPN community psychiatric nurse CSIP Care Services Improvement Partnership CSWO Chief Social Work Officer CTO compulsory treatment order DES Dissociative Experiences Scale DID dissociative identity disorder DoH Department of Health EC European Commission ECT electroconvulsive therapy EE expressed emotion EMCDDA European Monitoring Centre for Drugs and Drug Addiction EU European Union EVOC Edinburgh Voluntary Organisations Council GDS Geriatric Depression Scale GHQ General Health Questionnaire GIRFEC ‘Getting It Right for Every Child’ GP general practitioner GTCS General Teaching Council for Scotland HMIe Her Majesty's Inspectorate of Education HMSO Her Majesty's Stationery Office HUG Highland Users Group [Page viii] IAF Integrated Assessment Framework ICP individual care pathway IPT interpersonal therapy MAPPA multi-agency public protection arrangements MDO mentally disordered offender MHO mental health officer MHTS Mental Health Tribunal for Scotland MWC Mental Welfare Commission NES NHS Scotland Education NHS National Health Service NICE National Institute for Clinical Excellence NIMHE National Institute of Mental Health for England NMC Nursing and Midwifery Council ONS Office for National Statistics OPCS Office of Population, Censuses and Surveys OPG Office of the Public Guardian OPM Office of Public Management OT occupational therapist PHCT primary health care team PHIS Public Health Institute of Scotland QoL quality of life RMA Risk Management Authority RMO responsible medical officer SACAM Scottish Advisory Committee on Alcohol Misuse SACDM Scottish Advisory Committee on Drug Misuse SAMH Scottish Association for Mental Health SCID-D Structured Clinical Interview ScotPHO Scottish Public Health Observatory SiSWE Standards in Social Work Education SPDN Scottish Personality Disorder Network SSRI selective seratonin reuptake inhibitor SSSC Scottish Social Services Council SWSI Social Work Services Inspectorate TMS transcranial magnetic stimulation VNS vagus nerve stimulation WHO World Health Organisation
This book is a text for students of mental health social work and for those in related professions. We know of no other such exclusively Scottish text at this level and, as such, it appears to be unique. It may be used as a beginner's guide to mental health law and policy in Scotland and it may, therefore, be of value to practitioners of greater experience who come anew to the mental health arena. For example, practitioners contemplating taking the step up to Mental Health Officer training will find it very useful as an introductory orientation before beginning their MHO studies.
The book is a completely new edition of Social work and mental health (Golightley, 2006) which has been substantially revised to accommodate the Scottish mental health scene.
The question a reader might ask at this point is exactly how much revision was needed to shift the perspective from England/Wales to Scotland!
The answer is that since the inception of the Scottish Parliament in 1999, mental health law, policy, practice and ethos have changed so dramatically as to represent a quantum shift from what is happening south of the border. There were always some marked differences between Scottish and English/Welsh law and policy, but the advent of the Scottish Parliament in 1999 coincided with the movement for change in mental health service provision in Scotland gaining critical mass and it is possible that no other aspect of civil life in Scotland has been so dramatically overhauled since devolution.
It was therefore not just a case of changing all the references to law and policy in this book, substantial though that exercise was in itself. The very tone of much of the text has had to be changed to take account of what is now a very Scottish perspective. Some of this is reflected in the policy drivers to include recovery in all aspects of a person's journey through mental health services, the notion that everybody is entitled to find an individual personal solution to their mental health problems and to walk a path towards their own recovery. Some of the difference is found in the relatively different ethnic mix of modern Scotland as well as the fact that Scotland, while not free of racism and ethnic tensions, has so far not felt the impact of some of the major incidents like Clunis (Ritchie et al., 1994) and Bennett, which indicate large-scale problems in how mental health services are delivered to the black community. Some of the difference is also found in the institutions of the Scottish Parliament and the Scottish Government which diverge widely from aspects of Westminster.
Much of the crucial difference is, however, to be found in the rapidly changed law around mental health in Scotland which has necessitated making three new chapters out of the original one relating to the law in the original Golightley edition. Some of the tone of the original text has been altered because the close working relationship between health and social work partners in Scotland, while not devoid of tensions, make the old conflict between medical and social models of mental health and illness seem out of date.[Page x]
However, the most subtle and all-pervasive difference is in the shift in thinking about mental health which, early on in the book, causes the authors to have to explain the use of terms like mental health, mental disorder, mental illness and mental well-being.
The reader might now ask the question what has been retained from the original book? This book has kept the original text where it has not had to be revised by the above. It has retained the original structure and the focus upon social work, mental disorder, the medical perspective, the orientation to service users’ perspectives and to ethics, values and anti-discriminatory practice but reoriented these towards the uniquely Scottish developments referred to above.
It is hoped that this book conveys a flavour of the optimism surrounding mental health in Scotland despite the strange mix of prejudicial attitudes to people who struggle to maintain good mental health and the chronic and endemic poor mental health felt by vast numbers of the population (a strange mix because it is surely counter to self-interest for us to be prejudiced against something which is very likely to impact upon ourselves). Scotland is a relatively small place of about 5 million people. That means that much can be achieved on a manageable scale. However, this book is not merely an explanation of the wonderful steps towards improving the mental well-being of the population as it is also critical of the process and very open about discussing the huge problems faced.Chapter Outline
Chapter 1 introduces the concepts of mental health, mental illness and mental disorder. It discusses social work practice in relation to these concepts by way of introducing a discourse on values and an ethical base for practice. It gives illustration of this with recourse to race and ethnicity, disability and other attributes which amplify the problems experienced by service users. The chapter also introduces some different ways of understanding mental health and mental illness. Most notably it discusses the medical framework for understanding, diagnosing and treating mental disorder and the social orientation to understanding its impact upon individuals.
Chapter 2 discusses civil law in Scotland as it relates to mental disorder, with a central focus on the Mental Health (Care and Treatment) (Scotland) Act 2003 and the sources of human rights law.
Chapter 3 introduces the concepts of capacity and incapacity and relates them to the protective suite of legislation (Adults with Incapacity (Scotland) Act 2000 and Adult Support and Protection (Scotland) Act 2007.
Chapter 4 completes the introduction to what is often called ‘mental health law’. It focuses on criminal law aspects of the Mental Health (Care and Treatment) (Scotland) Act 2003 and the Criminal Procedures (Scotland) Act 1995. The chapter also focuses on risk assessment and management strategies and policy for mentally disordered offenders.
Chapter 5 discusses the policy and practice relating to child and adolescent services in Scotland.[Page xi]
Chapter 6 expands the discussion of practice-related issues by examining provision for people who receive short-term assistance. It centres on support for depression and prevention of suicide.
Chapter 7 continues the theme of practice in relation to the provision of longer-term assistance and service users with longitudinal needs. It focuses upon the case study of a man with schizophrenia.
Chapter 8 provides a focus on inter-professional working. It introduces wider issues relating to the dynamics of collaboration, examining some of the influences such as the legal and policy frameworks which facilitate effective partnerships.
It would just not be possible to provide comprehensive coverage for all aspects of mental health social work in a book of this size, particularly at a time of such rapid growth. Indeed, if you take the message of recovery to heart you might say that it is hardly possible to provide such coverage in any book because it would mean telling the stories and getting the opinions of every individual in Scotland who has personal experience of the struggle to maintain good mental health. We have therefore had to make choices about which key issues to relate to and we have chosen to draw focus on values and ethics, the differentiation of mental health from mental illness and related terms, some of the key perspectives on what we call mental illness, diagnosis, treatment and assessment, mental health law (both civil and in relation to the criminal law), the law relating to incapacity and adult protection, issues of support for children and young people and people with short-term and long-term problems and, finally, commentary on the importance of understanding the organisational context and collaborative working.
Throughout this we have threaded important themes for modern social work practice in Scotland: working alongside service users in a recovery oriented way; taking account of the service user's perspective and balancing it against the professional knowledge bases of doctors and social workers; and taking account of policy directives and shifts in emphasis.
In this list of the core contents of the text, there are many tensions which have to be resolved in practice. For example, the biochemical treatment orientation of the medical perspective is nowadays to be viewed less and less as the antithesis of the social perspective on mental health. However, there are undeniable tensions in that a doctor will always have a strong view based upon systematic medical knowledge of what a patient ought to do for his or her own good, while a social perspective might suggest that self-determination is what is best for any marginalised person in order for them to work towards inclusion. Buried somewhere in this conundrum is the problem of how to uphold the individual rights of the service user while sometimes having to enforce protective measures upon him or her. These tensions are evident in the two wings of policy: the one which encourages social inclusion, self-determination, anti-oppression and mental well-being, and the other which expands the powers to restrict the liberty of mentally disordered people who are vulnerable and at risk of harm by the imposition of compulsion.
We have highlighted these tensions and, in case studies and exercises, have encouraged you to think about how you might manage them in practice. What we cannot do in this or any book, is to resolve these tensions for you. You will need to do that yourself, by reference to your own knowledge and skills and to that of others around you. And we hope that this book will provide you with some assistance in that challenging but nonetheless rewarding task.[Page 176]
Adults with Incapacity (Scotland) Act 2000 (the 2000 Act) The 2000 Act gives powers to manage the finances, property and welfare of adults who lack capacity to determine their own choices in these matters because of mental disorder or physical disability which amounts to an inability to communicate. It contains major roles for the mental health officer (see below).
Adult (the adult) The term used by the 2000 Act for a person over the age of 16 years who requires the use of powers of the Act.
Approved medical practitioner (AMP) Under s 22(1) of the Mental Health (Care and Treatment) (Scotland) Act 2003 doctor is approved by Direction from the Scottish Ministers. Currently the Direction on Approval of Medical Practitioners states that they must have four years of experience working in psychiatric services and have undertaken special AMP training. They may then be subsequently approved by their employing health board as ‘having special experience in the diagnosis and treatment of mental disorder’(s 22(1), 2003 Act).
Behaviour modification Based on the idea of learning theory and conditioning. Intervention focuses on the relearning of behaviour.
BNF Stands for the British National Formulary reference text, which is published twice a year and contains up-to-date information about the maximum dosage of medication for patients. Hospital wards should always have the latest copy available.
Bolam test Where a health care professional is not considered to be negligent if s/he adopts the practice which a responsible body of professionals (e.g. psychiatrists, nurses or social workers) accept as appropriate.
CAMHS Child and Adolescent Mental Health Services.
CMHT Community Mental Health Team.
Cognitive therapy A treatment intervention, available on the NHS, that focuses on maladaptive patterns of thinking that affect the person's behaviour.
CPN Community psychiatric nurses are qualified and experienced psychiatric nurses who play a major role in the supervision and treatment of patients in the community. Along with MHOs, psychiatrists and others, they have a pivotal role in community mental health and outreach teams.
Criminal Procedure (Scotland) Act 1995 (the 1995 Act) The 1995 Act provides the framework in which criminal courts make their decisions in Scotland. As such, it interfaces with the 2003 Act to make decisions about the disposal of mentally disordered offenders who require care and treatment within the mental health services.
CSIP NIMHE (National Institute of Mental Health for England) has now been absorbed into a successor body, the Care Services Improvement Partnership (CSIP). CSIP embraces eight programmes. They are the National Child and Adolescent Mental Health Services (CAMHS) Support Service, Health in Criminal Justice, the Integrated Care Network, Integrating Community Equipment and Support, the National [Page 178]Institute for Mental Health in England, the Health and Social Care Change Agent Team, the Valuing People Support Team and Children for Change. It has an annual budget of more than £30 million. Website: http://www.csip.org.uk
Diagnosis Forms part of the assessment process and the identification of specific mental disorder in which reference is made to either the DSM-IV or to the ICD–10 reference texts both of which classify mental disorder.
Direction of the Scottish Ministers Directions are written requirements which are allowed by law. The principle Directions for the purposes of mental health law are those for the appointment of MHOs (s 32, 2003 Art) and AMPs (s 22, 2003 Act). They allow the Ministers to change or add to the requirements for appointment without having to change the law itself.
Expressed emotion This term is used usually in the sense that the family may have ‘high expressed emotion’ that is having an adverse effect on the service user. This includes over-involved parents and a highly critical atmosphere.
Family therapy The focus is on working with the family to restore the family system to a more functioning unit.
LA (local authority) Any one of the 32 Scottish local councils which provide a range of statutory local services including social work services
Levels of security There are three levels of security designated by policy for the in-patient management of mentally disordered offenders (high, medium and low security). There is one high secure unit and three medium secure units, shared by all health boards.
Mentally disordered offender (MDO) An MDO is a person who has committed or appears to have committed a criminal offence and suffers from a mental disorder.
Mental health officer (MHO) A registered social worker who has undergone a Scottish Social Services Council approved additional training course and meets the other requirements set out by Directions of the Scottish Minister under s 32 of the 2003 Act. In order to comply with the 2003 Act and ensure independence of role, the MHO must be appointed and employed by the local authority.
Mental Health (Care and Treatment) (Scotland) Act 2003 (the 2003 Act) The primary legislation in this area. It is primarily about the compulsory measures of care and treatment of people who are diagnosed as having a mental disorder.
Mental Welfare Commission for Scotland (MWC) An independent body the commissioners of which are appointed by Royal Appointment for a set period to undertake this statutory role. The MWC monitors the operation of the 2003 Act in respect of patients subject to compulsion. The MWC publishes an Annual Report and a list of Inquiries into Deficiencies of Care and Treatment. Commissioners and their officers regularly visit all hospitals in Scotland and meet with detained patients, those subject to compulsion or restriction in the community and adults subject to guardianship under the Adults with Incapacity (Scotland) Act 2000.
Mental Health Tribunal for Scotland (MHTS) The MHTS is an autonomous body the purpose of which is to hear applications for measures of compulsion and patients’ appeals against compulsory treatment orders, compulsion orders and other orders. It also reviews orders where there is no appeal. A Tribunal comprises three people: a legal member (chair), a lay member and a medical member.[Page 179]
Named person Clearly defined under s 250 to 254 of the 2003 Act. Named persons are nominated by people who are at risk of being subject to powers under the Act. They exercise protecting functions such as a right to be heard at Tribunal hearings.
National Institute for Clinical Excellence (NICE) Conducts research and evaluations of various treatments and publishes guidance and advice.
Office of the Public Guardian (OPG) The independent agency which registers, regulates and monitors financial powers under the 2000 Act.
NES NHS Education for Scotland
NHS National Health Service.
Patient The term used throughout the 2003 Act using the male pronoun. Social workers use the term ‘service user’, implying that more of a partnership exists between themselves and the user of the service, but ‘patient’ is still used as the term of reference in proximity to the Act.
PHCT Primary health care team or GP surgery.
Principles In the legal context, principles are those fundamental and overarching principles which must guide any action taken by those given powers and duties under that particular piece of legislation. They are statutory duties (see below) and, as such, any action performed by an agent of the legislation without regard to the principles will risk being unlawful.
Prognosis The medical assessment of the future course of events and probable outcome of the patient's mental disorder.
Psychoanalysis Based on Freudian thinking, the aim is that through the client/therapist relationship, people can resolve conflicted states of mind. Not (usually) available on the NHS.
Recovery Recovery is the term of preference to acknowledge that everyone who has a mental illness may and should be assisted to recover from the experience.
Responsible medical officer (RMO) The psychiatrist who has full clinical legal responsibility for a patient detained under the 2003 Act. They will usually be a consultant psychiatrist and approved under s 22 of the Act as having a special experience in the diagnosis and treatment of mental disorder.
Restricted patient The legal term used to describe a mentally disordered offender who has been placed under a restriction order with a compulsion order (a CORO) by the court. This means that the person cannot be discharged from the orders, nor can the measures of care and treatment be altered without consultation with the First Minister. Restricted patients will be mentally disordered offenders who have committed crimes of a serious violent or sexual nature.
Second opinion appointed doctor (designated medical practitioner) A registered medical practitioner (experienced psychiatrist) appointed by the MWC to provide an independent opinion in respect of consent to treatment under s 233 of the 2003 Act.
State Hospital The State Hospital is Scotland's only high security hospital for the care and treatment of mentally disordered offenders. It is located near to the village of Carstairs in South Lanarkshire and is sometimes referred to as Carstairs.[Page 180]
Statutory A requirement dictated by Act of Parliament, e.g. the 2000 Act or the 2003 Act.
Statutory duty A duty that must be complied with, if contained within an Act of Parliament.
Statutory instrument Relates to delegated legislation drafted by the relevant department under powers attributed by an Act of Parliament. Statutory regulations are most commonly drafted as Statutory Instruments and laid before Parliament.
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