The Mental Health Bill: what it means for nurses

The Mental Health Bill, which was published in mid-November, gives new roles to nurses, and introduces safeguards to protect patients and the public.

The key measures introduced by the bill are outlined below.

Supervised community treatment (SCT)

SCT will enable clinicians to provide more effective support to discharged patients who were originally detained under the current Mental Health Act. The Bill proposes that, where appropriate, these patients should be given a care plan for SCT on discharge. If a person breaks any of the conditions of their plan – for example by failing to take their medicine or becoming violent – the clinical team will be able to readmit them.

Broader professional roles

Under the measures in the Bill, it will be possible for nurses, as well as psychiatrists, to be the clinical supervisor in charge of patients receiving SCT. This role replaces the responsible medical officer role.

Another new role, the approved mental health practitioner, will replace the approved social worker role. Again, it will be possible for nurses to act in this role, taking on responsibility for approving patient admissions.

New definitions

The Bill proposes a single definition of mental disorder and also gets rid of the current ‘treatability test’, whereby some patients are excluded from services if they are deemed not to have treatable conditions.

More safeguards for patients

Other measures to protect patients include the power to introduce an earlier automatic referral to mental health tribunals. Also, patients will be given the right to appoint an acting ‘nearest relative’. The Bill also introduces the Bournewood safeguards, which are designed to ensure that patients who lack mental capacity, for example those with dementia, aren’t deprived of their liberty when they are being nursed in a hospital or care home.

More choice for better mental health

'Our Choices in Mental Health', written in consultation with service users and carers, provides advice to patients as well as guidance for professionals. It makes recommendations in the four main areas where people want more choice, as follows.

Life choices

Mental health professionals need to consider all aspects of individuals’ lives and work with them and their carers to maintain their quality of life. This could include providing health promotion services to help people reduce risks and manage their illness.

Contacting mental health services

People should be able to choose how to contact mental health services, for example through community or self-help groups or via extended primary care services as well as through their GP. Advice to help users navigate the system and discuss their options should be easily available.

Assessments

Assessments should be based on a discussion of service users’ needs and the options available. Except in emergencies, everyone should be given a choice of the time, place and date of their assessment.

Care and treatment

Service users should be supported to make more decisions about care and treatment for themselves.

The report includes several examples showing how these improvements are already being achieved in many areas.

Help for parents with learning disabilities

Health visitors are being asked to give parents with learning disabilities a new book about caring for a baby.

Produced in 'easy read' format, 'You and Your Baby' uses graphics to help people who have difficulty reading and is designed to supplement the Birth to 5 book already given to all pregnant women.

Copies can ordered on 08701 555 455.

Disability Rights Commission DVD

A new report by the Disability Rights Commission (DRC) highlights "overwhelming" inequalities in primary care experienced by people with learning disabilities and/or mental health problems.

'Equal Treatment: Closing the Gap' - produced following an 18-month investigation - states that people with these problems have a greater likelihood of major illness, of developing health problems at an earlier age, and of dying earlier.

One of the reasons is thought to be that many patients with learning disabilities have difficulties gaining access to services and getting the necessary treatment and support.

Now the DRC has produced a training and awareness-raising DVD (order form here) for NHS staff, which highlights the NHS experiences of people with mental health problems and those with learning disabilities.

Producing a disability equality scheme

From December, the Disability Equality Duty requires all NHS organisations to produce a Disability Equality Scheme that describes how they will promote equality of opportunity for people with disabilities.

A new Department of Health guide, 'Creating a Disability Equality Scheme: A Practical Guide for the NHS', provides advice about how to produce such a scheme. It sets out the rationale behind the new duty, and explains the outcomes that the schemes should seek to achieve.

It also gives advice on the processes and actions required to produce and implement a scheme, as well as providing links to sources of further information and support.

Toolkit for assessing and improving diabetes care

The 'Diabetes commissioning toolkit', developed by the Department of Health in conjunction with diabetes charities and professional bodies, has been produced to help service commissioners in PCTs and practices take a strategic approach to improving quality of care and making the best use of available resources.

The first section of the toolkit provides advice on how to carry out a health needs assessment to help commissioners benchmark current services and prioritise areas for improvement.

It suggests questions to ask to build a picture of local need, for example:

• how common is diabetes locally?
• what are the risk factors and the health inequalities?
• how many diabetes related hospitalisations were there in the last year?

Section two outlines the core elements of high quality diabetes care, pointing to relevant quality markers such as NSF standards and NICE guidelines.

It also suggests key outcomes that commissioners might want to specify as part of the service provider’s contract. For example, key outcomes in relation to children and young people would include improved educational attendance and a reduction in acute admissions for ketoacidosis.

Identifying Problem Drinkers

Nurses could help more than 300,000 people a year to reduce their alcohol intake to low-risk levels by asking simple questions and offering brief information and advice.

The Alcohol Needs Assessment Research Project found that primary care teams tend to under-identify alcohol use disorders, especially in younger patients. Teams recognised harmful drinking in just one in 80 patients, and dependent drinking in one in 28.

Simply asking patients how much they drink is not enough to detect harmful drinking. The World Health Organization developed the Alcohol Use Disorder Identification Test (AUDIT), which has become the gold standard for identifying alcohol misuse. However, at 10 questions long, it can be time-consuming.

A one-question version - the Single Alcohol Screening Questionnaire - involves asking patients when they last drank eight units (for men) or six units (for women) of alcohol on one occasion. People who have done so in the past three months should be offered brief information and advice.

Research shows that when patients who are drinking at hazardous levels are given brief advice, one in eight will moderate their drinking to low-risk levels.