Welcoming the White Paper on reform of the Mental Health Act Marjorie Wallace, Chief Executive of SANE, said:

"We are pleased that the proposals will end the out-dated polarisation between hospital and community"We are disappointed that it does not seem likely that they will provide positive rights to treatment and involvement of families and carers.

"SANE does not wish to see any further compulsion. The greatly increased use of compulsion we have seen in recent years is due to the lack of early intervention and to impoverished community and in-patient care. The way forward is not more safeguards but a revolution in attitude and more resources.

"We need to replace the lost concept of asylum and ensure the beds, the supported places and far more skilled staff to provide the rigorous risk assessment and care needed."

SANE believes that people with mental illness should be accorded the dignity and respect of being given an option for treatment, and wishes to see a duty to provide care imposed on mental health services in the new Mental Health Act. SANE wishes to see compulsion for service users minimised by ensuring early intervention and providing modern mental health services and new, more targeted medication and therapies.

Currently one in three people who seek help are turned away from services. Many of the thousand people a week who call our national helpline SANELINE give graphic evidence of this, with families and carers often feeling there is nowhere to turn. If a person who is ill fails to keep an appointment or appears not to co-operate with the system, they are all too easily allowed to lose contact with services. SANE believes that mental health services must be legally required to respond to requests for assessment and treatment, and to provide more pro-active care for those already receiving services to prevent vulnerable people being lost or neglected in the community.

SANE believes that compulsion should always be a last resort, and that the need for it would be greatly reduced by more rigorous risk assessment, more imaginative and responsive services, and more consistent and skilled supervision. People should be encouraged to use services voluntarily by improving in-patient and out-patient facilities and providing new, more targeted medication combined with other therapies.

The 1983 Mental Health Act was drawn up at a time when the majority of mentally ill people were in institutions, to give them sorely needed rights. SANE's Balance of Rights campaign called for families, partners and other carers to have their own needs assessed - now granted in the Mental Health National Service Framework - to be given sufficient information, and to be involved where appropriate in key decisions.

Where they are not taken into the confidence of the person for whom they are caring, families and carers can find themselves caught in a lonely circle of ignorance. It is the vision of SANELINE to combine emotional support and crisis support with practical information, to give families and carers as well as service users options for action. This is what SANELINE and our Caller Care service seek to do through listening support informed by the wealth of information about services and local support groups on the SANELINE Information Database.

SANE's analysis of more than 30 inquiries into homicides involving people in contact with mental health services revealed that in over half of all cases, carers' direct concerns regarding the patient's safety had not been taken seriously.

Over one-fifth of the calls to SANE's helpline SANELINE are from 'informal' carers, friends or relatives who support and many cases live with someone with mental illness. A recent survey of carers calling the helpline showed that the need for information was the main reason for calling, and that carers are three times more likely to contact SANELINE for information than service users. The type of information requested related to information on medication (32%), the availability of social support groups in the caller's area (24%); general information on mental illness (20%) and enquiries on legal matters and social security benefits (14%).

The majority of those included in the survey were already in contact with services, and a large proportion of those for whom they were caring had seen a mental health professional within the month preceding the call. The high proportion contacting SANELINE, despite their established links with statutory services, indicates that their information needs are not being met.

Marjorie Wallace, Chief Executive of SANE, said:

"We want to look at the culture of the care and treatment that are being brought to mentally ill people. We don't want to deprive them of the rights they and others have fought to gain, but we do want families to be able to have a night's peace or a week's respite"families are often left to take over the burden, but without the benefit of information or training.

"Information is not a cure for mental illness but we believe that knowledge can bring relief. By overcoming the impasse in which many families find themselves, we can bring reason and comfort into a world where reason has failed."

SANE welcomes the new resources being put into mental health services and endorses much of what the government is proposing in the Mental Health National Service Framework. But it considers it essential that the new measures target not only the politically visible minority who hit the headlines but provide a revolution in health care for all, looking beyond the law and guaranteeing the funding needed to achieve this.

SANE's priorities are:

• more psychiatric beds and twenty-four hour nursed units in small, modern centres of excellence able to provide assessment, diagnosis and high quality care in a therapeutic environment;
  
  

• recruitment and training of mental health professionals in sufficient numbers to allow manageable caseloads and acceptable bed occupancy levels;
  
  

• and accommodation in the community staffed by trained and experienced mental health professionals able to provide risk assessment, care and supervision, if necessary on a twenty-four hour basis.
  

Until supported accommodation in the community, trained mental health professionals and beds in 24-hour nursed units and hospitals are made available in sufficient numbers, care in the community will not be able to cater properly for people with acute mental illness. Resources need to be backed by recognition that acute mental illness needs to be taken seriously at all times. Everyone concerned - the patient, the family or carer, and the professionals - need to be aware of the possible manifestations of acute mental illness, of the potential need for more intensive treatment and support, and the possibility of relapse.

Marjorie Wallace, Chief Executive of SANE, said:

"We hope the legislation will recognise that the landscape of mental health has changed dramatically, that it is no longer a question of institution versus the community. The reality is that people have to move between hospitals, supported accommodation and the community, and may need to go back to hospital. We have to cater for all levels of independence, supervision and security. We hope the new proposals will recognise this. If they do, it should make it easier for people to get hospital care voluntarily and with less stigma, and reduce the need for compulsion."

"Assessment, care and treatment must be given legally binding reality, with sanctions on services which fail to provide them. Where rights cannot be included in the new Mental Health Act itself, they should be reflected in good practice guidelines in a Code of Practice with teeth."


Marjorie Wallace on mental health white paper - Epolitix, 20 December 2000