Private and Public Protection: Civil Mental Health Legislation

Private and Public Protection: Civil Mental Health Legislation

Private and Public Protection: Civil Mental Health Legislation

Private and Public Protection: Civil Mental Health Legislation

Synopsis

Direct payments are cash payments made in lieu of social service provisions, to individuals who have been assessed as needing services. The implementation of direct payments in the UK in 1997 represented a major victory for the disability movement in securing enhanced choice and control in service provision. Successive governments have promoted direct payments as part of wider strategies to develop local care markets and enable a 'personalization of care.' Since 1997, a number of changes have emerged to the original policy framework, allowing wider access and a more diverse user population. While these changes have occurred across the UK, different take-up patterns have emerged in the various UK countries where administration of social services have devolved. In exploring these patterns, this study focuses on the impact of direct payments in Scotland. Drawing on findings from a major UK wide two-year study of direct payments, the authors highlight some of the key tensions which have characterized policy implementation in Scotland, alongside a comparative overview with the rest of the UK. The approach adopted in the UK has features that are of interest to those contemplating effective methods for care provision in other States.

Excerpt

The Mental Health (Care and Treatment) (Scotland) Act 2003 (MHCT Act, or, unless otherwise stated, 'the Act') came into operation in October 2005 to broad support, concerns about particular areas and some considerable anxiety about how it would affect services. Based on ten principles, it seeks to protect patients, both by strengthening their rights and seeking to preserve autonomy, but also by ensuring that people who are at significant risk and unable to make a competent decision about their medical care receive treatment – something that can be seen as protecting the public as well as the patient. Although public risk is usually seen in terms of direct risk to individual safety, society has wider concerns, and caring for people unable to do so for themselves may contribute to wider benefits.

This book only deals with the civil aspects of the new Act, and even then there is not space to do justice to its entirety, so some broad areas have been chosen. the Act is put in the context in which it came into being. the introduction of the tribunal system is such a material change that it cannot be overlooked. the introduction of community-based compulsory treatment orders was one of the most controversial elements and requires consideration. Advance statements, which have been greeted with enthusiasm in some quarters and could radically support patient autonomy and participation, may not live up to their expectations. the role of relatives has changed significantly with the introduction of the named person. Lastly, there is the impact on services and concern about the development of a two-tier service. Running through all these is the application of the underlying principles. the Act is a brave attempt to balance the interests of individual patients and the wider society. Time will tell how well it succeeds.

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