Response 8528707

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Barry Gale

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1. Our framework sets out 8 priorities for a new Mental Health Strategy that we think will transform mental health in Scotland over 10 years. Are these the most important priorities?

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If no, what priorities do you think will deliver this transformation?
My own experience of the mental health system is limited to caring for my elderly mother with dementia and my unsuccessful defence as Named Person in the MH Tribunal and appeal up to the Court of Session. Social and health services refused to rehabilitate her after a fall at home and invoked compulsory powers in the Mental Health Act to keep her in hospital against her and my wishes, to prevent me from caring for and mobilising her, without any evidence of failure in my care. She died needlessly in hospital in February 2016, among strangers, confined to the same building with only one supervised outing in 20 months. She was refused an examination by a willing independent specialist which could have saved her life. In my opinion the most urgent priority is A REVIEW OF MENTAL HEALTH LEGISLATION from the point of view of the Patient/Named Person. The public needs effective fairer legislation (not policy) based in human rights as viewed by the common man/woman rather than by health, social work and legal professionals. Current legislation gives far too much power to the state to intervene on the basis of what it considers to be "in the patient's best interests" rather than democratic imperative (ECHR Article 8). The legal system does not provide the Named Person with an effective means of challenging medical and Tribunal decisions before they are implemented, even when the issue is non-medical. National policies which support service users (eg the Standards of Care, the Charter of Rights for People with Dementia, the Triangle of Care/Equal Partners in Care) are ignored by decision-makers in the NHS, Social Work Departments, Office of the Ombudsman, Tribunals, and Courts. Those with a mental disorder should have the same absolute right to refuse treatment (if necessary through their legal representative) as someone with a physical disorder, and the same right to take risks in order to promote quality of life. Short term detention and compulsory treatment orders should be abolished so that health and social services are forced to co-operate with patients and their carers and formulate an agreed care plan, if necessary through arbitration. Compulsion is not compatible with a human-rights-based approach. Lack of control over one's own life is a major cause of mental disorder. The existence of willing family carers should provide a legal presumption against state intervention. Their ability to care, with state support, should also be a legal presumption requiring a separate finding to the contrary, on the basis of stated allegations and a hearing of evidence (facts not medical opinion) in court. The review of learning disability, autism and dementia within the meaning of "mental disorder" is not a priority. It is divisive and counter-productive. The law will become bogged down in medical or legal distinctions instead of being focussed on broad human-rights-based principles and the particular facts of each case. Special-interest groups for other disorders will campaign for equal treatment. ALL MENTAL DISORDERS SHOULD BE TREATED ALIKE UNDER THE LAW. Any intervention should be on the basis of significant risk and the democratic necessity of provision of medical treatment (see below), not medical or legal distinctions. Reviews which I think are needed include the meanings of "medical treatment" in s 329 and "significant risk" in ss 44 & 64 of the MHA 2003. Medical treatment should be restricted to therapeutic treatment which cannot be delivered by those who are not licensed medical practitioners, and should exclude personal care (which may only be delivered as ancilliary - see B v Croydon Health Authority 1995 Fam 133). Significant risk should exclude any risk which a person with mental capacity could lawfully take without being declared insane.

2. The table in Annex A sets out a number of early actions that we think will support improvements for mental health.

Are there any other actions that you think we need to take to improve mental health in Scotland?
OPEN VISITING should be implemented in all hospitals for physical as well as mental disorders. The involvement of family carers in feeding, medication, mobilising, physical exercise, outings - perhaps even bathing and toiletting - will promote rapid recuperation and early rehabilitation, and will smooth the transition back into the community. It will also relieve the demands on nursing staff.

3. The table in Annex A sets out some of the results we expect to see.

What do you want mental health services in Scotland to look like in 10 years' time?
I want health and social services to be services offered to the public, not authorities which impose their views on the public. That means an end to compulsory treatment and detention. I want to see patients having absolute control of (and responsibility for) their own mental health as they have of their physical health, and their absolute right to refuse any form of treatment being respected. I want to see the promises which have been made in policies such as the Charter of Rights for People with Dementia, the Standards of Care, and the Triangle of Care, enacted in law and enforceable in the Courts.