Friday, 11 December 2015

Review: Deprivation of Liberty Safeguards: A Best Interest Assessor Time Study

Cornwall Council’s much anticipated study, compiled and written by Emma Goodall and Paul Wilkins, was published at the beginning of December 2015.

This has obtained empirical evidence of the impact on BIA’s of the Supreme Court judgment that came out last year (2014). I wrote about this judgment, which it was anticipated would have far reaching effects on the workloads of AMHPs and BIAs, here. Cornwall’s research complements the College of Social Work’s document assessing the impact of this judgment on AMHP practice, about which I wrote here.
So that’s enough of the links for now. What did this Time Study actually find?
Since the Cheshire West Judgment extended the qualifying criteria for incapacitated people who might be in situations where they are being deprived of their liberty, it was thought extremely likely that there would be a huge increase in requests not just for formal assessments under the Mental Health Act, but also for requests for Deprivation of Liberty Authorisations, which have to be undertaken by Best Interest Assessors.
As this report highlights, “The first annual statistics published by the Health & Information Centre in September 2015 reports that there has been a “tenfold increase” in new referrals, with 137,540 DoLS applications received by councils between 1st April 2014 and 31st March 2015.” I am certainly aware that it is not uncommon for local authorities, who are responsible for conducting these assessment, to have backlogs of 2,000 or more.
The research took the form of asking practicing BIAs via a wide range of social media to complete a questionnaire relating to their practice and experiences. They received responses from a total of 507 BIAs, which I think is a remarkable achievement.
The study focused on the overall time that each assessment took, looking in particular at time taken in traveling, gathering information and consultation prior to and following the assessment, the length of time spent at the hospital obtaining necessary information, consultation with other relevant assessors, writing up the necessary documentation, and giving feedback to interested agencies and individuals.
The study found that the overall average time taken to conduct a DoLS assessment was 726 minutes, or 12.1 hours. This compares with an average of 600 minutes, or 10 hours, that local authorities estimate that an assessment should take. Some of the BIAs in the study reported a considerable discrepancy between the hours what they were paid for, and the actual length of time taken, for example one BIA saying: “I’m paid for 7 hours but each assessment takes at least 11 hours”.
While it may be tempting for local authorities to attempt to quantify the time taken and set a standard timescale for completion of assessments, the study points out that, while DoLS assessments can vary widely in complexity, “in all cases the BIA must involve the relevant person in the assessment process, consult widely and gather information relevant to their decision-making and  provide a report that explains their conclusion and their reasons for it. This work can be time consuming, particularly when there are several consultees or extended travelling times.”
The study also makes the point that BIAs have enormous responsibility in making their assessments, as they can be open to legal challenge.
The Law Commission recently published its consultation document into mental capacity and deprivation of liberty, which I considered here. Among its recommendations, the first of which is the abolition of DoLS as incomprehensible and unworkable, is the proposal to create the Approved Mental Capacity Professional. AMCPs would have more far reaching powers than BIAs, and would carry even greater responsibility.
Were these proposals to be made into law (through amendments to the Mental Health Act), it would be interesting to see the impact both on the work of this new professional compared to the BIA, and the overall bombardment rate of local authorities for people lacking capacity.

Sunday, 6 December 2015

Review: The Mersey Care Annual Mental Health Social Care Conference 2015

Peter Beresford giving a rousing address to the conference
The Mersey Care Trust’s annual conference was held in Liverpool on 6th November 2015. This year the theme was Service Users’ Voice: Change, Rights and Advocacy: What is the Reality?
I have reported at length on two previous Mersey Care conferences; I am afraid that this report will necessarily have to be briefer on this occasion.
The event was oversubscribed, with well over 200 delegates squeezing into the venue. As ever there was an impressive list of scheduled speakers, including Professor Martin Webber, Professor Peter Beresford, the human rights lawyer Peter Edwards, the Community Care journalist Andy McNicoll, and the erstwhile chair of the mental health steering committee of the now defunct College of Social Work Dr Ruth Allen. Indeed, it appeared as if there were almost as many speakers as there were delegates!
Roger Phillips, a presenter on Radio Merseyside with a keen interest in mental health, opened the conference. Emad Lilo, the intrepid organiser and manager of the Mersey Care Integrated Care Demonstrator Site Project, along with several of the Trust AMHP’s then outlined projects and other development work they had undertaken during the year.
Peter Edwards discussed the thorny issue of whether the rights of service users could actually be exercised, or were in effect illusory, then the Masked AMHP himself presented a case study of an assessment under the Mental Health Act, arguing that the AMHP has an advocacy role, and that an AMHP can successfully take a deliberately low key approach to assessment. A version of this case study was subsequently published in Community Care Magazine. You can read it here.
The morning was rounded off by an extraordinary presentation by members of the People First Merseyside organisation. This is a user led self advocacy organisation for people with learning difficulties. It has been in operation for over 25 years.
The staff and volunteers (most of whom were service users) gave an excellent dramatised presentation on the right (and wrong!) ways to approach people with learning difficulties who require assistance with a health problem, as well as showing exactly what people with learning difficulties can achieve when given encouragement and empowerment. It was entertaining, educational, and moving.
Peter Beresford kicked off the afternoon with an, as ever, eloquent, incisive and stirring dissection of the failings of current mental health policy and practice, tearing into the current Government plans and exposing an apparent deliberate intention to dismantle the NHS and marginalise disadvantaged people.
Ann Williams, Commissioning & Contract Manager for Liverpool City Council, gave a presentation on the roles of the Independent Mental Capacity Advocate and the Independent Mental Health Advocate, followed by Jake Mills.
Jake Mills is a stand up comedian. In 2013, he experienced a severe period of depression, during which he came close to committing suicide. As a result of this, he set up the mental health charity Chasing the Stigma which aims to “normalise and humanise mental illness.” He gave an intensely moving, but also funny account of his experiences.
The last session was Naomi Good, Regional Development & Research Manager of the National Survivor User Network for Mental Health. Her presentation was entitled Survivor Voices: Re-authoring Disrupted Identities. She outlined research she had done into the experiences of mental health service users.
Unfortunately, time constraints meant that some speakers, such as Professor Martin Webber, literally only had five minutes to speak, and of three intended Q&A sessions, only the one featuring Andy McNicoll and Ruth Allen actually went ahead. This meant that a number of prominent people in the mental health field did not have an opportunity to be heard.
I suppose this is a consequence of the popularity of these annual conferences, not just for delegates, but for speakers as well. Emad Lilo, who organises these events, appears to have boundless energy and enthusiasm, and this is reflected in the very real buzz that permeates the day.
This was the third Mersey Care Conference I have attended, and I very much hope to have the opportunity to speak at future ones.