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STUCK IN THE NHS A STORY OF DELAYED DISCHARGES
In total, there are about 280 people with learning disabilities in NHS Learning Disability units at some point during the year. Many are placed there due to Compulsory Treatment Orders (CTOs). They can end up staying for up to 9 years, long after they should have moved back to the community.
Earlier this year the Mental Welfare Commission found that at least one third were ready to live in the community but there is no place for them to go. The worst was in NHS Lothian, 46% are in hospital when they no longer need to be.
Where compulsion is used people with learning disabilities have it tough, spending an average of 4 years detained in hospital. For people without learning disabilities it was less than 2 years.
And it is happening to more. Between 2006 and 2012, there was a 39% increase in the number of people with learning disabilities subject to compulsory measures In comparison, in the same period, there was just a 7% increase in the use of compulsion for people without learning disabilities.
Mental Health Tribunals are meant to provide scrutiny so people are not treated unfairly. But of 1,378 application for CTOs in the first 8 months of this year, only 1.8% (24) were rejected. Once you are in it is easier to keep you in. Of 289 applications to extend a CTO only 2 were rejected.
Sometimes the threat of a CTO is enough. For nine years Daniel Young from Dundee lived in his own house with 24 hour support from a care team. He was happy and enjoying life. However in 2014 things started to go wrong. Daniel 
reported feeling insecure and unsafe in his home, resulting in verbal aggression towards staff and physical harm towards himself. Staff responses, in effect, punishing Daniel, helped to escalate his concerns and behaviour, until there was a “breakdown” in care provision in January 2015.
Rather than deal with his care, I as his Welfare Guardian, was only given the choice of medicating Daniel at home or admitting him to a NHS assessment unit. If I didn’t choose one, then a CTO would be used.
In order that Daniel had a place of safety, I chose the NHS Unit while we tried to find a more suitable care provider. Things haven’t gone well for Daniel in the last year. He has become depressed and withdrawn; a stark contrast to the articulate and humorous young man two years ago. And 18 months on, no suitable residential placements have been identified for him. His mental health continues to deteriorate so significantly that he may not be fit for discharge by the time a home is found for him.
There is a lack of adequate care and support for some of the most vulnerable people in our society. The growing use of CTOs indicate that mental health services are being used to respond to what is in many cases an issue of inadequate provision of support.
Mental health services not should serve as a buffer for lack of social housing and adequate community services. Two things that might help change this are:
The Scottish Government’s review of the Mental Health Act in relation to people with learning disabilities and autism might help by providing new rights to services and support. But the review proper won’t start until April 2017 and any resulting legislation is likely not to be implemented until well into the 2020s.
Over the summer the launch of the “Shared Ambition for Social Care” aimed at rethinking the whole approach to the funding of social care in Scotland. We do need a different approach that can tackle all the problems that we face from low wages to inadequate services otherwise people like my brother, Daniel will remain trapped and lost in the wrong place.
By Ian Hood & Hannah Young
Are Mental Health Tribunals A Good Use Of Money?
In the ongoing process of examining the review of the Mental Health (Care and Treatment) Act 2003, the question of Compulsory Treatment Order has come up.
Some people with learning disabilities have expressed concerns to us about the role psychiatrists play in making determination about the treatment of people with learning disabilities and that tribunals do not give them the right support. .
Mental Health Tribunals were set up in 2003 to provide a specialist check on the use of Compulsory Treatment Orders. The service costs almost £9 million per year with Tribunal members being paid about £400 per day when sitting.
Yet from our research it appears that less than 2% of applications for Compulsory Treatment Orders are refused. Other research based on a Randomised Control Study from England has suggested that Compulsory Treatment Orders are no more effective at helping people get better than the previous legislative provisions for compulsion in medical treatment.[1]
What do Mental Health Tribunals do?
The main role of the Tribunal is to consider and determine applications for compulsory treatment orders (CTOs) under the 2003 Act. It also considers appeals against compulsory measures such as short term detention certificates and compulsory treatment orders. The Tribunal also reviews every compulsory treatment order once it has been in place for two years and every two years after that.
Each Tribunal meeting has a group of three people - a doctor (psychiatrist), a lawyer and another general member, that is a person with relevant skills and experience, e.g. a nurse, social worker or someone with personal experience of mental illness, learning disability or related condition.
Initial Concerns about bias
When the Tribunal were set up there were some concerns that they would be biased towards the views of the psychiatrist. It was said that many of the “general members” were Community Psychiatric Nurses and more likely to give more weight to the psychiatrist. The Legal Member who chairs the meeting might make sure the formalities were carried out properly but would not have any medical experience to challenge the view of the responsible psychiatrist.
The evidence that the tribunal hears comes from either a Mental Health Officer (normally a social worker) or the Responsible Medical Officer (who can often be another psychiatrist).
The domination of psychiatry in the process led to worries that the patient would not be in a strong position to challenge the use of Compulsory Treatment.[2]
These worries were challenged at the time as unevidenced and unsupported. All members of a Tribunal come with their own views and have different approaches. All parties to the tribunal system have a “discipline-based approach” reflecting their own training and experience. The point of a Tribunal is to bring together these approaches into a vigorous consideration of the evidence and come to the conclusion that is in the “best interests” of the patient. [3]
Struggling To Pay the Living Wage
Earlier this year, the Scottish Government promised that all social care workers would get at least the Living Wage, currently at £8.25 per hour.
Social care providers have been badly squeezed over the last few years with frozen budgets and unrealistic tenders from councils. Staff wages have been the main victim and in many areas retail workers are paid more than care workers. 
Now with only a few weeks to go till the deadline, Scottish Care and CCPS are reporting that many councils have not put funding plans in place yet
Some councils have made reasonable efforts to resolve the matter. Aberdeen City, which has long had a problem recruiting social care worker due to the high wages on offer elsewhere has offered a rise of 6.4% on all contracts.
Many social care providers already pay more than the living wage and the question of how to support those who have always valued their staff has challenged local authorities.
Falkirk has raised the price for all hourly contracts to £16.50 which they think will allow providers to pay the Living Wage. For those who were higher than this, there is only a 50p an hour increase.
Glasgow demonstrates the difference between Care Homes and Care At Home services. Care Homes are covered by a National Contract so Glasgow is increasing its offer for this by 6.5%. Its offer to Care at Home providers is only 3.1%.
North Lanarkshire has not stated what it is going to do but it has increased wages of ”in house” staff to £12.17 per hour at a cost of £5.4 million because of “equal pay” legislation. It’s a shame such rules only applies to council staff.
Part of what drives the reluctance to meet the full cost of the Living Wage, is that any savings can be used by councils for other purposes. East Lothian is planning to put its “saving” of twice the cost of the Living Wage into more Care At Home Hours.
In another development, Glasgow is giving some providers an opportunity to be more flexible in their “Proof of Concept” scheme. They will no longer count hours of support so providers can spend more on wages as long as services users still get good outcomes. Of course, there is still a sting in the tail, with the council expecting this scheme to deliver 5% budget savings!
New Faces At LDAS
After 10 years our Coordinator, Ian Hood, is leaving.
Starting soon as Coordinator is Donna Nicholson.
Donna was formerly a journalist in the papers and on radio. Over the last 10 years, she ran a big campaigning organisation and has a lot of further experience in the 3rd sector. You’ll be hearing a lot from Donna and the rest of LDAS over the next few months.
Personal Independence Payment Statistics
The Department of Work and Pensions has published statistics on the take up of the new benefit.
Most of the figures relate to new claims rather than reassessments so the claims are mainly for people under the age of 25.
The national figures go into a lot of detail about particular conditions. So we now know that throughout the UK, there have been successful claims from 2,858 people with Down’s Syndrome and 354 people with Fragile X syndrome
For people with autism, there were 17,257 people with autism and a further 9.764 with Asperger’s Syndrome.
The figures for Scotland did not go into so much detail and only gave the global category for people. There were 2,444 awards for people with learning disabilities and 2,234 for people with autism.
The percentage of people in both categories are 10% lower than the national figures. So we will be keeping an eye on this over the next couple of years to make sure that assessors in Scotland are applying the same standards as the rest of the UK.
