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|28 Feb 2017|
Dundee Stronger Together
The Herald's story on the shocking treatment of Margaret McEwan from Glasgow shows some of the real challenges that people with learning disabilities face in Scotland today.Stephen Naysmith wrote on Saturday 25th Of October. "Margaret McEwan epitomises Scotland's journey towards a more humane way of dealing with vulnerable elderly and disabled people. Her supporters hope she doesn't end up being a symbol of the collapse of those hopes. Freed from the notorious Lennox Castle 20 years ago, Margaret was taken into the bosom of a loving family, where her life has been transformed. But now she faces being denied that home life." Read More Here.
Margaret who has learning disabilities and a visual impairment is being asked to move into a care home to save the council money.
In Scotland there is a new national strategy called the Keys to Life designed to prioritise the things that are important to people with learning disabilities. It doesn't seem to help in this case. There is also a national strategy to promote Self Directed Support, a policy designed to give more choice to people who need support. It doesn't seem to help in this case. It seems that councils can choose to do whatever they want instead of national policies.
Some of the results of this approach in Glasgow can be seen in this chart published by the Care Inspectorate last week. It shows the change in Social Work spending in Glasgow and in Scotland over the last 9 years.
The figures in green show the areas that now spend proportionately more and those in the red the ones that spend less. We can see that in most of Scotland spending on services for people with learning disability has gone up. While in Glasgow spending on people with learning disabilities and other adult groups has been transferred over to services and support for children and older people. Councillors often say that Glasgow has been cut, this chart says it is really about priorities.
Glasgow is making a choice in treating Margaret this way and it is the wrong choice!
I am writing to ask for your help in reversing an unfair decision by Dumfries & Galloway Council earlier this year. The effect of this are only coming to light now and causing great hardship to disabled people under the age of 65 throughout the area.
On 29th February the Council approved a report which changed the income allowance that people under 65 could keep before paying charges. The Income Allowance for people under 65 went down from £177 to £132 per week while the Income Allowance for people over 65 went up from £177 to £195 per week.
At the same time the tax rate that people paid on the extra income they had about the Income Allowance went up from 55% to 65%.
The increase for every disabled person under 65 in Dumfries and Galloway getting social care is between £25 and £40 per week. (65% of the £45 extra plus or minus a little more) This payment will be on top of any existing payments meaning that many people will now be asked to pay as much as £70-80 per week.
The trigger for this change was a payment of £184,000 from the Scottish Government to reduce the amount that disabled people should pay in care charges. In Dumfries & Galloway this became a proposal to increase the amount people would have to pay.
Significant worries were raised in Perth and Kinross recently when the local council announced a plan to consider care homes for everyone who Individual Budget came to 10% more than the cost of a care home place. This arose out a plan to transform social care services. But rather than improve things this ran the risk of taking things back to the last century.
The consultation process for this measure was wholly inappropriate and inadequate. The timescales given to family carers who lead incredibly busy and stressful caring roles were totally unrealistic. A letter was written on the 8th August 2016 and by the time the families received it there was less than 3 weeks to respond. The closing date was the 31st August 2016.
This type of proposal goes against all national government policies and legislation. It fundamentally breaches the United Nations Convention on the Rights of Persons with Disabilities supported within The Scottish Government’s Draft Delivery Plan 2016-2020. It is totally discriminatory and has placed huge stress on family carers who are supporting their family member to lead a valued and included life within their community.
Fortunately in the last week, Perth and Kinross have agreed to put things on hold and make no changes until there is much wider consultation. The council said
“we accept our initial consultation process has raised concerns and therefore we are going to take much more time to discuss and consider all the options from stakeholders ... we will shortly be communicating how and when we are going to undertake the work.”
Unfortunately this does not mean the proposal has gone away for good and disabled people and their families will have to keep aware about this.
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
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.
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.
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.