Nicola Glover-Thomas

The Health and Social Care Act 2012: The emergence of equal treatment for mental health care or another false dawn?

Although the National Health Service (NHS) is regarded as a national treasure, it is no longer immune from the colossal financial pressures brought about by global recession. Economic sustainability has largely driven the reform process leading to the Health and Social Care Act (HSCA) 2012, however; other considerations have also played a role in the journey to turn the health and social care service into an institution which is fit for the 21st-century needs. This article examines the impact of the HSCA 2012 on those made vulnerable through mental ill health. It then considers three issues: First, whether parity between mental and physical health can have life beyond political rhetoric; second, what impact driving up efficiency within the NHS will have upon mental health patients; and finally, the extent to which the personalisation agenda can be meaningfully applied within the mental health context.

Joint Working: Reality or Rhetoric in Housing the Mentally Vulnerable?

Effective joint working has become an essential component of public‐service delivery. The interface between the public, the private and the third sector is increasingly complicated as co‐working and the possible pooling of resources is required to meet greater service demands. Within housing, joint working has emerged as a particularly thorny problem, since a legislative gap within the Housing Act 1996 has required other organisations to step in and meet unmet housing needs. This article explores the nature and impetus for joint working in relation to social housing for the mentally vulnerable. It draws upon empirical data collected from an ESRC‐funded (Economic and Social Research Council) project called ‘Housing The Mentally Vulnerable: The Role Of Charities’. It examines the benefits that can accrue from successful collaboration, the barriers to joint working that currently exist and the need to draw upon known mechanisms that could facilitate the joint working process.

THE AGE OF RISK: RISK PERCEPTION AND DETERMINATION FOLLOWING THE MENTAL HEALTH ACT 2007

Reforms to the mental health law framework for England and Wales, which were introduced by the Mental Health Act 2007, are now having a practical effect on day-to-day mental health decision-making. The 2007 Act amends the Mental Health Act 1983, which governs the compulsory hospitalisation and treatment of people with mental disorder; and represents the culmination of a protracted and controversial reform process which has spanned much of the last 15 years. One of the key foci in the 2007 Act is the question of the risk posed by the patient, primarily to others; a result of both the social and political impetus behind the reform process and mounting public anxiety at the management of the mentally disordered. The new Act seeks, as with past legislation, to find the elusive balance between protecting and facilitating the individuals autonomy while also providing an effective framework for the wider public right to protection. The 2007 Act solidifies the dominance of risk by providing a legitimating framework in which risk can be assessed, monitored, and managed. This attitudinal change is demonstrated by the gradual and almost insidious adoption of risk terminology within the practical decision-making setting and the increasing use of risk assessment and management tools. This article is informed by an empirical study which examined individual professional and institutional responses to the mental health legislation in relation to risk. It examines whether the amended legislative framework amplifies risk as an increasingly dominant concern within decision-making. The paper then goes on to consider how decision-makers use risk to assist with their daily roles. Extrapolated from data obtained through the study, several models of risk determination are then discussed. Finally, some thought is given to whether the extension of the risk concept has the potential to become more fundamental within the organisation and legitimisation of mental health care.

Making decisions for the mentally incapacitated adult

Introduction This paper considers the approach to decision-making on behalf of mentally incapacitated adults. It updates and revises the 1996 article Ethical Aspects of the Law Commission Report on Mental Incapacity in this journal. The Law Commission Report No. 231, Mental Incapacity , issued in February 1995, was the final outcome of a lengthy and wide-ranging process of consultation. This process resulted in four consultation papers over a period of four years. The Government did not support the Law Commission’s draft bill on mental incapacity and a further consultation period was initiated ( Who Decides? Making Decisions on Behalf of Mentally Incapacitated Adults , Cm. 3803). This process culminated in October 1999 when the Lord Chancellor’s Office issued its report, Making Decisions (Cm. 4465). This policy statement sets out the Government’s proposals to improve the decision-making process for those who are incapable of making decisions for themselves or who cannot communicate their decisions.

Mental health law in motion--confronting new challenges in the modern psychiatric landscape.

In the UK alone, at any one time, around one adult in six experiences symptoms of mental illness. One in four adults experience mental illness during their lifetime. Mental illness is the largest single cause of disability in our society. To place this in context, mental ill health is the largest single cause of disability in the UK, contributing almost 23 percent of the overall burden of disease compared to about 16 percent each for cancer and cardiovascular disease. The economic [and social] costs of mental health problems in England and Wales have been estimated to be around �105 billion per year. Such figures imply that mental health services should be sufficiently robust and well resourced in order to respond to such need. Yet, this is far from the truth. Much public attention on mental health care has tended to be negative: media interest is fuelled when failures in care provision emerge because of harm caused to unsuspecting ?victims? within the wider community. Failures in care standards tend to illicit a less pronounced public response. In many respects, the legislative frameworks in many countries that govern the provision of mental health care have limped along, far behind the medical and social developments in the field; legal reform has been entirely dependent upon the political will to engage with these issues.

Compulsory vaccination: Going beyond a civic duty?

Margaret Brazier has been described as one whose work ‘light[s] the way’1 for those that follow, the ‘paradigmatic female role model for young academics’2, and as a ‘lawyer, whose heart is in the law’.3 We agree and argue that Brazier has a distinctive way of both analysing legal issues and evaluating legal problems. This chapter identifies and examines the distinctive elements of the Brazier method. Drawing on this method, and a case study, we argue that she has made a fundamental contribution to the development of healthcare law. Brazier has highlighted the importance of recognising the humanity of different stakeholders in the healthcare enterprise. Particularly important is her recognition of the fallibility and vulnerability of healthcare professionals alongside patients. Where previously medical law was a tool for confrontation between human patients and machine-like doctors, Brazier has facilitated its evolution into a new role as mediator between fallible and vulnerable players.This book celebrates Professor Margaret Braziers outstanding contribution to the field of healthcare law and bioethics. It examines key aspects developed in Professor Braziers agenda-setting body of work, with contributions being provide by leading experts in the field from the UK, Australia, the US and continental Europe. They examine a range of current and future challenges for healthcare law and bioethics, representing state-of-the-art scholarship in the field.