Editorial
| Published date | 15 May 2009 |
| Pages | 2-2 |
| DOI | https://doi.org/10.1108/13619322200900001 |
| Date | 15 May 2009 |
| Author | Mark Freestone |
| Subject Matter | Health & social care |
Mental Health Review Journal Volume 14 Issue 1 March 2009 © Pavilion Journals (Brighton) Ltd
2
Editorial
Having recently moved to work in a new NHS Trust,
I was afforded the opportunity to retake the ’core
induction’ programme that nearly all trusts now
offer to new employees. For me, perhaps one of the
things most striking to emerge during the induction
– essentially into the ’core working principles’
of the health service – was the strong distinction
between the policies and strategies discussed when
compared to those offered in my first NHS position
in 2004. In particular, the Mental Health Act
training I experienced – commensurate with the
new legislation – took a more direct approach to the
reality of much inpatient care; that is, that our core
business often involves the deprivation of our clients’
liberty. For some of us, particularly those working in
forensic care, this aspect of our work seems almost
taken for granted, but elsewhere the decision to
detain someone against their will because they suffer
from a ’disorder of the mind’ is rightly the subject of
deliberate and nuanced debate.
The current government, having apparently
broadened the range of conditions for which an
individual may be detained under the new Mental
Health Act, is now concerned to ensure that ’due
process’ is followed, and thus we have the new
Deprivation of Liberty Safeguards that come into
force in April (Department of Health, 2008). As with
much of the recent legislation, the watchwords of
’the patient’s best interests’ and ’mental capacity’
feature strongly in these new safeguards. Yet with
each new piece of legislation comes additional
complexity and bureaucracy; and with this
complexity, the increased possibility of something
going wrong in the process due to an incomplete
understanding.
In light of these developments, it is encouraging
to see that academics and practitioners are already
beginning to generate frameworks for working
practically and intellectually with these new concepts.
A paper by Shah, Heginbotham and Kinton in this
edition looks at the complex linkages between the
Mental Capacity Act 2005 and the revised Mental
Health Act, specifically in the light of the Deprivation
of Liberty Safeguards, and highlights the critical
areas of uncertainty and complication, currently only
partially addressed by existing Codes of Practice.
From a forensic perspective, Andy Bickle’s paper
considers the role of psychiatric evidence and case
management in relation to the detention of those
mentally disordered offenders considered ’dangerous’
under the new Criminal Justice Acts of 2003 and
2008. With careful attention to case law, Bickle
highlights the need for psychiatric services and
clinical managers to consider the forensic notions
of ’risk of serious harm’ alongside more traditional
medical questions of care and treatability. He
also explores the changing relationship between
forensic healthcare services and the Ministry of
Justice (NOMS) in the context of the new Indefinite
Public Protection (IPP) sentences, which courts are
increasingly likely to impose on ’dangerous’, mentally
disordered offenders.
On a similar note of clinical management, Young
and Turner provide an audit of existing NHS trust
training for conflict resolution within acute mental
healthcare; a crucial intervention for inpatient
services for whom active restraint of patients is
increasingly an option of last recourse. Despite this,
however, it is clear that there is considerable diversity
and inequality in the way that trusts in England
prioritise and co-ordinate conflict resolution training.
Wolfe, Ogden and Clare also provide an evaluative
study, this time of a day treatment programme
for eating disorders, which focuses on factors
predictive of treatment completion and – critically –
retention in services. Despite overall positive clinical
improvements in the treatment population, there is
also evidence that certain factors are associated with
reduced treatment compliance; a finding that proves
worryingly robust across complex interventions.
Finally, to return to an issue raised in previous
editorials, it is encouraging to see that the tradition
of qualitative research in mental health continues
to find an outlet in the Mental Health Review. In
this issue, Joseph et al provide a contentious paper,
arguing that the recent – broadly welcomed –
adaptation of qualitative research methods to the
traditionally naturalistic world of health research
has also involved a dilution of the original ethos of
qualitative methods. The authors outline this ethos
and its dissonances with many of the assumptions of
’evidence-based mental health’, as well as suggesting
ways in which researchers might reconnect with the
traditional qualitative epistemology.
Mark Freestone
References
Department of Health (2008) Mental Capacity Act 2005:
Deprivation of Liberty Safeguards in England. London:
Department of Health.
To continue reading
Request your trial