Electronic Letters to:
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eLetters: Electronic letters published:
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The conditional discharge model: just common sense?
- Philip A Sugarman (8 August 2008)
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More debate is necessary
- David H Yates (24 September 2008)
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Philip A Sugarman, CEO and Medical Director St Andrew's Healthcare
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psugarman{at}standrew.co.uk Philip A Sugarman
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Lawton-Smith, Dawson and Burns set out their fears and hopes around the new community treatment orders, and appear to agree that usage should be selective. Compulsory community treatment in the UK has been contentious for many years (Mental Health Act Commission 1988), such that the Government's concrete proposals for de novo compulsion of "non- resident" patients brought great anxiety (Department of Health 2002). The legislation that eventually emerged is less radical, being only applicable to detained in-patients. Arguably, it is just a new variant of the tried and tested formula of leave from hospital; and the key powers of requirements and of recall are very close to the equally road-tested conditional discharge for restricted forensic patients (Sugarman 1999). So the new law builds on current clinical experience and extends the powers of psychiatrists. I believe we should respond to this trust with professionalism and common sense. DEPARTMENT OF HEALTH (2002). Draft Mental Health Bill. Cm 5538-1. London, The Stationery Office. MENTAL HEALTH ACT COMMISSION (1988) Compulsory Treatment of the Mentally Disordered in the Community: the Field of Choice. London: Mental Health Act Commission. SUGARMAN (1999) New Community Mental Health Law: the Conditional Discharge Model. Psychiatric Bulletin. 23, 195-198. |
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David H Yates, retd: carer FRC Psych
Send letter to journal:
david{at}jidgey.e7even.com David H Yates
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. The debate is necessary . CTO's may help in putting pressure on Commissioning Trusts and provider Trust to fund after-care needs so that those within this compulsion can be led into outside activities.. I meet with other carers. They all know that medications is not enough - although they reduce the chance of relapse. They know that nothing moves forward from that, unless sufferers reach some kind of life, meaningful and directional, for themselves. CTO's would help in passing authority,from professional expertise and experience in the long-term condition, into the carer situation, to help family carer escape the argument, recrimination and retaliation, when the family carer 'pushes' , on their own, for sufferer to 'exercise their lost neurons' outside themselves , outside the care base in safe areas for them. Professional service has the authority to come to conclusions from expertise, and advise from that authority – if they exert that authority – no more so than the advice from the lead consultant psychiatrist . If the consultant psychiatrist does not specify a need at the Need Assessment stage then it will neither be commissioned by the Primary Care Trust , nor funded, nor delivered .in the Care Plan for after-care, where there is long term illness. Home treatment is now the forefront area of care and treatment of schizophrenia,.. At present family carers feel let down. They are not given protection by being able to say – 'this is what the doctor's expert advice says is necessary, which I have to follow .. – ' you must exercise your neurons on something as you would exercise your leg after injury to get fit again' ... . CTO,s will come into consideration here. Present consultant psychiatrist lead is failing to put their authority behind 'breaks in the week' as a Home Treatment after-care need at the Needs Assessment stage of the Care programme Approach. The separation of parties reduces the chance of high EE. When 'breaks in the week' are not there as a request from authoritative psychiatric statement, there is no pressure on funders and deliverers to fund and find after-care outlets. If the outlets are not there to meet the need , the consultant lead should have the absence registered as an UNMET NEED in the Care Plan , which will stay there in the Review stage of the CPA , or under CTO. mental health teams should register it as a SERVICE Deficiency at the needs assessment stage.. Professional service has authority but little front-line presence to exercise it. Family carers have presence in abundance but neither authority to push long-term patients into engagement, nor clout to influence commissioners, on their own. They need an authoritative prescription of after-care to sustain their claims. D H Yates FRC Psych www.schizophreniawatch.co.uk |
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