Tag Archives: mental health

Covert medication to residents guidance

Care homes in Scotland have been provided with fresh guidance on giving residents medication covertly when they lack the capacity to consent but are refusing treatment.

The Mental Welfare Commission for Scotland’s revised guidance is designed to address rising use of covert medication in care homes and a lack of clarity about the legal basis for giving it. In 2012, 1.6% of Scotland’s 37,411 care home residents were given covert medication, up from 1.1% in 2010.

Covert medication involves administering medicines in disguised form, for example in food and drink, where a person is refusing treatment necessary for their physical or mental health.

Click here for the covert medication Care Plan.

Mental capacity

The guidance makes clear that it should only ever be considered when the individual has been found to lack capacity to consent to the treatment because of a mental disorder, Under the Adults with Incapacity Act (Scotland) 2000, treatment by force can only be used in an emergency. In its guidance, the commission said that it did not see covert medication as involving treatment by force, meaning that it can be used under the general provisions of the legislation.

Individuals are presumed to have capacity and should be supported to take decisions as far as possible, through information and explanations and means such as communication aids, speech and language therapy or psychological support.

“Covert medication is no substitute for explanation and education,” it says. “It should only be considered if impaired intellectual function makes this impossible.”

A medical or other health professional must have assessed the person as lacking capacity to consent to the treatment in question and issued a certificate of incapacity, under section 47 of the Act, specifying the treatment that should be given. The certificate can last for up to a year. Where the certificate is accompanied by a treatment plan, this should cover the use of covert medication, where this is deemed necessary.

The professional with primary responsibility for the individual’s medical treatment is responsible for deciding whether covert medication should be used. Before doing so, they must consider several factors.

Benefit and risk

Firstly, they must consider if the treatment is necessary for the individual, and the benefit must be sufficient to outweigh the risks of giving medication covertly. These include the risk that the individual will taste the medication in their food and drink, damaging their relationship with staff and potentially leading them to refuse food or drink.

Covert medication can also increase risks to safety and a risk-benefit analysis must be carried out before it is issued. For example, if medicine is crushed, this will generally mean it will be given outside the terms of its licence. In particular, slow-releasing or enteric-coated must never be crushed as this could be dangerous for the individual. Before administering the medication covertly, documented advice must be obtained from a pharmacist on doing this safely. Care staff must know how to administer the medication and there must be appropriate supervision available for them to do so.

Minimum restriction of freedom

Under the Adults with Incapacity Act 2000, interventions must be the least restrictive of the individual’s freedom, to achieve the desired benefit. Practitioners must question whether covert medication is really the least restrictive option. The guidance also warns that, in some cases, covert medication could be seen as degrading treatment, in breach of Article 3 of the European Convention on Human Rights.

Past and present wishes

Under the Adults with Incapacity Act, interventions must take account of the individual’s past and present wishes. Practitioners must inquire into why the person is refusing medication. It could be that they no longer wish to receive treatment or have never been in favour of taking medication.

Consult those closest to the person

Relatives or friends must be consulted about the person’s past statements or wishes on the subject. But those who know the person best will also be best placed to suggest how the person may be encouraged to take the medication without disguise. If covert medication is deemed necessary, they will be able to advise on the best way to disguise it.

Where there are no friends or relatives to consult, the guidance advises providing the individual with an independent advocate before covert medication is issued. The relevant local authority should be informed in these cases, as they may consider that a welfare guardian should be appointed by the courts to take decisions on the person’s behalf.

Record and review

The guidance also states that any use of covert medication must be recorded, and kept under regular review, with timescales based on the individual’s circumstances. If any additional medication is required, this should not just be administered covertly but should be considered as a fresh case and justified in the same way.

Click here for the Covert Administration of Medication Review.

The mental health crisis needs to be fought as robustly as the smoking battle

Like much of the United States, New York City is facing a crisis when it comes to mental health, including addiction.

One in five adult New Yorkers is estimated to experience a mental health disorder annually, a figure similar to national estimates. And in New York City, unintentional drug overdose deaths outnumber both homicide and motor vehicle fatalities.

Despite these troubling statistics, what we have now is a culture of silence and stigma around mental illness and substance use disorders, a fragmented array of services and little attention to prevention.

New York City, which has been at the forefront of a number of public health battles in the past, hopes to lead a national movement to elevate mental health as a top public health priority.

To achieve this, we will have to look to lessons learned from one of the greatest public health successes in recent years: tobacco.

We learned from the fight against tobacco that public health responses require long-term investment, sustained attention, strong collaboration and ongoing political will in order to see results.

After decades of incremental progress in the fight against tobacco, lawmakers raised taxes in New York City and banned smoking in bars and restaurants.

Then, city officials blanketed the airwaves, newspapers and subway cars with information about the harms of smoking.

And the health department deployed new treatment tools, setting up a quit-line with the offer of free nicotine patches.

It worked. The adult smoking rate declined by 35% between 2002 and 2014, and the youth smoking rate fell by a stunning 53% from 2001 to 2013.

We need that kind of a dramatic improvement when it comes to mental health.

New calculations show that mental health and substance use disorders are among the top contributors to shortening the healthy years of life for New Yorkers.

Mental illnesses rank right up there with heart disease, diabetes and stroke as causes of poor health when we take into account both what kills us too soon and what reduces the quality of life because of suffering and disability.

Major depressive disorder is the single greatest source of disability in the city, and second only to heart disease in terms of overall disease burden.

Our failure to address mental illness isn’t just felt by individuals or by their families.

When mental health challenges lead to job loss, dropping out of school or losing one’s housing, it can cost a city the size of New York billions of dollars.

Alcohol misuse alone is estimated to cost New York City nearly $6bn in citywide economic productivity losses every year.

Depression costs the city $2.4bn in losses.

But we’re starting to take cues from our tobacco successes, and we’ve started the same march forward on mental health.

In 2011, after an intense focus on reducing opioid analgesic overdoses in Staten Island, deaths from opioid misuse fell by nearly a third between 2011 and 2013.

The city has invested $130m to reform our criminal justice response to mental health, developed a program to support some of our most at-need New Yorkers and keep them connected to treatment, expanded mental health services in schools and shelters and more.

Too many New Yorkers have fallen through the cracks, because navigating the system is virtually impossible for people who lack the resources or time to make sense of the uncoordinated maze of programs.

It is time for bold action to start a sea change for mental health. The good news is that as a city we know how to take on challenging public health problems – from tobacco to tuberculosis, we have witnessed great victories.

That’s why, in the coming weeks, New York City will launch a roadmap for action to help chart a new path for improving the mental health of all who live in the city.

All parts of government – the school system, the police department, the department of homeless services and parks and recreation and many more agencies, are committing to be part of the solution.

This represents a real shift from the past – one we believe will result in a healthier and stronger city and a model for the country.

Source The Guardian

Canterbury nurse jailed for life for raping patients

A former nurse has been jailed for life for the rape and sexual assault of six people, including a 15-year-old girl.

Vijay Bundhun, 42, of Tonford Lane, Canterbury, was convicted at Maidstone Crown Court of four counts of rape and nine of sexual assault.

He was working as a mental health nurse when he assaulted a patient while visiting her at home in Sittingbourne.

Bundhun persuaded her to allow him to give her a massage before pinning her to the ground and assaulting her

He sexually assaulted her again while her child was in the room, Kent Police said.

‘Dazed’ on medication

While the sex attacks were being investigated, another woman came forward to report Bundhun had raped her several months previously while she was undergoing treatment and taking strong medication.

The nurse had visited her house several times and again suggested a massage would help her relax, before raping her.

She told police she was so dazed by the medication she was unable to fully understand what was happening.

Bundhun was also found guilty of sexually assaulting a 15-year-old girl in Canterbury.

There were six victims in total, Kent Police said.

Det Con Rebecca Taft, said: ‘Bundhun took advantage of his victims when they were at their most vulnerable and did not feel as though they could do anything about it.”

Bundhun was told he will service a minimum of 11 years in prison.

Source BBC News

Home Office to issue mental health disclosure advice

New guidelines will list factors that must be considered before people’s mental health crises are disclosed to employers in background checks.

Police will have to examine issues such as how long ago a detention under the Mental Health Act occurred, when assessing whether it is disclosed.

The advice covers Disclosure and Barring Service (formerly CRB) checks.

Home Office minister Karen Bradley said the guidelines aim to make the system fairer without lessening protection.

“It is important that checks provide employers with the information they need to protect children and vulnerable groups,” she said.

“At the same time, police disclosure of information relating to mental ill health can have a significant impact on the lives of those concerned, including their employment opportunities.”

‘Not a crime’

The Home Office said the new guidance, which will be issued on Monday, states that:

  • Detention under the Mental Health Act, which does not constitute a criminal investigation, is unlikely in itself to be sufficient to justify disclosure
  • The behaviour of the person during the incident must be a “key consideration” when considering checks. This could include assessing whether the person presented a risk of harm to others or whether they were involved in multiple incidents
  • The date of the mental ill health episode is an “important” factor. In cases where it took place a long time ago, officers should consider giving the applicant an opportunity to make representations about their current state of health
  • If information is disclosed, the certificate should provide an explanation so the employer or voluntary organisation understands the relevance of the information to the application

Community and social care minister Alistair Burt said the changes will help prevent people being “stigmatised” as they attempt to find work or volunteering opportunities.

He said: “Having a mental illness is not a crime – your medical history wouldn’t be flagged to your employer, so it’s right that we make the same true for someone who’s had a mental health crisis.”

Paul Farmer, chief executive of mental health charity Mind, welcomed the move.

He said: “There is no reason why having a mental health problem or having been previously detained under the Mental Health Act should necessarily be a red flag when it comes to DBS checks.”

Source BBC News

Mental health crisis care ‘inadequate’

People who need urgent mental health care in England are receiving inadequate support, regulators say.

The Care Quality Commission reviewed the help given to people in mental health crisis, which includes people who are suicidal, having serious panic attacks or psychotic episodes.

The regulator said the system was “struggling to cope”.

Its report also highlighted what it described as a “lack of compassion” from A&E staff.

The CQC carried out its investigation following the signing of a Crisis Care Concordat between the government and the sector last year which promised round-the-clock support to those who needed it.

This includes help from dedicated mental health staff, intensive support at home or telephone advice.

‘Wake-up call’

But the review – based on surveys of patients, analysis of national data and inspections of services – found that 42% of patients did not get the help they needed.

Patients were also asked about the attitudes of staff towards them. Staff working for charities and volunteers received the most positive ratings, while staff in A&E received the worst.

Just over a third of patients who ended up in A&E thought they had been treated with compassion and warmth and a similar proportion said their concerns had been taken seriously.

The dedicated crisis-resolution teams that are there to help those in trouble did little better with fewer than half answering positively to each question.

The report also highlighted the experiences of a number of patients. One said: “It was approximately seven hours before I got crisis support and that was only a call not a visit, which would have been more useful. As my crisis worsened, I took a small overdose as I was not coping or getting any immediate help.”

Dr Paul Lelliott, the CQC’s mental health lead, said while there were some excellent examples of care, the findings must “act as a wake-up call”.

“Worryingly many people told us that when they were having a crisis they often felt the police and ambulance crews were more caring and took their concerns more seriously than the medical and mental health professionals they encountered.”

Paul Farmer, chief executive of Mind, the mental health charity, said: “The report will not come as a surprise to anyone who has found themselves in crisis or who is involved in supporting people when they are at their most unwell.

“We take for granted that when we have a physical health emergency we will get the help we need urgently. It should be no different for mental health.”

Care Minister Alistair Burt said the government was trying to tackle the problems in mental health with its new treatment targets and extra funding that were both announced before the election.

“Improving mental health care is my priority,” he added.

Last year 1.8m people sought help for a mental health crisis.

Source BBC News

NHS Mental Health cuts could cost lives

NHS England and health regulator Monitor are imposing a 1.8% cut in tariff prices for community and mental health providers in 2014/15. Acute providers face a reduction of 1.5%.
In a joint letter published today in The Guardian, The Mental Health Foundation, Rethink Mental Illness, Mind, the NHS Confederation Mental Health Network and the Centre for Mental Health and the Royal College of Psychiatrists said the cut “completely contravenes the Government’s promise to put mental and physical health care on an equal footing.”
The letter comes as charity Mind warned that tens of thousands of people with mental health needs have been denied social care support due to local authority cuts and research by Rethink mental illness revealed cuts to early intervention psychosis teams.
This has to be a false economy. 
If people with mental health issues are not supported and treated, it could cost lives and most certainly lead to more acute hospital admissions. 
Instead of cutting corners we should be improving services.  

Psychiatric drugs do more harm than good, says expert

Psychiatric drugs do more harm than good and the use of most antidepressants and dementia drugs could be virtually stopped without causing harm, an expert on clinical trials argues in a leading medical journal.

The views expressed in a British Medical Journal debate by Peter Gøtzsche, professor and director of the Nordic Cochrane Centre in Denmark, are strongly opposed by many experts in mental health.

However, others say the debate around the use of psychiatric drugs is important and acknowledge that there has been overuse of antipsychotics to quieten aggressive patients with dementia.

Gøtzsche says more than half a million people over the age of 65 die as a result of the use of psychiatric drugs every year in the western world. “Their benefits would need to be colossal to justify this, but they are minimal,” he writes.

He claims that trials carried out with funding from drug companies into the efficacy of psychiatric drugs have almost all been biased, because the patients involved have usually been on other medication first.

They stop their drugs and often experience a withdrawal phase prior to starting the trial drug, which then appears to have a big benefit. He also claims that deaths from suicide in clinical trials are under-reported.

In trials of the modern antidepressants fluoxetine and venlafaxine, says Gøtzsche, it takes only a few extra days for depression in the placebo group – given dummy pills – to lift as much as in the group given the drugs.

He argues that there is spontaneous remission of the disease over time.

Click here for an excellent  Review of Medication Prescribed to Relieve Behavioural and Psychological Symptoms of Dementia 

Results from trials of schizophrenia drugs are also disappointing, he argues, and those for ADHD (attention deficit hyperactive disorder) are uncertain. “The short-term relief seems to be replaced by long-term harms. Animal studies strongly suggest that these drugs can produce brain damage, which is probably the case for all psychotropic drugs,” he writes.

“Given their lack of benefit, I estimate we could stop almost all psychotropic drugs without causing harm – by dropping all antidepressants, ADHD drugs and dementia drugs … and using only a fraction of the antipsychotics and benzodiazepines we currently use.

“This would lead to healthier and more long-lived populations. Because psychotropic drugs are immensely harmful when used long-term, they should almost exclusively be used in acute situations and always with a firm plan for tapering off, which can be difficult for many patients.”

In the BMJ discussion, which is a curtain-raiser for the Maudsley debate at King’s College London on Wednesday, Gøtzsche’s views are countered by Allan Young, a professor of mood disorders at King’s College London, and John Crace, a psychiatric patient and Guardian writer.

They argue that the research evidence shows the drugs do work and that they are just as beneficial and effective as medication for other complex conditions.

In fact, they are badly needed, they say, because psychiatric conditions are the fifth leading cause of disability worldwide.

Many psychiatric patients suffer from other physical conditions, they add, which are a bigger cause of early death than suicide.

They point out that the effects and safety of drugs are monitored and studied in the general population after the research trials have ended.

“Nevertheless, many concerns have been expressed about psychiatric drugs and for some critics the onus often seems to be on the drug needing to prove innocence from causing harm rather than a balanced approach to evaluating the available evidence,” they write.

“Whether concerns are genuine or an expression of prejudice is not clear, but over time many concerns have been found to be overinflated.”

They cite the example of lithium, now thought to have less severe side-effects than once feared, and clozapine, an atypical antipsychotic. Clozapine was thought to have increased patients’ risk of death, but recent data has been reassuring, they say.

Dementia experts said use of antipsychotics for elderly patients who become difficult to handle had been a problem.

“The dangers of long-term use of antipsychotic drugs for symptoms of aggression and agitation in dementia were highlighted in an Alzheimer’s Research UK-funded study in 2009 and since then moves have been made to reduce their use,” said Dr Simon Ridley, of Alzheimer’s Research UK.

But he and Dr Doug Brown, director of research and development at the Alzheimer’s Society, both argued that drugs such as Aricept, specifically developed for people with dementia, had some effect and were needed.

Dr Michael Bloomfield, academic clinical fellow in psychiatry at the Medical Research Council and University College London, said Gøtzsche’s view that most psychotropic drugs could be stopped without harm was not supported by the evidence.

Long-term use of schizophrenia drugs appeared to reduce early deaths, but he added: “In practice, there need to be regular reviews of treatments between a patient and their psychiatrist in order to continually weigh up the pros and cons of any treatment.”

Source The Guardian

Mental health spending cuts forecast

Mental health trusts in England are forecasting significant cuts to their funding over the next four years, figures seen by the BBC suggest.

Data from three-quarters of trusts shows from 2014-15 to 2018-19 income is expected to fall by 8% in real terms.

The forecasts were submitted to regulators last summer – before extra money was promised in the last Budget.

But NHS England said accurate predictions could not be made until a new government set out spending plans.

The revelations come despite promises in recent years that mental health will be treated on a par with physical health services.

The figures seen by the BBC are from five-year plans submitted by 41 mental health trusts setting out what they expect their financial position to be in the coming years.

They show that funding for both adults and children’s services in 2014-15 was £5.86bn, but by 2018-19 that is expected to be £5.74bn – an 8% cut once inflation is taken into account.

But since then, extra money – £250m a year over the next five years – was promised as part of a mental health announcement made in the Budget.

‘Poor access’

But experts said the findings were still worrying. Anita Charlesworth, chief economist of the Health Foundation, said the cuts would pile more pressure on services that were under strain.

“What we are seeing is potentially real-terms resources falling, against a backdrop of growing need and already real concerns about whether there is the quality of care. And that’s not just a human imperative, but there’s a big economic cost to poor access to mental health services.”

Q&A: Health and care – the background issues

Stephen Dalton, of the Mental Health Network, which represents trusts, said: “These figures won’t be a surprise to providers because they have been dealing with cuts to mental health services over the past five years. There is an institutional bias against mental health services.”

But a spokeswoman for NHS England said it was not possible to forecast what spending on mental health services would be until the new government’s spending review later this year.

She also pointed to figures showing that overall mental health spending had actually risen from £11.36bn in 2013-14 to £11.66bn last year, which amounts to a small rise once inflation is taken into account.

This includes spending by both mental health trusts and other organisations, such as mainstream hospitals and community services, which provide mental health care.

Investing more in mental health has been mentioned by the Conservatives, Labour, the Liberal Democrats, the Greens and UKIP during the election campaign.

Source BBC News

Girls face ‘sharp rise in emotional problems’

The number of schoolgirls at risk of emotional problems has risen sharply, an English study in the Journal of Adolescent Mental Health suggests.

Scientists analysed questionnaires completed by 1,600 pupils aged 11-13 in 2009, comparing them with similar surveys conducted five years later.

They were “surprised” by a 7% spike in girls reporting emotional issues while boys’ answers remained fairly stable.

Charities are concerned pressures are particularly affecting girls.

Unique pressures

Scientists found that social, peer and behavioural problems remained relatively constant for boys and girls across the five years.

But the rise in emotional issues reported by girls suggested they faced unique pressures, the researchers suggested.

They said reasons behind this could include a drive to achieve unrealistic body images perpetuated by social media and an increasing sexualisation of young women.

Funding cuts to mental health services might also be to blame, they suggested.

“In a climate of limited resources, it is also possible teachers may focus more on behavioural and conduct issues as these tend to disrupt classrooms,” researcher Dr Helen Sharpe, of University College London, told the BBC.

To help overcome this, researchers suggest staff should be given the right resources to look out for emotional problems.

And they argue mental health services should be more widely available.

Sarah Brennan, of the charity YoungMinds, said:”This research is shocking further concrete evidence of the serious and worsening state of children and young people’s mental health in this country.

“Young people tell us they feel enormous pressures today ranging from bullying, the 24/7 online environment and sexual pressures to issues around body image, school stress and family breakdown.

“YoungMinds is concerned that these are affecting girls in particular.”

In the online questionnaire, children were asked how strongly they agreed with a series of statements that are clinically validated to assess the risks of developing a range of mental health issues.

The sample in 2009 was tailored to match the demographics of children who filled in the survey in 2014.

The last comprehensive national survey of children’s mental health was undertaken by the Office for National Statistics more than a decade ago.

The Royal College of Psychiatrists says there is now an urgent need to conduct another one to gather accurate estimates of mental health problems and plan services accordingly.

Sourced from the BBC Online

More pupils have mental health issues, say school staff

More children have mental health issues than two years ago, a survey of school teachers suggests.

More than half of 850 staff surveyed by the Association of Teachers and Lecturers (ATL) agreed more pupils had developed problems.

On Monday, the ATL’s annual conference will debate a call for more support for vulnerable pupils in schools.

General secretary Dr Mary Bousted blamed “poverty, poor housing, unemployment and financial insecurity”.

School staff have had to “plug the gaps in social care as best they can”, said Dr Bousted.

Some 861 ATL members responded to the survey earlier this month.

‘Completely overwhelmed’

More than one in six said they believed at least a quarter of students in their school or college were affected by mental health problems.

Almost 90% said staff have had to provide more support for these pupils over the past two years, while 43% said they had been finding it harder to access services for pupils with mental illness.

One head of department at a Reading secondary school said local Child and Adolescent Mental Health Services were “completely overwhelmed”.

“Unless there is significant risk of harm to either the child or others, there is pretty much no point in contacting them.”

Almost two-thirds (59%) said their school did not devote enough time and resources to mental health issues.

Only 9% felt they had been given enough training to help them spot the signs of mental illness in pupils, 45% said training had been inadequate and 32% said they had received no training at all.

The conference motion calls on the union to lobby the government, after the election, for more investment in measures including havens for vulnerable pupils and better funding for specialist staff.

Proposer Bella Hewes, a special needs teacher from Oxford, said the expertise to support pupils’ mental health was “just not there”.

“Where are the school nurses? Where are the school counsellors? Where are the expert social workers who have the time and resilience to support families in crisis? They have been made redundant!”

‘At risk’

Some 91% of respondents said it was important to make children aware of the issues surrounding mental illness, with better personal, social and health education to combat stigma.

“It comes as no surprise that so many education professionals are feeling so utterly let down on all sides when it comes to support for children’s and young adults’ mental health,” said Dr Bousted.

Cuts to services had left pupils “dangerously at risk”, she added.

Lucie Russell, campaigns director of the charity Young Minds, said the survey demonstrated the “huge burden” teachers were under.

“Having to manage a growing crisis in young people’s mental health and decreasing access to expert support makes their jobs so much harder.”

Ms Russell promised the charity would hold the next government to account to ensure Department of Health proposals to overhaul children’s mental health services were implemented.

Following the publication of a taskforce report earlier this month, the coalition government announced a five-year plan to improve services.

The move followed the allocation of £1.25bn to mental health services in England which will mainly go towards helping young people.

Sourced from the BBC Online