health and social

• Reasons for the increase in Mental illness in NI


  • Improvements in diagnosis and treatments, e.g. improvements in diagnosing children & adolescents
  • The economic recession and effects of same on employment, housing etc
  • Increase in drug and alcohol abuse leading to mental health problems
  • Less stigma so more people coming forward for help
  • Increase in PTSD linked to Northern Ireland coming out of conflict
  • Increased life expectancy is a factor as many older people suffer from mental illness, e.g. dementia, depression
  • Increased knowledge and understanding amongst professionals and the public, leading to increased referrals for assessment and diagnosis
  • Increase in immigrant communities – increased susceptibility to mental health problems linked to poor living conditions and employment conditions, isolation, discrimination etc.
  • Increase in use of social media linked to supporting behaviours associated with eating disorders or bullying causing mental health
• Professionals involved with mental illness

   Social worker (including MH Social Workers)

   GP

   Psychiatrist

   (Community) Psychiatric nurse/ Mental health nurse

   Psychologist

   Counsellor
• Hospital inpatient settings


  • Involve an overnight or longer stay in a psychiatric hospital
  • Provide treatment to more severely ill mental health patients, usually for less than 30 days
• Psychiatric hospitals


  • Treat mental illnesses exclusively
  • Might have speciality units for eating disorders, geriatric concerns, child and adolescent services, as well as substance abuse services
• Residential mental health treatment environments


  • Generally provide longer-term care for individuals
  • Most treatment settings provide medical care but are designed to be more comfortable and less like a hospital ward
• Nursing homes


  • Have psychiatric consultation available as needed
• Organisations that help support those with Mental Health issues

  ● Action Mental Health Northern Ireland

  ● Aware

  ● Lifeline

  ● Mind

  ● Mindwise
• The Mental Health (Northern Ireland) Order 1986


  Covers the assessment, treatment and rights of people with a mental health condition
• People receiving specialist mental health care and treatment


  • Many receive it in the community
  • Some require admission to hospital for assessment and treatment
• Severe mental health problems that require hospitalisation


  • Severe depression with suicidal ideation
  • Acute psychotic episodes (such as schizophrenia or bipolar disorder with psychosis)
  • Severe anxiety or panic attacks with inability to function
  • Acute mania in bipolar disorder
• Most people who receive treatment in hospitals or psychiatric units for mental health conditions are there on a voluntary basis and have the same rights as people receiving treatment for physical illnesses
• 1986 Mental Health (Northern Ireland) Order


  Provides the legal framework in Northern Ireland for compulsory admission and treatment of patients suffering from mental illness
• GP involvement in Mental Health Order assessments


  1. Community: Application for compulsory hospital admission for seven days, renewable to 14 days for assessment

  2. Extreme circumstances: Warrant authorizing police constable to secure access, obtained by approved social worker, other officer of the Health and Social Services Trust or a police constable from a Justice of the Peace

  3. Police constable must be accompanied by a medical practitioner (usually a GP) who will administer medical treatment if required
• Patient admission


  1. Patient admitted informally

  2. Patient wants to leave

  3. Patient is refusing treatment
• Application for assessment


  1. Patient's own GP (or another practitioner who has previous knowledge of the patient) attends hospital to give the medical recommendation

  2. Doctor on the staff of the hospital cannot give the recommendation except in a case of urgent necessity
• Criteria for detention


  The person must be suffering from a mental disorder as defined by the Order
• Application for assessment or treatment


  1. Supported in writing by two registered medical practitioners

  2. Recommendation must include a statement about why an assessment and/or treatment is necessary

  3. Recommendation must include a statement about why other methods of dealing with the patient are not appropriate
• No. The Applicant has a legal duty and right to ensure that the person is conveyed to hospital once Forms 1 or 2 and 3 are completed.
• However, once the person has been detained in hospital for assessment he or she has the right to appeal against their continuing detention through application to the Mental Health Review Tribunal.
• Approved social workers (ASW)


  Specially trained in both mental health and the law relating to it. They are appointed by local trusts to interview and assess people and can make an application for admission where they consider that detention is the most appropriate way of providing care and treatment.
• The Order


  Gives certain rights to the nearest relative which can be used to protect the patient's interests
• Nearest relative


  • Husband
  • Wife
  • Civil partner
• To protect the needs of the service users the nearest relative will

  1. Be told if an approved social worker applies for the patient to be detained for compulsory assessment

  2. Be consulted about, and object to, a social worker applying for the patient to be detained for compulsory treatment

  3. Discharge the patient

  4. Apply to a Mental Health Review Tribunal on behalf of the patient in certain situations

  5. Receive written information about the patient's detention, rights and discharge unless the patient objects
• The nearest relative's power of discharge


  Can be over-ruled by the doctor who is responsible for the patient's treatment if the doctor thinks the patient is likely to act dangerously if discharged
• An application for compulsory admission needs to be made by either the nearest relative or an ASW,

  supported by a medical recommendation, usually the patient own GP or, if not, a doctor who knows the patient personally.
• They will need enough information to decide if there is the possibility of an admission under the Mental

  Health Order and that the full assessment process is warranted.
• During the assessment


  1. The team necessary to make an application for compulsory admission is either:

  2. the nearest relative and a doctor (patient's own GP or doctor who knows the patient personally)

  3. an ASW and the patient's own GP or a doctor who knows the patient personally
• Where the nearest relative makes the application

  Advise them that they can ask for an ASW to consider making the application in their stead (because sometimes making such an application can be detrimental to family relationships)
• Where an ASW makes the application

  1. They must consult the nearest relative, unless this causes unreasonable delay

  2. If the nearest relative objects to the application, the ASW must consult another ASW
• All parties strive to reach a consensus, and if the doctor agrees to make the medical recommendation for

  compulsory admission, the social worker or the nearest relative makes the application to the admitting

  hospital managers.

  When the patient is not admitted to hospital, a package of follow-up care needs to be agreed with the patient

  and nearest relative, if appropriate. Arrangements may need to be made to contact mental health or social

  work teams during working hours to inform them of the assessment and/or to make a referral.
• Treatment for a person admitted to hospital


  1. Immediately assessed by a suitably qualified professional (usually a consultant psychiatrist) to ensure they agree with the assessment and allow the person to be detained for compulsory assessment

  2. Suitable qualified health professionals assess the patient throughout this time
• Possible decisions following examination


  • Detained in the hospital for assessment
  • Allowed to remain in hospital as a voluntary patient
  • Should not remain in hospital
• The examining doctor will report their opinion to the Health and Social Care Trust
• Maximum period a person can be detained for assessment

  14 days
• This period cannot be extended
• Ways in which the Mental Health Order protects the rights of service users with mental health problems


  1. The Order identified that named trained professionals/relatives could be involved in the sectioning process

  2. The Order empowered clients and encouraged voluntary admission for assessment and treatment

  3. The Order details the rights of people who have a mental disorder and the procedure that must be followed in order to provide them with appropriate care so safeguarding the client
• Mental Health Order


  • Involves multi-disciplinary team professionals (mental health team involved in the care of the particular individual – GP/ASW/RMO)
  • Admission and treatment without compulsion is a key principle
  • Safeguards the rights of clients with mental disorders
• Mental disorder


  Excludes immoral conduct, personality disorder, promiscuity, sexual deviancy, dependence on alcohol or drugs
• Grounds for compulsory admission to hospital

  • Clarified to ensure only those clients who meet specific criteria can be detained/sectioned
• Assessment period


  • Clients do not have to declare, e.g. for insurance or to emigrate