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Participation

People who use mental health services are clear about the value they place on participation in care and treatment decisions.

"Service User involvement in Mental Health is clearly desirable both for those carrying out functions as part of their employment and for our personal development, knowledge, confidence and feelings of self worth" (VoX Good Practice in Service User Involvment - Guidance Notes)

Under the principles of the 2003 Act each individual has a right to be fully involved, as much as possible, in all aspects of their assessment, care, treatment and support. Their wishes should be taken into account and they should be provided with information in a way which makes it most likely to be understood. The principles of the act also state that carers should receive appropriate information and have their views and needs taken into account.

Research commissioned by the Scottish Government and published in 2009-Experiences of the early implementation of the Mental Health Care & Treatment Act - identified the need for further detailed investigation into the quality and inclusiveness of care plans for those under compulsory measures. Particular attention was paid to user participation.

"Across the range of positive and negative experiences of participation of the service users in this study, a key issue to emerge was the extent to which service users believed their views and opinions had tangibly influenced decision-making about their care and treatment. In other words, while they understood they had opportunities to voice their opinions and used them, they did not believe they were being heard".

In their research article - Encouraging user involvement in mental health services -Tait and Lester have written about the benefits of service user involvement in care planning on the basis that service users:

  • are experts about their own illness and need for care;
  • may have different but equally important perspectives about their illness and care
  • can increase a possibly limited understanding of their mental distress
  • are able to develop alternative approaches to mental health and illness
  • may find this therapeutic in itself
  • may experience greater social inclusion as a result

The researchers found that despite these benefits some health and social care professionals do not recognise the value of user participation and take advantage of it sparingly and with some reluctance. They speculated that asking people to participate in decision making about their care and treatment options may challenge the professional's notion of themselves being the sole experts, and may appear to them to lack scientific rigour. If a health team has this attitude it is likely that individual participation, when it is used, will not be listened to or valued.

On our visits we found some good examples of participation and the benefits that flowed from this:

"Following admission, Ms Y and her parents subsequently met with the RMO and MHO to reflect on the admission process, reasons for the detention, and to inform Ms Y of her rights etc. She remains unhappy about the process but confirmed that her views are listened to and she is entirely satisfied with the care and treatment she is receiving"

In some cases we were unable to find evidence of involvement either because the individual refused to engage, or was still too unwell at the time of our visit. In a small number of cases we recorded examples where the level of involvement was poor or non-existent:

"The STDC was lapsing on the day of the visit and no one on the ward had any idea about whether an application for a CTO was being made or not. Finally after a lot of information gathering, the staff confirmed to me that the STDC will be allowed to lapse. In view of this I would find it hard to believe that the patient had been adequately involved or understood her status"

The code of practice states that it is essential when deciding whether or not to proceed with a CTO application to do so only after all the relevant members of the patient's multi-disciplinary team have been consulted and that it is:

"essential to have regard to the views of the patient and the patient's carers and named person" Code of Practice Vol 2, page 61

A recent article in the British Journal of Psychiatry noted that studies have shown that psychiatrists have "poor patient involvement abilities" (Involving patients in decisions during psychiatric consultations Goss et al 2008).  It is our view that participation of individuals in their care is both beneficial to clinical outcomes and required by the legislation. The evidence from this visit programme is that this view is widely supported by the majority of health care teams and we found many examples of this:

"Unhappy with medication prescribed on admission but after discussion and negotiation re her reasons for wanting different medication she was started on Quetiapine and she has been significantly more settled in the couple of days prior to the visit. She clearly feels that her views have been listened to and that staff are treating her well"

Voices of Experience (VoX) have produced a guidance document for service user involvement which aims to support services to involve service users in a meaningful way.