Part of the discussion around the current review of the Mental Health Act has been about how we can empower services users in a law which can be very disempowering. There already exists means by which patients can make their views known, before they become unwell and are admitted to hospital. It is likely to feature in changes to the Mental Health Act, and that is the ability to make an advance statement giving your views and choices about a whole range of health and non-health issues.
Changes in the law
The interim report of the independent review of the Mental Health Act published earlier this year said that ‘there are opportunities outside of the MHA for a person to explain how they wish to be treated in the future.’ In their discussions with service users the review team found evidence that these wishes did not receive due regard. The proposals for the new Act are likely to include stronger legal backing for advance planning.
At present advance statements are not legally binding. These are not to be confused with advance decisions to refuse physical health treatment, these are a much more powerful tool within the Mental Capacity Act.
Making choices
So how might someone with mental health problems who may be admitted to hospital at some time use an advance statement to have more control over their care and treatment? The Code of Practice gives some pointers. Remember the Code’s Guiding Principles, which includes the principle of empowerment and involvement. This is about giving people the ability to be involved in their own care and treatment. Now if someone is mentally unwell, in the middle of a mental health crisis and being assessed by a number of mental health professionals, they may feel disempowered, and may not be able to express their own wishes and feelings about what is happening to them. It is then that professionals need to seek other ways to understand the person’s perspective.
Future care arrangements
So this is the way an advance statement might be used. An advance statement is something the service user has written down, shown to their friends and family, and any carers or workers who they know, to say if I become unwell these are the things I want staff to know about. These might be about domestic arrangements, for example care of pets, or it might be about more critical health care issues such as which hospital I would wish to be admitted to. Now I said at the beginning of this article that advance statements are not legally binding, but the Code of Practice does say in its useful Chapter 9 about Wishes expressed in advance that ‘professionals should make all practicable efforts to comply with these preferences’. It goes onto say that if these can’t be followed then staff should explain why.
Are you including advance statements in your care planning procedures?
