Evaluation of Service User Involvement in Camden

Tonic report front page

Camden commissioners hired an independent organisation called Tonic to do an evaluation of service user involvement in Camden. Tonic heard from 123 users of both mental health and drug & alcohol services and they have produced a report which you can read here.

Tonic: Camden Service User Engagement report

The report proposes the following options for the continuation of Camden involvement. Watch this space because commissioners will decide soon!

Option 1: Refine and review the current specification. Commission an independent organisation to co-ordinate service user involvement across the Borough for mental health and substance misuse. This service would operate as the ‘go to’, impartial, service for service users to share views, or for the council to seek input for consultations.

Option 1a: Commission two separate independent organisations to co-ordinate service user involvement; one for substance misuse and one for mental health.

Option 2: Offer independent funding directly for service user groups (e.g. directly from the council to service user groups e.g. CBUG)

Option 2a: Stipulate in new contract with independent provider that some of the budget should be retained for service users to apply for grant funding for new initiatives.

Option 3: Contract with a current commissioned provider to provide and coordinate independent service user involvement activity across the cohort (either substance misuse or mental health). Key to this option is that service users feel confident that their views will not affect their care from said provider and this function is seen as an adjunct to the other activities offered.

Option 4: Do not commission an independent service user involvement service outside of the current service providers, as they already promote service user engagement as part of their individual contracts. This would, however, not benefit from a resource to pool together all of the separate service user engagement and feedback into one place for providers and commissioners and service users may be concerned they cannot give honest feedback to the service providers about their care/treatment.


What is it like to be sectioned? (BBC video)

Many people suffer a lack of dignity when they are detained under the Mental Health Act, an independent review has found. The review was set up to look at the rise in the number of people being detained, issues around detentions of people from black and minority ethnic groups and if the act is out of step with a modern health care system.

The BBC spoke to four people who have been sectioned to find out their experiences.
If any of these issues affect you then find out more by visiting Rethink. or VoiceAbility


To see this and other related videos on the BBC website, please visit: http://www.bbc.co.uk/news/av/uk-england-43974488/what-is-it-like-to-be-sectioned

Mental Health inpatients struggling with debt to be given breathing space

Good news: Thousands of people who are in mental health crisis and struggling with serious debt will be given breathing space from further interest, charges and enforcement action following a campaign victory by the Money and Mental Health Policy Institute.

Breathing space

The Recovery Space Campaign team delivering the petition

Read the full article on the Money Saving Expert website here: https://www.moneysavingexpert.com/news/protect/2018/04/people-in-mental-health-crisis-to-be-given-breathing-space-from-serious-debt-problems-

National Day of Action to Stop and Scrap Universal Credit

Disabled against cuts

Disabled campaigners held a national day of action yesterday (Wednesday 17th April) calling on the government to halt the roll-out of its Universal Credit.

Disabled People Against Cuts (DPAC), Single Mothers’ Self-Defence and WinVisible activists demonstrated in Westminster against the national introduction of the new benefit system.

To find out more about DPAC please visit their website: https://dpac.uk.net/2018/03/national-day-of-action-to-stopandscrap-universal-credit/

You can see the protest reported here:

CQC: Monitoring the Mental Health Act report

“Monitoring the Mental Health Act in 2016/17” is the CQC’s annual report on the use of the Mental Health Act (MHA), it looks at how providers are caring for patients, and whether patient’s rights are being protected.

CQC mental health report cover

During 2016/17, the CQC carried out 1,368 monitoring visits, met with 4,114 patients and required 6,475 actions from providers.

Their Second Opinion Appointed Doctor service carried out 14,594 visits to review patient treatment plans, and changed treatment plans in 26% of their visits.

They received 2,353 complaints and enquiries about the way the MHA was applied to patients.

They were notified of 186 deaths of detained patients by natural causes, 54 deaths by unnatural causes and 7 yet to be determined verdicts.

They were notified of 642 absences without leave from secure hospitals.

CQC detentions in hospital

Their findings

They have seen limited or no improvement in the key concerns they have raised in previous years.

They found:

  • 32% (1,034 of 3,253) of care plans reviewed showed no evidence of patient involvement. This was 29% last year.
  • 17% (594 of 3,434) showed no evidence of consideration of the patient’s particular needs. This was 10% last year.
  • 31% (550 of 1,788) showed no evidence of the patient’s views. In 2015/16, 26% had not been recorded.
  • 17% (588 of 3,372) showed no evidence of consideration of the least restrictive options for care. This compares to 10% of records last year.
  • 24% (570 of 2,403) showed no evidence of discharge planning, compared with 32% last year.

To read the whole report visit the CQC website here.

Mental Health Act 1983 – important changes

The changes to sections 135 and 136 of the Mental Health Act introduced by the Police and Crime Act 2017 came into force on 11 December 2017.

Hill Dickinson is a company providing legal advice and support to the NHS and independent healthcare organisations. They have written the following explanation of the changes:

“The key changes are designed to ensure that police officers are able to act more quickly and flexibly, whilst ensuring that people receive the assessment and treatment they need as soon as it is required. The changes relate to:

  • places of safety
  • time limits
  • protective searches
  • the duty to consult
  • decreased detention times

Definition of ‘public place’

The current wording of section 136 in relation to where police can exercise their powers is open to interpretation and often causes difficulties. Case law over the years has assisted to better define what is ‘a place to which the public have access’, however this remains a tricky area. The changes when they come into force will define this more clearly, by specifically identifying the following places where police cannot exercise their powers under section 136:

‘a) any house, flat or room where that person, or any other person, is living, or;
b) any yard, garden, garage or outhouse that is used in connection with the house, flat or room, other than one that is also used in connection with one or more other houses, flats or rooms.’

Save for in these excluded areas, the police will be able to exercise their powers under section 136 anywhere. This should allow officers to act quickly to protect people found in places such as railway lines, offices and rooftops which have previously not necessarily been considered as ‘places to which the public have access’.

Where practical to do so, the police have an added duty to consult: a registered medical practitioner, a registered nurse or an approved mental health professional, before deciding to remove a person to or to keep them at a place of safety.

Places of safety

The amendments make clear that it will be possible to use a suitable private property as a place of safety, with the consent of the occupier. Therefore, a person’s own home could potentially be a place of safety, as could places such as community centres or other multiple use buildings.

A new provision (section 136A) will prevent the use of police stations as a place of safety for under 18s and also increase the safeguards in place where a police station is used as a place of safety for an adult. Section 136A permits the secretary of state to make regulations regarding the use of police stations as places of safety. It is expected that such regulations will include provision for regular review and ensuring that appropriate medical treatment is available.

Time limits

The maximum period for detention under section 135 and section 136 to allow for a mental health assessment to be completed, is currently 72 hours. This will be reduced to an initial maximum period of 24 hours. The period will still commence from the time when the person arrives at the place of safety or the time a police officer enters the property if he/she subsequently decides to keep the person at that place.

It will be possible, at the end of the 24 hour period, for an extension of up to 12 hours to be granted, but only where it would not have been practicable to assess the person in the first 24 hours i.e. only where the condition of the person makes it necessary to do so. That extension can be granted by the registered medical practitioner responsible for the examination of the patient.
Protective searches

Section 136C will introduce the power for protective searches to be undertaken where a police officer has reasonable grounds to believe that the person may be a danger to themselves, or others, or is concealing an item on his or her person that could be used to cause physical injury to themselves or to others.


The government has produced guidance to support the implementation of the changes which can be accessed here.

The changes to the legislation have the clear aim of protecting patients’ rights, which is welcome. The reduction in time limits is likely to increase pressure on services, particularly in light of the current bed situation. Effective implementation, particularly in relation to the duty to consult and reduced detention times, will involve local authorities, healthcare providers and the police working very closely together. Policies and procedures will need to be updated and training may be required.”

Further sources of information

You can find the full article by Hill Dickinson here: https://www.hilldickinson.com/insights/articles/mental-health-act-1983-important-changes-coming-force-11-december-2017

The government has issued “Guidance for the implementation of changes to police powers and places of safety provisions in the mental health act 1983” which you can read here: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/656025/Guidance_on_Police_Powers.PDF

The mental health charity Mind have also written about these changes. You can see their article here: https://www.mind.org.uk/news-campaigns/legal-news/legal-newsletter-march-2017/policing-and-crime-act-2017/

Guardian: “NHS slashes funds for top homeless mental health team”

Fears for rough sleepers as specialist north London unit faces 42% budget reduction.

NHS Homeless funding cuts

NHS bosses are under fire for cutting back a team of doctors and nurses who provide mental health care to one of Britain’s largest groups of homeless people.

Camden NHS Clinical Commissioning Group (CCG) in north London is giving the Focus Homeless Outreach team £219,866 less a year starting on 1 April, a leaked CCG document reveals. One of the team’s two psychiatrists and one of its six nurses will lose their jobs as a result.

Critics say the decision makes a mockery of Theresa May and Jeremy Hunt’s repeated claims that NHS mental health services are receiving record amounts of funding to improve care. They fear it will lead to more rough sleepers suffering mental health crises and killing themselves, and that it will add to the already heavy demand for care being faced by hospitals and GPs in Camden.

The CCG is pressing ahead with the 42% cut to the £521,000 budget it gave the team this year despite a storm of protest from local GPs, psychiatrists, homeless charities and managers of hostels where rough sleepers sometimes stay. Camden had the third highest rate of rough sleeping in England in 2017, recent government statistics showed – more than Manchester, Bristol and Cornwall.

Focus, set up 25 years ago, helps treat the high levels of depression, psychosis and other mental health conditions found in rough sleepers, hostel dwellers and “sofa surfers”, including some asylum seekers and people who have been trafficked. Its budget is being reduced even though it is regarded by NHS, local council and social work bosses in London as a model of good practice of how to reach the kind of group that often shuns traditional NHS services…

Read the full article on the Guardian website here.