The Socialist Health Association set up a Working Group on Mental Health in 1986. This resulted in a discussion paper “Goodbye to all that? – the Politics of Mental Health”, published in March 1988. Following consultation throughout the Association, the Central Council of the SHA adopted the following policy points at its meeting on 25 September 1988.
- Legislation must ensure that there is no discrimination against people with a psychiatric history. Proper recognition of this must be included in the appeal procedures.
HOUSING FOR USERS OF MENTAL HEALTH SERVICES
- Recognising the role of housing in primary prevention, a massive increase in the currently available housing stock is required to help prevent the development of mental distress. The design of future housing should concentrate on low rise flats, or houses and there should be greater resources available for repairs, and cleaning of council estates.
- Every Health Authority, in conjunction with Local Authorities, housing co-operatives, housing associations and the voluntary sector must plan for and guarantee suitable accommodation for every person to be discharged from hospital. This planning should avoid the concentration of people with mental health problems. Such provision should be monitored by local forums of users and mental health workers along lines proposed by MIND’s “Common Concern” (1985).
- All people to be discharged from hospital should be consulted as to what type of housing they wish to live in in the community, and with whom. Housing options therefore need to be varied and responsive to different individual and group needs.
- A person’s right to informed choice about housing in the community should be protected by appropriate advocacy schemes. Local Authority Housing Departments should review and change their procedures for allocating housing to be more responsive to those with mental health problems.
- It has to be recognised that there will be a need for provision of residential facilities which offer asylum and follow up work as therapeutic communities. Therefore such facilities must be provided.
- The general anti-racist demands being made in the labour movement would, if successful, reverse institutional racism within the psychiatric system. Thus, the attempts to improve the mental health of black and other ethnic minorities cannot be divorced from the general anti-racist struggle.
- The composition of staff in local mental health services, in terms of racial and cultural background, should reflect the character of the local population and ensure the provision of special services such as interpreting and advocacy, particularly where compulsory orders must be made.
9. Where work entails cross-cultural relationships (as is inevitably often the case) staff training should take account of this and ensure that workers guard against stereotyping.
10. Statutory Authorities should fund autonomous projects in the voluntary sector, where voluntary services would command more confidence.
- Section 86 of the 1983 Mental Health Act, which refers to the “removal of alien patients”, and is used for the repatriation of the mentally ill, should be repealed.
- All services should take active steps to promote the development of Patients’ Councils.
- Services should promote the participation of users in all decision-making on their own treatment policies, including day-care programmes.
- Service providers should promote the development of self-advocacy groups.
- Everyone should have access to their records, with a right to amend inaccuracies.
- Section 58 of the 1983 Mental Health Act should be amended to clarify the relationship between treatment and control.
- Medical staff should give full information to patients about the risks and potential benefits of the proposed treatment, for instance the risks of addiction or brain damage, associated with tranquillisers and ECT.
- Subject to negotiations with the relevant Trade Unions, Section 139 of the 1983 Mental Health Act (which at present gives staff immunity from prosecution from users of the service) should be repealed.
INFORMAL MENTAL HEALTH CARE
- Self-help groups, voluntary organisations and carers should be funded by the State in ways which reflect the crucial contributions they make to mental health care in each locality.
THE REFORM OF PROFESSIONAL THERAPY
- Service providers should develop policies in their locality which are sensitive to the person’s emotional and social needs and seek to minimise as far as possible the use of drug treatments and electro-convulsive therapy (ECT) with a view to phasing out the latter.
- Doctors and nurses should have the right not to administer ECT.
- Wherever possible, drugs should be used only in a secondary role and on a temporary basis.
- All drugs should be prescribed generically.
- The SHA reaffirms its policy that at least one drug company should be nationalised.
- All community mental health facilities should be designed to take into consideration the proper needs of individual, group and family therapy (with regards to size of rooms, quietness, décor etc).
- In order to prevent hospitalisation, in each locality there should be a crisis intervention service with a wide range of facilities and personnel.
- Where residential facilities are provided by statutory services, they should be guided, whenever possible, by therapeutic community models.
- In the light of the extensive evidence on the prevalence of tardive dyskinesia (causing involuntary motor movements, similar to the
symptoms of Parkinson’s disease) in people prescribed major tranquillisers, the use of these drugs should be minimised.
- The government should find ways of phasing out minor tranquillisers and make a greater investment in other alternatives to drug treatments, such as relaxation techniques.
- The surgical destruction of healthy brain tissue for the purpose of effecting personality change (psychosurgery) should be made illegal.
- Special Hospitals should be replaced by a flexible range of secure provision under local health control. Appropriate facilities should be provided as an alternative to prison for offenders requiring psychiatric treatment.
- The prison medical service should be taken into the NHS and out of Home Office control.
- People with degenerative neurological conditions (such as senile dementia) require nursing care in appropriate facilities which are separate from mental health services.
- The need for research and adequate training in psychotherapy and for joint-funding for training in the implementation of care in the community is recognised.
COMMUNITY CARE POLICY
- Community Care must be funded by the many relevant departments of central government and co-ordinated at a local level by local authorities.
The components of a proper Community Care policy should include the following:
- Fulfilling employment/activity.
- An adequate level of income provided by social security.
- Where appropriate additional funding should be provided for a transitional period.
- People have a right to call directly upon various forms of assistance.
- The staffing of mental health services should include generic mental health workers.
- In order to reduce social isolation, a cheap and efficient public transport system should be available to all people.
- All old, large mental hospitals should be phased out by the year 2000 and their present residents returned to the community with full rights, dignity and income.
Proper asylum is a necessary component of a comprehensive community mental health service. It should be provided in order that people experiencing chaos and distress can feel safe and supported. Asylum is best seen as a concept rather than a particular place.
- For a lengthy period, both hospital and community services will have to be financed in tandem. A central bridging fund should be administered to facilitate this process. Money should be provided to retrain staff and guarantee no redundancies.
- A code of practice should be drawn up which guarantees that all money accruing from mental hospital sales should be retained for mental health projects, which should not be restricted to other forms of institutional provision.
- Research, monitoring and evaluation is essential to the provision of effective and efficient services.
Further copies of this Policy Leaflet are available from the Socialist Health Association, 195 Walworth Road, London SE17 1RP, at £2.00 for 100, £12 for 1000 (including p&p).
The SECOND (REVISED) EDITION OF “GOODBYE TO ALL THAT?” will be available from SHA in Summer 1989 at £2 (including p&p).
Membership of the Socialist Health Association is open to all Socialists with an interest in health policies and politics. Individual membership: £10 waged, £3 unwaged. Affiliation fees for local organisations: £10.