Análisis de cumplimiento de la Resolución 312 de 2019

Alongside the NSF (Department of Health, 1999b) developments, in 2002 the government published a draft bill, which, according to Dent (2007), was universally criticised. A further draft was published in September 2004 and was subject to scrutiny by a joint parliamentary committee, which described it as fundamentally flawed. In March 2006 the Department of Health announced that it was dropping the draft bill and would instead make amendments to the 1983 Act (Dent, 2007). After further deliberations The Mental Health Act 2007 (Department of Health, 2007a) received Royal Assent on 19 July 2007 and came into effect from October 2008. This did not replace the 1983 Mental Health Act, as originally intended, but instead amended the earlier legislation. It was also to introduce "deprivation of liberty safeguards", through amending the Mental Capacity Act 2005 (Department of Health, 2005), and to extend the rights of victims by amending the Domestic Violence, Crime and Victims Act 2004 (Home Office, 2004). The main changes to the above acts are described in the Mental Health Act Overview (Department of Health, 2009) and a summary of the important changes is presented below.

2.5.1.1 Amendments to the Mental Health Act 1983 (in respect of adults with mental health issues)

The 2007 MHA importantly changed the definition of mental disorder, so that a single definition applies throughout and references to categories of disorder are abolished. Criteria for detention are provided that introduce a new appropriate medical treatment test, which applies to all the longer-term powers of detention. A major implication for social work practice is the changes to professional roles. The new Act broadened the group of practitioners who could take on the functions previously performed by the ASW and the responsible medical officer (RMO). Some of the other important changes were in respect of the nearest relative. The Act gives patients the right to make an application to the county court to displace their nearest relative. It also enables county courts to displace a nearest relative who it thinks is not suitable to act as such the provisions for determining the nearest relative now include civil partners amongst the list of relatives. Supervised Community Treatment

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(SCT) allows certain patients with a mental disorder to be discharged from detention, subject to the possibility of recall to hospital if necessary. It also introduces new safeguards for patients receiving electro-convulsive therapy. For the Mental Health Review Tribunal (MHRT), the Act introduces an order-making power to reduce the time before a case has to be referred to the MHRT by the hospital managers. Introduction of the Independent Mental Health Advocate role places a duty on the appropriate national authority to make arrangements for help to be provided by independent mental health advocates. Finally, the introduction of the principle of age-appropriate services requires hospital managers to ensure that patients aged under 18 admitted to hospital for mental disorder are accommodated in an environment that is suitable for their age.

2.5.2. Changes to the professional roles

2.5.2.1 Responsible Medical Officer (RMO) to Responsible Clinician (RC)

The Act has introduced two new roles, the Approved Clinician and the Responsible Clinician. Section 145 (1) of the 2007 Act defines an approved clinician as “A person approved by the appropriate national authority to act as an approved clinician for the purposes of the Mental Health Act 1983”. A responsible clinician is the approved clinician who has been given overall responsibility for a patient‟s case. Approved clinicians who are designated as responsible clinicians will undertake the majority of the functions previously performed by Responsible Medical Officers under the 1983 Act (NIMHE, 2008). Hospital managers are responsible for ensuring local protocols are in place for allocating responsible clinicians to detain and for Supervised Community Treatment patients. LASSDs authorise approved clinicians to act as responsible clinicians for guardianship patients. Certain decisions, such as renewing a patient‟s detention or placing a patient on Supervised Community Treatment, can only be taken by the patient‟s responsible clinician (NIMHE, 2008). The professionals who can act as an approved clinicians are:

 Registered medical practitioners (doctors)

 Charted psychologists

 First level nurses whose field of practice is mental health or learning disabilities

36  Registered occupational therapists

 Registered social workers

These professionals are expected to bring expertise from their own backgrounds to this new role.

2.5.2.2 ASWs to Approved Mental Health Practitioners (AMHPs)

The new act has broadened the group of professionals who can carry out the statutory duties previously executed by the ASWs. As a result the AMHP role is now open to:

 First level nurses whose field of practice is mental health or learning disabilities

 Registered social workers

 Registered OTs

 Chartered psychologists

This inclusion of different professionals is expected to harness expertise from their individual backgrounds but within an established set of values and standards of practice that pertain to the AMHP role (NIMHE, 2008). Opening the role to non social work staff is also viewed as a solution to address the shortage of AMHPs in some areas. Parker (2010:19) suggests:

The inclusion of other professionals has occurred to address the shortages of ASWs in some areas (Huxley et al, 2005a) and reflects changes in service provision in line with integration of health and social services into multidisciplinary community mental health teams (NIMHE, 2005; Rapaport, 2005).The change also recognises that drawing AMHPs from nursing and other disciplines may add to the diversity and quality of the role (Jones et al, 2006) and create a further path for career progression for mental health workers.

The LA retains responsibility for approving AMHPs; however the requirement that AMHPs are employed by the LA has been removed in the new act. AMHPs must be approved by only one LA, but they can be authorised to act on behalf of a number of English LAs with whom they have an agreement. They must be approved for five years. The LA is responsible for ensuring that the AMHP is competent to practice as an AMHP. The role of the LA in warranting AMHPs has been retained, under the revised legislation, in an attempt to sustain the focus of the role on anti-oppressive

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practice and the promotion of social work values in fostering recovery from mental distress.

The roles and responsibilities of the AMHPs are very similar to that of the ASWs, but in relation to the Supervised Community Treatment9 there are some additional responsibilities. NIMHE (2008:8) explains that:

AMHPs as individuals with functions of a public nature, are also bound by various duties on public authorities under the Human Rights Act 1998, the Mental Capacity Act 2005, the Equality Act 2006 and other anti-discrimination legislation; all of which contribute to the need for an AMHP to be independent in their decision-making and for their role in safeguarding the rights of the patient.

Educational and Training Requirements of AMHPs

Despite being open to non social work staff, as Parker (2010:20) explains, „AMHP training is still directly linked to the GSCC post-qualifying social work framework (like the previous ASW training), with requirements for AMHP training being specified by the GSCC and linked to the Post Qualifying (PQ) higher specialist award, which requires assessment at Masters level‟. As Section 114A of the 2007 MHA (Department of Health, 2007a) explains, persons who are or wish to become AMHPs should complete a course approved by the relevant council, in accordance with rules made by it. They must demonstrate a certain level of professional competence, capacity and ability to undertake and complete the training programme at the PQ Higher Specialist Social Work Award level, as recognised by the requirements set out in the GSCC PQ framework. Finally, with all these qualifications, they have to be nominated by a LA or other employer for the training course.

Asking the candidates to complete the PQ Higher Specialist Social Work Award ensures the need for AMHPs to learn social perspectives of mental health. Parker (2010:20) describes, “Leaving AMHP training within social work post-qualifying framework goes some way to reassure that the social perspective and the core social work values remain embedded with the training”. However there are concerns

9 _{Arrangements under which patients can be discharged from detention in hospital under the Mental Health}

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about the independence of the role when undertaken by the non social work staff and fears around the future of the social work contribution in mental health.

The GSCC (2010:Section 51) states that; „The primary purpose of the training is to ensure the competence of professionals that may include social workers, nurses, occupational therapists or psychologists who are being considered for approval as AMHPs in accordance with the relevant mental health legislation to carry out statutory responsibilities under the Mental Health Act 2007”. The GSCC (2010:Section 51) further stresses that:

AMHPs must represent and maintain the values, integrity and relevance of the social perspective on mental distress, and training must enable AMHPs to articulate the social perspective through the role and responsibilities laid on them. Training must also prepare all AMHPs, regardless of individual profession backgrounds, to be able to assert an alternative social perspective to the medical view and act independently.

Parker (2010:20) emphasises that “this responds to many of the initial concerns expressed when the change in professional roles was announced, with concern that the AMHP would not be independent of medical influence (BASW, 2005), and concerns regarding the potential loss of the independence of the ASW role and uncertainty about the future role of social work in mental health (Merchant et al, 2007)”. Therefore, it has been essential for programme providers to reflect on course content and, in particular, how the emphasis on social perspective flows through the programme and assessment strategies.

As Parker (2010:19) further explains “the reform of mental health law in England and Wales with the amendments to the Mental Health Act 1983 has important implications for education and training of AMHPs in terms of the professional background of students and academic level of the award”. By now many Universities are providing post qualifying courses in Mental Health Social Work that are being revised in line with the AMHP requirements, even though the GSCC as the social work professional body currently continues to retain responsibility for their accreditation. The need for a Masters level qualification for AMHP training has raised many concerns (Parker, 2010:20). Many scholars question the need, validity and appropriateness of academic knowledge in Masters Level to perform in a practical role such as an AMHP. On the other hand some argue that for the decision making

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in such complex situations AMHPs need a higher level of education plus the necessary skills and training.