1834 Poor Law (Amendment) Act

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RISK AND CONTROL:
high profile homicides led to Care Programme Approach (1990) to co-ordinate support, provide full needs assessment and care plan •supervision registers (1994) and Mental Health (Patients in the Community) Act 1995 tightened co-ordination and control over patients •Mental Health Act 2007: supervised community treatment and wider role for mental health professionals

CARE AND RIGHTS
National Service Framework 1998, 2009: set national standards and guidelines and targets for developing services •recovery approach represents shift from medical focus on cure to individual capacity, regardless of diagnosis and symptoms •measures to protect rights of people with mental illness in Mental Capacity Act 2005 and Mental Health Act 2007

PERSONALISATION:
mental health service users’ limited access to direct payments the result of professional paternalism and fears about risk •personal budget studies showed most positive outcomes for mental health service users in terms of overall wellbeing and quality of life •Pathways to Personalisation, Putting Us First and New Horizons designed to increase access e.g. through risk management strategies ASS007-3DEPENDENCY AND CARE: CRITICAL PERSPECTIVES ON POLICY AND PRACTICE

Week 20Mental health service users

1.Facts and figures
How many, what and why An estimated one in four people experience some form of mental illness during their lives which makes it one of the most common causes of disability. Common mental disorders are more likely to affect women than men, and the rates amongst women aged 45-64 have risen by about a fifth over the past fifteen years. People aged 75 and over are least likely to have a common mental disorder. More than half with a common mental disorder present with a mixed anxiety and depressive disorder. Whilst serious mental illnesses such as psychotic disorders (e.g. schizophrenia), anti-social personality disorder and borderline personality disorders receive considerable publicity they each affect one percent or less of the adult population. There are slightly higher rates of psychotic disorder amongst women than men but little difference in relation to personality disorders. The highest prevalence rates are amongst the 35-44 age group, with a significantly higher diagnosis of psychotic disorder amongst black men than men from other ethnic groups. Psychosis is also more prevalent amongst adults in the lowest income groups. A relatively high percentage of adult psychiatric patients, particularly amongst urban populations, have a co-diagnosis of substance misuse. The mental health disorders discussed so far may be transient, recurrent or chronic but degenerative brain disorders, commonly collectively known as dementia, are permanent and terminal. Because they affect one in twenty people over the age of 65, and one in five over the age of 80, an ageing population means that its prevalence will continue to increase. Need for social care The stigma attached to mental illness continues to affect service users, their families and carers. Although there are some encouraging signs of a shift in public attitudes, surveys show that a high proportion still believe that people with a mental illness should be kept in a psychiatric hospital. Stigma affects the lives of people with mental disorders in a number of dimensions, such as relationships, paid employment, housing and quality of life. This makes mental illness an issue for social care as well as health policy, whilst the growing prevalence of dementia will place increasing demands on both health and social care providers.

2.From institutionalisation to community care
Institutionalisation In the 18C and 19C, as discussed in previous sessions, people regarded as dangerous were commonly confined to institutions under harsh and degrading conditions – initially in private madhouses and later in publicly-funded asylums. Successive Lunacy Acts passed during the 19C...
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