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|24 Oct 2017|
Dundee Stronger Together
Pupils with learning disabilities in Scottish schools feel “bullied, isolated and excluded” according to a report by charity ENABLE Scotland. In a survey of young people with a learning disability in Scottish schools 60 per cent said they felt lonely at school while 67 per cent said they had been bullied. Sixteen years after initial moves to educate those with learning disabilities in mainstream schools the number of additional support for learning teachers in Scotland has fallen to its lowest level since 2007. In the ENABLE survey 98 per cent of teachers said initial teacher training does not prepare them for teaching young people who have additional support for learning needs.
A hospital facility in Aberdeen which provides learning disability services is being closed down due to a lack of staff. The Bracken Ward in the Royal Cornhill Hospital, which contains 10 beds, has only been able to stay open recently due to help from employees in other departments and community workers. But now the ward has been closed to new patients because the situation became “unsustainable”. Staff attempted to find alternative accommodation for the existing patients in the ward but were unable to do so meaning they will remain there for the time being.
North-east MSP Lewis Macdonald said it was a “symptom” of the problems with the health board. He said: “For families of patients who have used this service in the past this is a real concern as it is for current patients. I think it is another symptom of the ailments afflicting the NHS in that it does not have the funds for its staff and services.”
NHS Grampian has attempted to get nurses returning to practice after a break to consider training in learning disabilities. However, the only two places in Scotland where qualifications in this practice can be obtained are Edinburgh Napier University and Glasgow Caledonian University, meaning people have to leave the north-east to train.
In the ongoing process of examining the review of the Mental Health (Care and Treatment) Act 2003, the question of Compulsory Treatment Order has come up.
Some people with learning disabilities have expressed concerns to us about the role psychiatrists play in making determination about the treatment of people with learning disabilities and that tribunals do not give them the right support. .
Mental Health Tribunals were set up in 2003 to provide a specialist check on the use of Compulsory Treatment Orders. The service costs almost £9 million per year with Tribunal members being paid about £400 per day when sitting.
Yet from our research it appears that less than 2% of applications for Compulsory Treatment Orders are refused. Other research based on a Randomised Control Study from England has suggested that Compulsory Treatment Orders are no more effective at helping people get better than the previous legislative provisions for compulsion in medical treatment.
What do Mental Health Tribunals do?
The main role of the Tribunal is to consider and determine applications for compulsory treatment orders (CTOs) under the 2003 Act. It also considers appeals against compulsory measures such as short term detention certificates and compulsory treatment orders. The Tribunal also reviews every compulsory treatment order once it has been in place for two years and every two years after that.
Each Tribunal meeting has a group of three people - a doctor (psychiatrist), a lawyer and another general member, that is a person with relevant skills and experience, e.g. a nurse, social worker or someone with personal experience of mental illness, learning disability or related condition.
Initial Concerns about bias
When the Tribunal were set up there were some concerns that they would be biased towards the views of the psychiatrist. It was said that many of the “general members” were Community Psychiatric Nurses and more likely to give more weight to the psychiatrist. The Legal Member who chairs the meeting might make sure the formalities were carried out properly but would not have any medical experience to challenge the view of the responsible psychiatrist.
The evidence that the tribunal hears comes from either a Mental Health Officer (normally a social worker) or the Responsible Medical Officer (who can often be another psychiatrist).
The domination of psychiatry in the process led to worries that the patient would not be in a strong position to challenge the use of Compulsory Treatment.
These worries were challenged at the time as unevidenced and unsupported. All members of a Tribunal come with their own views and have different approaches. All parties to the tribunal system have a “discipline-based approach” reflecting their own training and experience. The point of a Tribunal is to bring together these approaches into a vigorous consideration of the evidence and come to the conclusion that is in the “best interests” of the patient. 
The Aberdeen Stronger Together Group met with Lewis MacDonald at his new office in Rosemount Place. Sadie, George, Calum, Derek and Keith came along and asked Lewis some challenging questions. He answered them well and everyone was really happy that he had listened so well.
The questions were on
- Social Security
- Bullying and Harassment
- Making Scotland Better
Stronger Together groups from all around Scotland have been meeting with MSPs to discuss areas of concern and to raise awareness amongst MSPs of the issues that matter to people with learning disabilities.
In Kilmarnock the group met with Willie Coffey, the MSP for Kilmarnock
We spoke in frank terms about
- Personal Independence Payment
- The Work Capability Assessment
- Access to Community Activities
- The Concessionary Travel Scheme
- Care Charges
In Stirling the group met with Mark Ruskell, one of the list MSPs for Central Scotland
With Mark we talked about