| Introduction |
| The Mental Health (Scotland) Act 1984 introduced the requirement for local authorities to appoint experienced, trained and accredited personnel to be involved in the compulsory detention of people with mental disorders. Under the terms of the Act, it is the responsibility of the MHO to "satisfy himself that detention in a hospital is in all circumstances of the case the most appropriate way of providing the care and medical treatment the patient needs". Prior to the 1984 Act, research had revealed problems for MHOs caused by confusion over roles and responsibilities as well as lack of experience and inadequate training. One of the main objectives of the present research project was to examine the extent to which the 1981 Act has clarified the Mental Health Officer role. In doing this, the researchers obtained the views of managers and consultant psychiatrists, as well as examining the outcomes for a sample of service users for whom there had been MHO intervention. |
| Statutory role Assessment |
| The majority of assessments undertaken by MHOs took place in relation to people who were already in hospital. In the course of their assessment MHOs drew on a wide range of evidence, from interviews with the individual, to reference to medical and social work records. The study revealed the complexity of the task facing the MHO and underlined the for MHOs to have the time and space within their workload to undertake the role. In all but 3 cases assessment by the MHO resulted in the compulsory detention of the mentally ill person. However, on the occasions when MHOs were able to consider alternatives to detention, they felt that their options were limited either because of the needs of the individuals (specifically for medication) or the perceived lack of suitable resources in the community. |
| Withholding consent |
| The data suggests that some MHOs may be more confident about challenging a decision made by medical staff to compulsorily detain an individual than others, but that even the more experienced MHOs felt in a weak position. The data suggests that MHOs need not only the experience and confidence to challenge, but also clear guidelines. MHOs require access to alternative solutions to detention and support from their social work managers to pursue these options. |
| Working relationships |
| Hospital based MHOs had the advantage of knowing other professionals in the hospital and this helped them to discuss and negotiate. Although MHOs outwith the hospital were more independent, they tended to feel undermined by lack of experience. Consultants who valued the MHO role identified: their information gathering function; their non-clinical perspective; their safeguarding role; and their communication skills. |
| Assessment Reports |
| In preparing a Social Circumstance Report (SCR), MHOs had to try to meet the information needs of the RMO and the Mental Welfare Commission. In doing so they tended to emphasise one function over the other, leaving one audience without the required information. Both MHOs and consultants questioned the usefulness of SCRs to decision making, however, managers believed that the introduction of care management might provide a more clearly defined focus for the SCR. |
| MHO role and the courts |
| MHOs reported that the different expectations placed on them by the courts could leave them feeling 'wrong footed' and stressed the need for more training for this aspect of their work. Practice varied across the Regions in respect of legal presentation and in only one region were MHOs legally represented in contested cases. |
| Beyond the statutory role |
| Social work input was provided by the MHO or another social worker in over half of the cases in the sample. People who were already clients of the MHO/social worker were more likely to receive a follow up service. Some MHOs were found to perform a consultancy role for other professional colleagues and some were also involved in service development. In these respects the MHO functions as a social work resource. |
| Users |
| The MHOs felt that for at least some people, the outcome of detention was either prevention of further deterioration, or improvement. Housing problems arose in some cases. The users did not appear to attach any importance to the presence of the MHO at the point of detention. However, they would look to the MHO, as a social worker, for practical assistance and support after detention. |
| Workload, organisation and deployment of MHOs |
| Even those MHOs based in hospitals spent only a small proportion of their time on statutory mental health work. Both hospital based and area based MHOs experienced mental health work as an 'add on' function, and felt that they had to 'juggle' time to accommodate these demands. In general, hospital based MHOs undertook substantially more statutory mental health work than their hospital based colleagues. For community based MHOs the infrequent level of referrals lead them to question their competence. However, interviews with managers indicated that some of the problems which stemmed from systems of referral were being addressed. They emphasised the importance of ensuring that MHOs have sufficient practice experience. |
| Support |
| For professional support, MHOs relied upon other MHOs, either on a one-to-one basis or through an MHO forum. The perceived lack of formal support mechanisms was felt most acutely by the community based MHOs, especially those based in teams without other MHOs. MHO fora provided a source of support and guidance, particularly for community based MHOs. MHOs interpret the 'semi-autonomous' nature of their role as meaning that they are personally responsible for the decisions they make. Although MHOs felt they had independent status, their location within a hierarchical organisation with its own priorities meant that they could be faced with conflicting priorities. They also felt less protected by systems of accountability and this lead to a 'safety first' attitude. |
| Managers saw the potential for setting standards and developing performance indicators in mental health work in general. Comments suggested moves towards greater management responsibility and control over the MHO service and its practitioners. Responses suggested that when guidance proposed something which was not desirable from the MHO's point of view, it was regarded more as an imposition rather than a support. The data emphasised the importance of involving 'grass roots' practitioners in the process of developing local standards to encourage a sense of ownership. |
| Training |
| The comments of managers suggested that a more strategic approach is being taken toward the selection of social workers for MHO training than in the past. This strategy combines: a more effective use of those already trained; and a selection process more closely linked to future deployment. The responses emphasised that training can only provide a base which must be built upon by practice experience. Those who did not practice regularly began to question their own competence and felt that they would benefit from a refresher course. |
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| Marion Ulas, Fiona Myers and Bill Whyte |
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