The views of policy influencers and mental health officers concerning the Named Person provisions of the Mental Health (Care and Treatment) (Scotland) Act 2003.

BACKGROUND: The Mental Health (Care and Treatment) (Scotland) Act 2003 introduced the role of the Named Person, who can be nominated by service users to protect their interests if they become subject to compulsory measures and replaces the Nearest Relative. If no nomination is made, the primary carer or nearest relative is appointed the Named Person. The views of professionals involved in the development and implementation of the provisions were unknown. AIM: To describe the perceptions of mental health officers and policy makers involved in the development and implementation of the new provisions. METHOD: Sixteen professionals were interviewed to explore their perceptions of and experiences with the Named Person provisions. Data were analysed using Thematic Analysis. RESULTS: Perceptions of the Named Person provisions were generally favourable but concerns were expressed over low uptake; service users' and carers' lack of understanding of the role; and potential conflict with human rights legislation over choice and information sharing. CONCLUSIONS: Legislation should be amended to allow the choice of no Named Person and the prevention of information being shared with the default appointed Named Person. Removal of the default appointment should be considered.

The content of mental health advance directives: Advance statements in Scotland.

BACKGROUND: Where advance directives in mental health have been introduced concern has been expressed about their content including inappropriate treatment choices, ambiguity, or the impact of decisions on resources. AIM: To examine the content of advance statements in Scotland. METHOD: A thematic analysis of 55 advance statements presented to the Mental Health Tribunal for Scotland. RESULTS: The format of statements did not always follow the guidelines and there were considerable differences in the content. A total of 96% of the statements included at least one specific treatment refusal. In contrast 45% named specific medications they were prepared to take. 55% contained wider information than 'treatment', including setting and other supports. CONCLUSIONS: The majority of advance statements contained clear information about preferences as to medical treatment. The additional requests raise questions about what is meant by treatment.

Models of advance directives in mental health care: stakeholder views.

OBJECTIVE: The aim of this study was to examine perceptions of the place of advance directives in mental health care. METHODS: Postal survey of stakeholders was carried out to assess their views on different models of advance directives in mental health care. A total of 473 responded. RESULTS: In all, 28% of psychiatrists thought advance directives were needed compared to 89% of voluntary organisations and above two-thirds of the other stakeholder groups. There were clear tensions between patient "autonomy" and "right to treatment" which underpin many of the concerns raised. Autonomy provided by advance directive can be contrasted with a co-operative partnership approach to advance planning. The legal status of advance directives is important for some people in relation to treatment refusal. There was general concern about the practical issues surrounding their implementation. CONCLUSION: There is a wide range of views in all stakeholder groups about the possible form advance directives should take. Although there is a widespread desire to increase patient involvement in treatment decisions, which advance directives could possibly help to realise, they may also have unwanted consequences for mental health services and individuals.

Prevalence and experience of harassment of people with mental health problems living in the community.

BACKGROUND: The levels and experiences of harassment of people with mental health problems in the community compared with those of the general population have not been explored. AIMS: To measure the levels and experience of harassment experienced by people with mental health problems in the community in Scotland and compare them with the general population. METHOD: Experiences of harassment were collected by interviewing 165 individuals with mental health problems and a control group of 165 people from the general population. RESULTS: Harassment in the community was found to be twice as common for individuals with mental health problems (41%) than for those in the general population (15%). The harassment commonly involved verbal abuse referring to the individual's mental health problems and was committed primarily by teenagers and neighbours. CONCLUSIONS: Harassment has a significantly higher prevalence among individuals with mental health problems living in the community and is believed to have a detrimental effect on mental health.

Does writing a list help cancer patients ask relevant questions?

We examined the use of written lists to give patients an opportunity to have their questions answered. Patients undergoing radical radiotherapy for cancer were given a sheet of paper with the simple prompt to write questions and give to the hospital doctor at their appointment 3 weeks later. At 3 months, patients were asked about their use and opinions of the written list. About half of the 478 patients attended with a written list. Fewer patients living in deprived areas used the list compared to more affluent areas. Doctors thought that 34% of patients would not otherwise have asked those questions and 91% of prompted discussions were a worthwhile use of time.