The state of legal information and advice services to people with mental health problems

Dr Jim Campbell, senior lecturer, School of Social Work, Queen’s University Belfast, is co author of ‘Unmet Need: A Study of Mental Health Legal Advice and Information Services in Northern Ireland’, research commissioned last year by Law Centre (NI). Here, he reflects on research findings in relation to the right of people with mental health problems to adequate legal protection.

It was Francis Bacon who coined the phrase ‘knowledge itself is power’. The following article reflects on research which was recently carried out with users, carers and professionals in the fields of legal information and advice in mental health services.{footnote}Campbell, J. and Wilson, D. (2004) Unmet Need: A Study of Mental Health Legal Advice and Information Services in Northern Ireland, Belfast: Law Centre (NI).{/footnote} Any passing examination of the literature in these fields reveals widespread discrimination against people with mental health problems – in terms of income maintenance, housing, access to employment and a wide range of other good and services. No doubt these facts are borne out daily in the work of legal and information advice centres throughout Northern Ireland. Many people who read this article can think of times when they needed some sort of specialist advice or knowledge to help a mental health service user or carer deal with the pain of surviving ‘the system’. It was important, therefore, to carry out a preliminary mapping of the range and quality of services in this significant sector.

In the process of the research we carried out a number of focus groups with service users and carers and interviewed lawyers and service managers. We also surveyed all solicitors who claimed to provide legal advice on mental issues. From the outset it became clear that nearly all of these constituencies had inadequate knowledge about a range of crucial matters. For example, before, during and after admission to psychiatric hospital, many service users and carers were either unaware of their rights or found great difficulty in finding information about their rights. It was also apparent that any limited advice and information provided by hospitals varied greatly and it wasn’t clear who was responsible for it. Such deficits in knowledge can have serious consequences for people who are already multiply disadvantaged. Under the Mental Health (NI) Order 1986, professionals have access to draconian powers to detain and even force people to be treated against their wishes, so one would imagine that there would be a reciprocal duty on trusts to provide adequate safeguards in terms of information – this did not appear to be the case for the people we interviewed.

The law, however, allows people who have been detained in hospital to appeal to the Mental Health Review Tribunal (MHRT); this indeed is an important safeguard – although one which respondents were not always aware of. Service users and carers had mixed views about their experiences of the MHRT and how well it met their needs. Interestingly, when lawyers were asked about the value of the MHRT, they too offered a range of views, both positive and negative. They felt that tribunal members generally treated applicants with sensitivity and sought to have their clients’ legal rights protected. On the other hand, nearly all the solicitors who responded to the survey admitted that they were ill-equipped to defend their clients, either because of a lack of training or insufficient time and resources to build their case. The most worrying finding of the research was that a high proportion of applicants to MHRT were ‘regraded’ by hospital authorities from detained to voluntary status, just prior to the hearing. This suggests that some of these clients may have been detained illegally.

We wanted to know how well legal information and advice services had been developed in the community so we asked service users, carers and managers to rate and describe their experience in these fields. Service users and carers tended to need most help in the areas of benefits, housing and employment, and found Citizens Advice Bureaux, Law Centre (NI), mental health charities and some politicians to be good advocates on their behalf. Professionals were less likely to be knowledgeable or interested in helping them understand their legal rights. The managers of specialist advice agencies whom we interviewed appeared to be very committed to helping their clients, and benefited from service user and carer directed activities and governance of their organisations. Yet there were still obstacles to helping people find out about their rights – professional resistance, lack of adequate resources to help people fight their cases at tribunals, and, even within this specialist core, some lack of understanding of key aspects of mental health law.

What then can this brief overview of a much longer report say about the state of legal and information advice services for people with mental health problems living in Northern Ireland? Maybe we should start with the uncomfortable fact which faces policy makers and politicians – historically, mental health services have been underfunded and continue to be viewed as less deserving than other sectors. This situation is compounded by the fact that populist, negative stereotypes about the capacity of people with mental health problems to understand their rights are prevalent in professional discourses. We may talk as though the twenty first century is ushering new, progressive ways of dealing with disadvantage, but old fashioned paternalism is alive and kicking in mental health services. Sometimes these thoughts and behaviours are deliberate, but more often they are borne of ignorance and lack of thought about our fellow citizens.

Ignorance of the law, and a lack of awareness of how to provide information and advice to services users and carers, were themes which emerged in our research. Of course, professionals and agencies have to work much harder in making sure they understand mental health law and other forms of legal entitlement, before they intervene in the lives of vulnerable clients. This is why one of our major recommendations was that a specialist agency be set up in Northern Ireland - to provide such knowledge, support and training for non-specialists. But maybe it is at the level of attitude where most needs to be done. If we are serious about empowering service users and carers then let’s take this task seriously and provide good systems of information and advice so that they can make sustainable, informed decisions about their lives, and not about the lives we would wish them to have. Bacon’s dictum about ‘knowledge as power’ is just as relevant today as it was when he was writing nearly five hundred years ago.