Bamford Review of Mental Health and Learning Disability

This section provides information on the Bamford Review of Mental Health and Learning Disability (N.Ireland).

About the Review

In October 2002 DHSSPS initiated a major, wide-ranging and independent review of the law, policy and provision affecting people with mental health needs or a learning disability in Northern Ireland. The Review follows similar exercises in England and Scotland.

The Reviews was overseen by a Steering Committee comprising representatives from professional and other interested groups in the mental health and learning disability fields, under the Chairmanship of Professor David Bamford of the University of Ulster. Professor Roy McClelland of Queen’s University, Belfast, was the Deputy Chair.

Scope of the Review

The Review will take into account recent policy and other developments here and in the European Union, and address how best to provide services to people with specific mental health needs or a learning disability in accordance with the statutory equality obligations of the Northern Ireland Act 1998, with the Human Rights Act 1998, and to promote their social inclusion.

Equally, the Review will address how to promote positive mental health in society, analysing the relevance of key concepts such as community education, prevention and the promotion of mental health awareness. The Review will undertake research to facilitate its work and will seek out exemplars of best practice which are available regionally, nationally and internationally.

The Review will also cover the role and function of the Mental Health Commission and the Mental Health Review Tribunal, and relevant social issues including education, employment, housing, and social security benefits. It will work in partnership with the Northern Ireland Office and criminal justice agencies to review therapeutic intervention with offenders who have psychiatric difficulties. Issues relating to incapacity will also be addressed.

Mission Statement

The Review will adopt an inclusive and transparent approach, and will have an inherently multi-disciplinary ethos. Consumer expertise, both in terms of users and carers, will be seen as a core value and a means by which the Review can test out its ongoing work and proposals.

This independent Review will strive to promote equality of opportunity and good relations between people of different religious belief; political opinion, racial group, age, marital status, or sexual orientation, between men and women generally, between persons with a disability and persons without, and between persons with dependents and persons without. The Review will be conducted in the context of respect for persons, a commitment to the self-realisation of people, social inclusion, and full citizenship for all.

Our Mission is to grasp this opportunity and ensure that the set of recommendations we present to Government chart the course for the 21st Century

Guiding Principles for Review

Involvement and Open Access - We will recognise, encourage and value the contribution that everyone can make to the Review – users, volunteers, professionals, organisations, carers and other groups. The principle of open access will be employed throughout the Review.

Confidentiality - High value will be placed on the importance of confidentiality with respect to attribution of statements in relation to all Committee deliberations.

Integrity - The Steering Committee and Expert Working Committees will be committed and objective in their work.

Inclusivity - The scope of the Review is a major challenge. All dimension of the Review are of equal importance and will be given equal priority. Committee members will be expected to identify with the full work of the Review.

Quality - All involved with the Review will work to the highest possible standards in our endeavours, monitoring and evaluating to maximise effectiveness.

Teamwork - A collective culture of teamwork and ownership will be fostered, thus building momentum and energising the Review.

Harmonisation - Clearly there will be opportunities for practical harmonisation at every level at both a North-South and East-West basis, as endorsed by “Investing for Health”.

Coherence - Given the scope and range of issues being examined in the Review, the project will be conducted in an integrated and cohesive manner.

Existing Excellence - The Steering Committee wish to both acknowledge and use the many current examples of strategic, policy and practice excellence in Northern Ireland.

Research and Information - Appropriate research will be conducted to inform the work of the Review, and to enhance a comprehensive database which will be developed, and which will draw on the best relevant material.

Government Support - The Steering Committee acknowledge the wholehearted support of the Minister for this Review, and are gratified that he regards modernising mental health and learning disability services as a priority. Regular and appropriate briefing will be provided to him (and his successors) and to DHSSPS officials.

Goals for the Review Process

To work towards a set of recommendations which contain the best practice, policy and legislative perspectives.
To anchor our recommendations in a broad financial and economic context.
To make recommendations on workforce implications.
To make recommendations on the effective management of services.
To keep all stakeholders fully informed of the progress and directions of the Review.
To ensure that user and carer partnership is intrinsic to the Review at all stages.

Terms of Reference

1.To carry out an independent review of the effectiveness of current policy and service provision relating to mental health and learning disability, and of the Mental Health (Northern Ireland) Order 1986

2. To take into account:

the need to recognise, preserve, promote and enhance the personal dignity of people with mental health needs or a learning disability and their carers;
the need to promote positive mental health in society;
relevant legislative and other requirements, particularly relating to human rights, discrimination and equality of opportunity;
evidence - based best practice developments in assessment, treatment and care regionally, nationally and internationally;
the need for collaborative working among all relevant stakeholders both within and outside the health and personal social services sector;
the need for comprehensive assessment, treatment and care for people with a mental health need or a learning disability who have offended or are at risk of offending; and
issues relating to incapacity.

3. To make recommendations regarding future policy, strategy, service priorities and legislation, to reflect the needs of users and carers.

Strategic Framework

Strategic Framework Vision

The vision behind this strategic framework is to give a real and meaningful priority to the challenges of mental health and learning disability, embracing a reduction in the incidence and prevalence, a reduction in mortality and in the extent and severity of problems associated with mental ill-health and learning disability. Central to the vision is a valuing of people with mental health needs or a learning disability, their rights to full citizenship, equality of opportunity and self-determination. It anticipates a process of reform, renewal and modernisation of services.

The strategic framework embraces the complementary challenges of mental health and learning disability. It also recognises the requirement for:

a balanced response to the need for better services for people with mental health and learning disability;
a clear framework to promote positive mental health and reduce stigma.

Strategic Framework Values and Principles

The framework is based on a set of fundamental values and guiding principles. People with mental health needs, learning disability and their carers should look forward to a response from services which:

respects their individual autonomy - through openness and honesty in the providing of information, respect and courtesy in individual interactions with service users, partnership and empowerment in service planning and delivery - with Government, providers and wider society each accepting their respective responsibilities;
demonstrates justice and fairness – resources for services should be allocated and managed according to criteria which are transparent, and which demonstrate equity.

The framework for service development and service provision is based on the following principles:

partnership with users and carers in the development, evaluation and monitoring of services;
partnership with users in the individual assessment process, and in the development of their programme of treatment and care and support;
delivery of high quality, effective treatment, care and support;
provision of services which are readily accessible;
delivery of continuity of care and support for as long as is needed;
provision of a comprehensive and co-ordinated range of services and accommodation based on individual needs;
take account of the needs and views of carers, where appropriate, in relation to assessment, treatment, care and support;
provision of comprehensive and equitable advocacy support, where required or requested;
promotion of independence, self-esteem and social interaction through choice of services and opportunities for meaningful employment;
promotion of safety of service users, carers, providers and members of the public;
staff are provided with the necessary education, training and support;
services are subject to quality control, informed by the evidence.

Strategic Framework Goals and High Level Objectives

Informed by these values and principles, the service review provides a unique opportunity to address the full spectrum of issues relating to mental ill-health and learning disability. The Review goes beyond specific mental health problems or individual groupings, to include, for example, mental health promotion, public health measures to reduce mental ill-health and suicide, and the challenges of stigma. In responding to the needs of individual service users and their carers, there is a need for clear specification of models and standards.

To ensure a balanced and inclusive framework, the following high level objectives have been set:

recommend specific reforms of service for each of the following user groups – children, young people, men and women with mental health needs or a learning disability; [Service reforms will specify models of care and standards of provision in relation to the quality, comprehensiveness, effectiveness, accessibility and acceptability of provision. They will include detailed consideration of primary and secondary care services, the interface between these services, the linkages and interfaces between health and social care, education, culture arts and leisure, employment and housing, the complementary roles of statutory and non-statutory services, and the issues surrounding multi-disciplinary and multi-agency working];
review the strategy for mental health promotion, embracing public health measures to reduce mental ill health and suicide;
review of the law;
review of relevant legislation and other requirements relating to human rights, equality of opportunity and social inclusion of people with mental health needs or learning disability and their carers;
review of the Mental Health Order (NI) 1986; and
make recommendations regarding future legislation to reflect the needs of users and carers in the context of the framework values and principles.

All proposals will be evidence-based, noting the quality of evidence presently available.

Work to Date

In October 2002, Professor Bamford wrote to a wide range of statutory, voluntary, community, academic, professional and other bodies seeking initial submissions on the strengths and weaknesses of current legislation, policy and service delivery in the fields of mental health or learning disability. The Chairman also wrote to a similar range of organisations seeking details of recent and current research and strategy documents which these organisations had either undertaken or commissioned.

Responses to these letters helped inform preparations for the work of the Steering Committee and the focus of the expert Working Committees which are being established, to examine and report on, after thorough consultation, a number of key issues /areas.

Current Position

Much of the work of the review is being carried forward through 10 expert Working Committees reporting back to the Steering Committee on specific issues. Four of these Working Committees were established in the first half of 2003 with the remainder established since July 2003.

Further information on the implementation of recommendations from this review can be found on the Patient and Client Council website in the Bamford Monitoring Group section.