Dr Gary Morrison is Executive Director (Medical) at The Mental Welfare Commission (MWC) for Scotland. Here he outlines some of the challenges faced by doctors, the MWC, and the patients they are trying to protect. 

We protect and promote the human rights of people with mental health problems, learning disabilities, dementia and related conditions across Scotland.

A large part of our work involves visiting people and we see over 1500 people each year – this can be in hospital, care settings, at home or even in prison. Mostly they are people who are receiving care and/or treatment but we also talk to family members and carers.

We listen to what they have to say and check that professionals such as doctors, nurses and social workers are doing what they should be doing and operating within the legal framework.

What are the challenges facing the people we seek to protect?

There is a variable quality of care across the country. Some people are very well cared for while others receive care that we deem unacceptable.

Our Dignity and Respect report highlights the results  of visits to 52 NHS units that provide continuing care for people with dementia. We found examples of best practice, but we also found poor care, and the overuse of psychotropic medication (used to treat psychiatric conditions).

We have come across situations where there is a lack of recognition of the needs that are basic to a fulfilling life while in care. Things like exercise, human contact, access to the outdoors and being offered a variety of things to do.

A short video by the Mental Welfare Commission for Scotland highlighting the winner of their person centred or recovery focussed approaches to long term care and support award: Fit for Life

Our investigations work can be critical of health professions, public services and government departments. For example, our report:  Left alone: the end of life support and treatment of Mr JL , was about the end of life care of a vulnerable individual and examined the actions of professionals including GPs. It made a wide range of recommendations including about assessing capacity to refuse treatment, in the hope that lessons will be learned across the country.

How can the Commission help?

There is a wide lack of understanding of the legal framework for protecting the rights of vulnerable adults and this can be a recurring challenge for us. We try to help by having a telephone advice line and by publishing a range of good practice guides which are on our website.

We also know there is a continued pressure on services and sometimes our influence helps to get the resources to improve.

Other guidance, information and statistics

We provide guidance on a wide range of subjects for professionals. Examples include power of attorney, young people in adult wards, the use of covert medication, and artificial feeding.

In addition we collect and publish national data which show how the Adults with Incapacity Act and the Mental Health Act are being complied with. We also have information for people receiving services and for their families and carers.

We will soon be publishing new guidance which considers how professionals can include carers who are supporting a family member or friend without confidentiality being breached. Also coming up we will be promoting the use of advance statements allowing people to set out their wishes for treatment should they require treatment for a mental illness in future.

Advice for doctors in supporting vulnerable adults?

Do be aware of your legal duties, and be vigilant for people who may be at risk.

We understand the pressure on GPs. They are called upon to apply the law and operate in a complex adult protection framework when this is just part of their work.

But we can help. Check our website, for full details of our guidance and advice. And don’t be afraid to call the Commission if you want to speak to us about a difficult issue related to mental ill health or adult incapacity. We run a helpline – 0131 313 8777, and give expert professional advice.

Photography by The Studio Agency www.thestudioagency.co.uk

Dr Gary Morrison is Executive Director (Medical) at The Mental Welfare Commission (MWC) for Scotland.

The GMC has guidance, resources and signposts to help doctors deal with dementia and mental health issues related to the care of older people. Find more at Better Care for Older People

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