The Patients report – patients view on radical changes to day services

There have been several reports proposing radical changes to Day Services in Manchester, The Blue Tree Report, Bob Mercer’s Report (MHJCT) and perhaps other reports, which service users have not yet seen. Both of the above reports have been contrary to service users’ needs and wants. Manchester Users’ Network agreed that Alan Hartman compiles the Patients views and suggestions in a report to consider Mainway, the Horticultural Therapy, and Harpurhey Day Centre, Patients without a meaningful Day Service and other suggestions and proposals for decision makers.

Needs, Views and Proposals.

Report to the Joint Commissioning Executive. (Chair-Ian Bell)


{People with Severe & And Enduring Mental illness}

Presented to:


Manchester Mental Health and Social Care Trust.

Mental Health Joint Commissioning Team.

North West SHA, Mental Health Commission.

Manchester City Council.

Manchester Links.

Health Care Commission,(Anna Walker, Chief Executive).

Local MPs:-

Mental Health Minister, Ivan Lewis MP.
Alan Johnson, Secretary of State for Health MP.
Nick Clegg MP (Leader of Liberal Democratic Party) 
David Cameron MP (Leader of Conservative Party)


1. Introduction

There have been several reports proposing radical changes to Day Services in Manchester, The Blue Tree Report, Bob Mercer’s Report (MHJCT) and perhaps other reports, which service users have not yet seen. Both of the above reports have been contrary to service users’ needs and wants. Manchester Users’ Network agreed that Alan Hartman compiles the Patients views and suggestions in a report to consider Mainway, the Horticultural Therapy, and Harpurhey Day Centre, Patients without a meaningful Day Service and other suggestions and proposals for decision makers.

We also include our views to the government to listen and consider amendments to National Policy/ Legislation.


1.1 Financial Resources

The Secondary Mental Health Users report is based on needs and not financial resources. However, it is axiomatic that cutting services regardless of patient’s wants and needs are causing a false economy increasing the cost of our mental health services. Patients without services, causes exclusion, isolation in the public domain, turning to alcohol & illegal substances and worsening mental health. This puts financial strain on in-patient services, the criminal justice system, housing, community support etc.


1.2 Further views and proposals

Employment, access to services, referrals, integration, information and the process of user involvement are also documented in this report.














Mental Health Users receive from Mainway, Industrial and meaningful therapy, Social Contact and good supervision, access to professional support (Social workers, Nurses, Welfare Rights etc, etc. when the need arises).
The services and meaningful activity provided are as follows:-
Packing (Therapeutic Work), Printing, Standard Computing Training, woodwork and crafts.
We see Mainway as a crucial Specialist Mental Health Service.
We have a very good relationship with the staff who are very supportive.
For the Therapeutic Work we are paid up to £15 per wk. for attending the Packing Therapy.

2.1 Referral system at the moment it is very limited and blocks people with great needs of the services at Mainway. Information about Mainway is poor, e.g, virtually nobody knows one can do woodwork at Mainway.

2.2 “Health Care Patients”- The Evidence:-

· “We have made long term friends.

* Keeps us well and out of hospital.

* It gets me out of the house; if Mainway close I would stay in and become ill.

* Realistically most of us would have serious problems functioning in the normal labour market. Doing therapeutic work is a kind of work, which we enjoy and feel we have self respect and contribute to society.

* Mainway acts as a first stepping stone for some of us that have the potential of employment.

· * We receive supervision, support and easy access to treatment for our mental illness also good social support.

* We attend Users’ Meeting every other week.

* Some meetings are at Mainway, which makes it easy to attend.

* When I become ill, I’m treated with understanding by others service users of Mainway, because of their own experiences. In the mainstream of society I’m excluded and isolated, when I become ill.

* Some of us have used this service for many years.

* I have used this service for 41years; it’s kept me out of Hospital. I need to keep on using this service.

* You should use this service if you need to and not because how old you are.”

2.3 Would be Mainway Services Users

There are many people with Severe Enduring Mental illness who are wandering the streets of Manchester, staying at home, or in Hospital who would use and benefit from the Service at Mainway. The main reasons, why people are unable to use the service because of no information, limited referral system, in fear of being pushed to work and proposals of closing the therapy down.

2.4 Mainway in the future.

Patients need and want this service to remain open!! Slow change, (therapeutic work, other meaningful therapies and activities), which do not destroy peoples health or ending up in hospital or without any service.

2.5 Individual Budgets/ Direct Payments.

We would consider pooling our individual budgets together to help Mainway to remain open.

2.6 No reasonable alternative, when services close.

Manchester Mental Health & Social Care Trust has a history of closing services used by the most vulnerable, ie. Seper Day Hospital, Social Therapy and Art Therapy. Many who used these therapies have no services. Many of these patients, who were our friends passed away prematurely or disappeared. The only service provided as an alternative, which patients used was temporary for 12 months. Patients were not consulted as beforehand this was temporary. Some people were under section 117 of the mental health act 1983, which was disregarded.

2.7 Mainway is becoming unique because of its care for the most vulnerable. The quality of service, as a result leads to an increased life expectancy. This type of service we need in the 21stcentury or any age.



The service has functioned for 25 years and was previously called “the farm.” This part of the service closed several years ago on grounds of health & safety. The service users wanted this to be continued, but their views were disregarded.

The service offers individuals the opportunity with severe and enduring mental health needs to develop commercial and recreational skills.
The aims are to promote independence, by supporting individuals to develop the skills, interest, confidence and social networks to employ their skills and interest in the local community. This may be as part of a local gardening group on an allotment, or by securing paid or voluntary employment in a related field. NVQs (national vocational qualifications) can also be obtained.

Service users are paid up to £20 per week for attending the service.
About 30 patients attend. Also there is a Drop-in which between 8-10 patients/ members of the public (usually without a service) use per day. People who attend the drop-in who are not known are assessed, but they can still use the drop-in on the same day of the assessment. The assessment is done in a very informal, caring and friendly way. This part of the service is excellent, because the nurse in charge helps people to be referred to agencies that meet their needs. They also receive help with travel passes, benefits, advice about the medication, and informal counselling which is crucial. Many of us are unable to receive this kind of help via formal channels.
Some patients are under section 117 of Mental Health Act.
Some mental health users do not feed themselves and can be literally starving.
The service provides sandwiches and free tea continuously during the day.

3.1 Referrals & Access to service:-

This service attracts many people, but is limited by a bureaucratic, one service referral system. Lack of attentive information is also a problem.

Service users are against Horticultural Therapy being changed into a Social Firm or any kind of employment business, replacing their therapy.

3.2 “Health Care Patients”- The Evidence:-

· “Changing Horticultural Therapy into a social firm is the same as closing a mental health services and replacing it with a business. I would be forced to leave.

· 6

*I get medical support, counselling help with forms and especially in obtaining a travel pass.

* The therapy keeps me off the streets!

* If they change this service into a business, I will spend the days in the bookmakers and drinking alcohol in the pub.

* I like the work I do here, it keeps me well. I would be unable to do a proper job, I would become ill!!

* When I don’t feed myself I look forward to the sandwich and the cup of tea.



· * I would be at home rotting away, if this turns from treatment into a business.

* The side effects of the medication stops’ me being employed.

* If they change this therapy into a social firm or a business, many that use or need this therapy will be excluded.

* I use this service, because it reduces my anxiety and depression. Proposals to change the mental health service in a social firm will achieve the opposite.

* I would end up back in hospital, if they sack the nurses and change the Horticultural Therapy into a business.

* I enjoy the plants and the out-side activity, I can’t take pressure, I would get ill if I was employed to do this.”


3.3 General views

Mental Health Users need the Horticultural Therapy to remain a mental health specialist service, and they are against closing this service and replacing it by a Social firm or a Horticultural business.

We need the medical support from the staff which keep us well and stop us from being admitted into hospital.
The staff treat us with respect, equality and kindness, which has built up a good relationship with them.

We want to campaign if we are ignored. We have rights.



This service is known to the majority of mental health stakeholders as “Harpurhey Day Centre.” However the centre has been recently named The “Wellbeing Centre”, due to the centre now being used by the general public, besides people with severe and enduring mental health problems. The day centre was established by the local authority in the mid-seventies for people with mental health problems. The centre is managed by Manchester Mental Health & Social Care Trust.



User Involvement is almost nonexistent and communication is very poor. 
Decisions are not shared or communicated adequately to the service users of the centre. Users have had no say or were not aware that this is now called “The Wellbeing Centre”.

A service user of the centre did not know the change of the name, until it appeared in the local paper. It concerns us that we are not being consulted reasonably about the changes being made and which is suiting the service rather than the needs of the service users.
It would be fair to say Section 11 of the Health & Social Care Act 2001 and Section 242 of NHS Act 2006 to “involve and consult” are ignored.



The number of members of the centre has diminished by 30%, because almost of the one point referral system and the enhance CPA rules. The manager of the centre has voiced this concern. Other Reasons :- Information not being made attentive, fears that the centre will become a service for the general public, gradually abolishing the centre as a specialist mental health service, privatization and being forced into employment, when not well.



· NB: The views were taken after the decision was made to change the centre for use of the general public and it into a wellbeing centre.
* “I would feel intimidated by strangers especially those who would not accept or understand my fragile state of health.
* I have an open mind about social integration. If done in a careful and controlled way it could coax shy members out of their shells, thus increasing confidence in everyday life contact with non- service users.
* I object to the satisfying of healthy peoples’ curiosity. Those who decide to mix may not have our best interest in mind, and they could even see us as a freak show.

· I have no Mental Health Specialist Day Service to attend, since they cut Art Therapy, I would not use this service. I would feel very insecure and unsafe, with the general public. Surely health and safety will be at risk.
* I already mix with “outsiders” in the heartbeat group. They are non-judgemental and friendly. We can have a laugh and I do not feel stigmatised. When the alternative therapies are up and running, the existing service users may want to take advantage of them. A steady number of attendees would prove how useful the centre is and thereby ensure its future.
* There has been a significant reduction in therapeutic activities for the mentally ill. Clients in need are not being referred to Day Services, which can lead to misdirection and misconduct. Members at Harpurhey are supportive of each other and feel “Socially included”. Within the centre more referrals on the mental health side would be of great benefit initially and there is always the possibility of community integration later on.
* I did not know we were a wellbeing centre till I saw it in local paper.
* When I’m ill and vulnerable, I fear some members of the general public can take advantage for example, take my DLA off me.”


· At a meeting with the majority being existing Harpurhey Service Users, it was stated that they would not use the service if it was put out to tender. If charging was introduced, which is likely at a private day service, staff would be less qualified, especially if the service was not recognised as a mental health specialist service.


Members and other Mental Health Users have consistently requested to have a drop-in all day at the centre. (The Present drop-in times are not compatible to service users needs.), so that if you are ill and unable to attend your activity or therapy group, instead of staying at home or ending up being admitted to Hospital. We should attend the drop-in, what ever time during the day, which helps greatly and meets our needs at the time.


· *Regular user meetings without the staff – unless invited!. The need for User representatives, perhaps from the proposed “Patients Council”.
* Part of the Wellbeing Centre must remain as a Secondary Mental Health Specialist Service.
* The members’ proposal for an all day drop-in needs to be implemented. Many people with severe enduring mental illness have no-where to go. This will increase social inclusion and could be a stepping stone to meaningful day activity for the most excluded. The drop-in should be for the secondary mental health specialist service part of the Wellbeing Centre.
* The need for a named link Psychiatric Nurse (CPN) to the centre is essential.
* Health & Safety Policies need to be reviewed, due to the increase use by the general public in the Wellbeing Centre.



· Over the years there have been many cuts to the Secondary Mental Health Services, ie Art Therapy, Social Therapy (User run service) and Seper Day Unit, because of unreasonable consultation, and either no alternative service or a temporary service lasting no more then a year.

5.1 Residential Care Homes:-

· Many Mental Health Users in Care Homes are walking the streets during the day, going to the pub or just staying at home watching DVDs. Many residents used the Seper Day Unit, because the service was closed. An alternative service was open at St Mathews Church, staffed by Manchester Mental Health & Social Care Trust. The service was closed after one year, claiming that they did not have enough resources. The manager of “Community Living” of the Trust informed service users that the care homes had responsibility in financing and providing day services for their residents. Although this mental health cut happened several years ago, it did not only cause the number of existing service users with no meaningful activity or service during the day to increase, but also new service users in care homes.
St Mathews Monday morning drop-in was established, because of the way in which the most vulnerable people have been excluded and put at risk,
The staff, all voluntary workers, do an excellent job and give an example of how we should care, but admit people need proper support and qualified mental health professionals involved.

5.2 Cuts of Social Therapy & Art Therapy:-

Though these service cuts happened some years ago, they have caused serious consequences to-day. No reasonable alternatives which met peoples’ needs with severe enduring and mental illness were established. Some decided to self medicate, drinking in pubs or staying at home, becoming very isolated and ill.

5.3 Chain Reaction:-

Patients without any day service, living in the mainstream of housing, have an increased need of the Community Mental Health Teams (CMHTs), which have already been depleted by the “Changes in Mind.” Care coordinators/ support workers need to spend more time with clients without any day service. They have not the resources to do this! In turn patients go into crises, which the crises resolution teams are put under pressure and unable to deal with the problems. Emergency needs are poorly met, patients feedback claim that after hours from going from pillar to post all day, they are only offered more and more medication. People end up in the Criminal Justice System, the homeless, physically ill, and the most tragic vulnerable people, become seriously ill and attempt to harm themselves, eventually committing suicide or endangering members of the public.

5.4 Health Care Patients-The Evidence:-

· “I used to get a lot of support at Art Therapy. They consulted us and the Trust said that they would bring back Art Therapy, but they did not! When I get ill I need more support from the mental health teams. I get none! I end up sleeping rough around the country.
* They don’t care and don’t treat me fairly. I’ve lost my motivation. I am satisfied to stay at home.
* I am 51 live in a small care home have no day service activity. I like gardening.
We are treated as being retired.
* I am 48 in a care home stay in watching DVDs and we wait for the nurse to come round to give us our medication.
* The pub is now my new Day Centre.
* I keep away; all they want to do is push me to work. I will become violent if they force me.
* They ask me what I want, I say bring back Art Therapy, they say nothing.
* I do not know what day service there are! I get no information and the referral system and access to these therapies makes me ill with all the bureaucracy and stress.
* I explain I need to attend a Jewish Day Centre at my CPA. I’m ignored as if this is impossible.
* I’m 30 years old, I visit my friends. There is nothing for me. My needs are not met.”

5.5 General Problems:-

It is unrealistic to expect Residential Care Homes to provide NHS & Social day therapies or services, because of poor information, cutting day services with no reasonable alternative, changing day activities for people with employment expectations and members of the public, and a bureaucratic referral system, which excludes many with a severe and enduring mental illness.

5.6. Recommendations:-

· Re-establish Art Therapy and Social Therapy, which many patients need and have asked for.
* A safe-guard to stop activities used by the most vulnerable being changed, which will render them without a day service.
* Attentive Information on day services and activities.
* Referral system needs to be made accessible.
* Care Home Residents, should have equal opportunity to use the day services outside their home. They should also be made aware that it’s possible to obtain direct payments collectively for social activities during the day.
* Meetings arranged by the Manchester Local Implementation Team, should be specifically involving Mental Health Users without day services or activities to find peoples needs.


· Referrals to Services……

Under the one point of referral system only care coordinators of community mental health teams (CMHTS) can refer patients to statutory mental health services providing one is on an Enhanced CPA. Meeting the needs of this criteria and worded terminology with many equivocal meanings fails to meet patients’ needs. It is self-evident this system has caused many people with severe and enduring mental illness to be isolated with no service. This is one of the reasons why Mainway, Harpurhey Day Centre, and The Horticultural Therapy numbers have diminished, although the need is high.
In October 2008 the terms Enhanced and Standard CPA will be abolished replaced with a CPA for people with complex needs. It stops the obstacle that you have to be on an Enhance CPA to receive a service from a Statutory Mental Health Care Trust. However, this will do little to solve the problem. The one point referral system, which only the CMHTS can refer you to has to remain, which is the Government policy.

6.1 Access & Information:-

· Our disabilities are ignored, ie patients who are on medication which have side effects that lowers ones motivation and gives blurred vision. Giving a Web address, booklets, overloading with pages and pages of writing is not going to be very attentive.
A lot of information on notice boards is out of date. Many recommendations by User Groups are ignored.

6.2 A Simple Recommendation:-

· Is a integrated Mental Health information team, made up of providers from the statutory and voluntary sector, which includes service users and takes their views seriously. The most important objective is to make sure information is attentive and patients can have access to services.

6.3 Integrated Information.

Apart from information not being attentive, it can only be accessible at particular places or displayed by the actual service provider. We need to have access to information at all public services and places. Hospitals, GP Surgeries, Mental Health Community Services, Job-Centre plus, Post Office, Banks, Supermarkets etc etc., so that one can have access to jobs, benefits, NHS services, Social services and also including information of services for the most vulnerable, Mainway, Harpurhey Day Centre and the Horticultural Therapy etc.


· Ninety something percent of the mentally ill want to be employed. The same percentage of the mentally ill do not want to be formal patients in Hospital, or be on psychotropic medication.
You have to be well enough to work and this should be decided by a Consultant Psychiatrist or more preferably by the patients’ own psychiatrist, who is best placed to make a decision.

· Some patients who are well enough to be employed, need support & supervision in the work place. As voiced many times before, if problems of mental disorder could be detected early in the work place, then many people could still be employed.

· Evidence from patients who have returned to employment, seem to indicate that they can only manage to sustain employment for weeks or months and then become ill again. Few have lasted over a year. Some people claim that the pressure and stress in the work place have caused them to be re-admitted to Hospital.

7.1 Jobs for the mentally ill!

· But do not cut Secondary Mental Health Services!
Changing mental health services into a business is a way of cutting mental health services. Doing this will take away services from people who cannot be employed and for some it takes away the stepping stone that can lead to employment.
 Social firms should be created and other types of sheltered employment, but not at the expense of secondary mental health services.
Employers must understand mental health problems, and try to diminish the stigma and discrimination against people who are able and well enough to work.

7.2 Recommendations:-

· *Social firms & sheltered employment should be created, but not by diminishing or cutting secondary mental health services, that for some can be a first stepping stone.
* Patients must be certified by a Consultant Psychiatrist that a patient is fit to work, not just wanting to work.
* Support & Supervision in the work place.
* Ensure support services are not taken away, because the Mental Health User is now employed.
* Service users should not be financially worse off, when employed (After housing costs, council tax etc).


· The first ever mental health users meeting in Greater Manchester took place in Springfield Hospital November 1986. The main principle was to ensure patients were genuinely consulted and involved by empowering patients and establishing Mental Health User Groups.
To-day Section 11 of the Health and Social Care Act 2001, which is now consolidated by the National Health Act 2006, Section 242, require NHS organisations to involve and consult patients. The vast majority of users say that our needs, views, proposals are ignored and we are involved too late in the process, with many decisions made before formal consultation.

8.1 Users Groups:-·

There are two recognised User Groups in Manchester, Manchester User Network, based in North Manchester and South Manchester Users Group based in South Manchester. There is no recognised User Group in Central Manchester.

Manchester Users Network(MUN) is a constituted group, based on democracy. Patients elect their own representatives and vote on decisions. There are regular meetings which are well attended. Manchester Mental Health & Social Trust does not recognise our representatives and rather selects their own user representatives regardless of individuals and Users Groups permission or views. Some NHS organisations also adapt this practice. This is to strengthen Mental Health Managers wants, and this disempowers individuals and groups, especially if views, and needs are diverse compared to Manchester NHS organisations. This also meets the needs of organisations and not the needs of patients.

MUN is autonomous, and independent of NHS services, local authorities, and voluntary or private sector organisations.

We have no paid workers or administration support. We had paid workers known as, User participation workers, who helped with minutes, meetings with managers etc. The funding was stopped for this type of job in Manchester. We rely now, solely on the good will of patients, when they are well on a completely voluntary basis to help in the Users Group.

Mainway, the Horticultural Therapy users attend Users Group meetings regularly.

We have a representative, when we are able, from what is now called “Harpurhey Wellbeing Centre”, and we have meetings there.


· 8.2 Manchester Patients Council Proposal :-

· The Patients Council would be fully controlled by Patients and act as an umbrella for User Groups in Manchester, also for individuals who do not attend User Groups or meetings to give their views. Patients’ Council representatives will be elected by patients.

8.3. Creations, proposals, ideas ignored by NHS organisations:-

· Mental health Users are only allowed to be reactive and ignored when we are proactive.
Some creations, proposals and ideas that have been ignored.
User Help Card (like a Crises Card, but with more detail), Patients Case II (A book of users experiences, proposals and advice), Individuals Time tables with a list of current available Day Services attached (A4 size), plus how to access services and A local Veto System.


Care Coordinators should have a list of available day services or activities and periodically go through them with their patients. Transport must be available so that vulnerable people can attend meetings.
There are many more ideas and proposals that can improve the service for all stakeholders.

8.4 Disabled Discrimination.

· Discrimination needs to be addressed.
When the venues of the meetings are a long way, professionals do not make adjustments for patients’ disabilities, as many patients especially the most disabled are unable to gain access.
Managers always take the best venues for meetings themselves. On occasions in the Users’ Office, where we generally have our meetings, it is a health & safety risk because of people disabilities, as well as overcrowding. Some people with disabilities are unable to attend because of this situation, and it is difficult to book venues.
Professionals make little adjustments, when patients, can’t use a computer or unable to read information, because of side effects of the medication.

8.5 Recommendations:-

· Patients’ Council should be put into action and supported and accepted by all organisations.
* Mental Health Users should elect their own representatives. Neither service providers nor commissioners should select User Representatives.
* Make adjustments to arrange transport for the most disabled to get access to meetings or have meetings where the most disabled are (in hospital, Day Centres Etc.).
* Support & supervision should be offered to patients actively involved. This lowers the risk of becoming ill and helps you to cope with any mental health disability.
* Allow Mental Health Users to be proactive ( ie creations, ideas and proposals).


The Government needs to listen to Mental Health Users and make sure that they receive genuine views with proposals from patients, and meaningful consultation, primarily involving patients. There needs to be a report direct from Mental Health Users as well as NHS professionals to address the balance so decision makers and politicians can make accurate changes if necessary. Section 11of the Health and Social Care Act 2001 and 242 of the NHS Act 2006, seem to have little or no effect to reasonably involve and consult patients.


9.1 Electing Mental Health Users Representatives:-

· To maximise authentic and accurate user involvement, Government must ensure that Mental Health Users should be able to elect their own representatives and not allow the practice of NHS organisations and other Government funded organisations to select whom they want to represent us. This is an undemocratic practice, and it excludes User Groups, and individuals who do not meet the needs and wants of these establishments. More importantly, many needs and views of patients are not documented, which means evidence and information is quite incorrect with wrong decisions being made and providing poor services that do not meet patients’ needs.

· *Recent experience: – “I disagreed with this National Organisation funded by the Government selecting by interview who they wanted to represent us. It should be the service users who elect their own representatives. However, I was informed that everybody will be selected as I have experience and expertise to offer, so I wished to be interviewed. Sadly this was not the case. I was excluded. I received a letter, which made me feel quite insulted that I was not chosen. Others were excluded, who like me were out spoken.”

· Ironically, The National Social Inclusion Programme (NSIP] are actually promoting this exclusion!!
The NSIP admits excluding most of North England from this National Users Group owing to the lack of resources. However, this cannot be called an authentic User Group.

9.2 One point of referral systems to use Mental Health Day Services of NHS Mental Health Care Trusts:-

The one point of Referral System urgently needs to be abolished. At the moment, it is causing chaos and many patients with a severe and enduring mental illness, have no day service. Services are under threat to close, because they are unable to receive referrals though the need can be high. For example, if one wants to use Mainway (An industrial Therapy Service), one would have to ask his/her GP, to refer one to the mental Health Team, which can take a very long time indeed. Then the mental health team would refer one to Mainway, which could take further time, and then one would be assessed by Mainway whether he/she is accepted. Patients cannot take the stress of this system and are too ill to cope with it. Mental Health Teams that have been cut drastically cannot cope with the extra work and bureaucracy. We recommend the simple Direct System of referrals . GPs and other professionals should be able to refer straight to the service one needs, whether provided by an NHS Secondary Mental Health Trust, or the Voluntary Sector. This would save finance, time, and stop patients and members of the public being put at risk, when, tragically, Mental Health Users can become very ill.


9.3 Consultant Psychiatrists, Doctors, should not make political decisions, but medical ones on patients being fit to work!

· An experience from a Patient: -“ I was approaching my 61st Birthday and saw a Consultant Psychiatrist who I did not know at my six monthly CPA review.
I am partially deaf, receiving continuous treatment for Cancer and suffer from severe side effects from the medication that I have to take. I have not been employed for about 30 years. The short time I saw the psychiatrist he said, ‘ What about work!’ I was shocked in disbelief that this was a medical opinion. A short time after I was sectioned once again under section3 of the Mental Health Act 1983 and spent my longest stay in hospital as an inpatient.”
We feel Consultant Psychiatrists, Doctors and other qualified Mental Health Professionals, who know the patient for some time, are best placed to make a decision if one is fit or unfit, or well enough to cope with employment or work related activity. Their decisions should have precedence over decision makers at the Job Centre Plus. Many people are under qualified and not best placed to make decisions with patients suffering from a severe and enduring mental illness. Patients, as well as members of the public, have serious concerns over the new benefit rules of Employment & Support Allowance.
The Government is putting Doctors under enormous pressure to get seriously ill patients to work, and causing them to be unable to make medical judgments, which is difficult enough, when it comes to an illness that is intangible such as mental illness!

9.4 Nurses and other front line workers being unfairly dismissed and intimidated for speaking up in the patients’ interest:-

The most unjust decision that happened in 2007 was the dismissal of a caring Community Psychiatric Nurse, Karen Reissmann. The Government refused to listen and ignore mental health users, MPs and more relevant, members of the public across the country.
Patients and other members of the public were shocked, when patients could not complain if managers intimidate or ill treat nurses or other employees. We were informed by the Health Care Commission that we could not complain, because this issue was outside the NHS complaints procedure. The reason given was that this was an employment issue, even if it is in the patients’ and the public interest. Over 40 complaints from patients that we know about went in and were completely ignored. The new NHS Complaints Procedure will be implemented in 2009. We recommend and hope that patients and other members of the public have the right to complain about the above issues.

9.5 Recommendations:-

· Mental Health Users or Users’ Groups must elect Users Representatives and not those chosen by NHS organisations, if the Government really wants authentic and accurate, views and needs etc.

* The Government urgently needs to abolish the one point referral system and replace this with a direct referral system.
* Consultant Psychiatrists, Doctors, and other qualified mental health professions who know their patients should have precedence over decision makers at the Job Centre Plus, whether a patient is fit or not fit for employment or work related activity.
* Patients and other members of the Public should have the right to use the NHS complaints procedure, if a nurse or any other front line worker, is being intimidated by a NHS organisation when they are employed, and the issue is in the patients’ interest.


· There was not any budget to do this report which was done completely voluntarily by Manchester Users Network, unlike the Blue Tree Report which had cost thousands of pounds, with so many service users who asked the report to be scrapped!
Patients’ hope that the Joint Commissioning Executive of Manchester, and other NHS organisations, Local Councillors, MPs, and the Government takes our report seriously, and acts on our recommendations, instead of refusing to listen and ignoring what ever we say!!!
(Experienced User of Secondary Mental Health Services for 38 years)

· Support, comments & questions of this report are welcome, Tel 0161 918 4343/ 061 492 0790.

· E-mail address:-

· 18th June 2008.

Many thanks and kind permission to the Mental Heath Users, who contributed to this report.

Alan L. Shatsman, John Szpila, Paul Reed, Joan Hardy, Helen Dunlop, Peter Cruice,

Mark R. Powers, John Banks, James Barr, Ronald Boxen, Pat Edgar, Theresa Healy,

Carol Heathcote, Julie Booth, Kevin Ashton, Mike Longworthy, B. Brennen, Alan Valentine,

Lionel Weller, Bill Kempster, Margaret Gayckiewicz, Harry Ashton, Sidney Coppel,

Stanley Giersh, Richard Harris, Larry Keogh, Therese Gergely, Tom Calvert, Kirsty Taylor,

Stephen Curtis, Derek Grundy, Nickolas Banks, John, Larry, Robert Mc Gannity,

Miranda Morland, Stuart Montgomery, Andrew Lizar, Gareth Williams, Freda Shovlin, Elaine Harrison.

In addition, those patients who have contributed to this endeavour anonymously.

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