Mental health service users’, carers’ and professionals’ perceptions of the named person provisions of the Mental Health (Care and Treatment) (Scotland) Act 2003
Background: The Mental Health (Care and Treatment) (Scotland) Act 2003 reduced the role of the nearest relative, identified by a hierarchy of relationships, who previously could admit and discharge a patient as well as receive information about their care. This role is now reduced to one of receiving basic information only and the hierarchy for identification has been modernised. Service users may now nominate a named person with similar rights to service users to help protect their interests. This person cannot admit or discharge but is entitled to information and consultation about their care. If a patient has not appointed a named person, then the primary carer is appointed by default and, if there is no primary carer, the nearest relative assumes the position.
Aims: To explore service users’, carers’ and professionals’ perceptions and experience of the named person provisions.
Method: Twenty service users, ten carers, seven MHOs and nine professionals with influence on government policy were interviewed about their experiences. Interviews were carried out face-to-face (service users and some carers) and by telephone (carers, MHOs and policy influencers). The resulting transcripts were analysed using thematic analysis.
Findings: The majority of all interviewees welcomed the introduction of the named person provisions because of the increased choice it gave service users. Service users often did not wish to nominate their nearest relative, many choosing to nominate a friend. Important factors in making a nomination were that the nominee knew the service user’s wishes and could be trusted to carry them out. Some service users chose not to nominate relatives to spare them responsibility. However, the provisions were not without their problems; uptake was perceived to be low and there were particular problems in relation to the level of understanding of the implications of a nomination by service users and of the lack of accessible information and support to increase this understanding. The imbalance of power in relationships between service users, carers and professionals was thought to impact on the autonomous choices of service users and carers. Further problems were identified with named persons appointed by default in relation to service user choice and confidentiality.
Conclusion and recommendations: Although the choice is welcome to some service users, there appears to be a lack of full understanding of the role, and continued awareness-raising is required with service users, carers and professionals which should further be supported by accessible information for both service users and carers. There is currently a lack of support for carers in particular and it is recommended that this be addressed using carers’ services. It seems that many named persons are being appointed by default (itself an anomaly in Scots law) which threatens human rights, because of the lack of choice of the service user about who is involved in their care and their inability to prevent the sharing of confidential information with the default named person. The current lack of a right of service users to reject having a named person at all restricts choice and autonomy, and may further place unwanted responsibilities on carers and relatives which are difficult to remove. To ensure that service users’ rights are fully protected, the named person should become an optional nominated position and the default mechanisms removed
