Use of Guardianship under the 1983 Mental Health Act

Abstract

The powers of guardianship under the 1983 Mental Health Act confer on the guardian powers to require the patient to reside in a specified place, to require attendance for treatment and to require access to the patient for appropriate health and social services personnel. This paper presents a descriptive study and analysis of the use of guardianship over a 5-year period in four geographical areas. Cases were collected retrospectively from a variety of sources and scrutinized systematically. Three cases of guardianship for mental impairment were excluded from the analysis leaving 23 patients with mental illness. All but two of the patients were female. Older patients, mostly with dementia, accounted for three-quarters of the sample and the majority of orders in this group were to require residence in an old people's home (usually with an apparently good outcome), though three were intended to facilitate home care. In most of the younger patients a functional psychiatric illness was diagnosed and powers were used to maintain the patient at home. The absence of a specific 'power to convey' needs to be resolved for elderly patients needing residential care. The use of guardianship orders to maintain older patients in the community needs further exploration.

Compulsory treatment in the community: current legal powers

“…There is some evidence to support this in Shaw's survey: 22% were classified as mentally impaired or severely mentally impaired; 26% were over 75 years of age; 33% had a 'serious mental illness' -schizophrenia or an affective disorder -and only 4% of guardianship orders were made by the courts. There have been descriptions of successful use of guardianship orders in the elderly (Wattis et al, 1990), the mentally impaired (Craig, 1988) and a younger group with functional psychosis (Wattis et al, 1990).…”

Elderly patients and the Mental Health Act 1983

“…What studies there have been have tended to concentrate on individual sections such as guardianship (Wattis et al, 1990) or Section 136 (Weller et al, 1988); or changes in practice from the previous, 1959, Act (Durani and Ford, 1989). Many have been presented in the form of short audits (Hoare and O'Brien, 1991;Joyce et al, 1991); few have attempted a wider perspective (Webster et al, 1987;Barnes et al, 1990).…”

The use of guardianship in mental handicap services

“…In conclusion, although our survey is small and retrospective, the findings appear to echo results of other studies in terms of the wide variations in the consideration/use of GOs by local authorities (Fisher, 1988), psychiatrists (Wattis. 1990) and by social workers (Craig, 1988).…”

“…A recent review criticised the order, particularly in its failure to include the power to transfer a patient to the required residence (Grant, 1992) and this may well, in part, account for its low rate of use both in general and in our survey. These points have been thoroughly discussed in the literature (Craig, 1988;Dooher, 1989;Wattis, 1990;Grant, 1992) and are not considered further. There has, however, been much debate among health professionals (Craig, 1988;Cooke, 1990) about the use of the GO in the mentally handicapped population.…”