HEALTH SERVICES MANAGEMENT AND LEGAL ISSUES

Health Services Management and Legal Issues



Health Services Management and Legal Issues

Introduction

Although all of the clients who are admitted to this service have a form of learning disability, a majority of them, like in this Case Study, also have mental health needs. For this reason in this Case Study's care is managed using a care plan package that is based on the Care Programme Approach (CPA). This has been called the "cornerstone of the Government's mental health policy." It was introduced in 1991, (Department of Health (DoH) 1991) and was intended to be the basis for the care of people with mental health needs outside hospital. Although in the recent government's document the DoH (1999a) now states that the CPA is not simply "an aftercare arrangement". They go on to emphasise that it is as applicable to service users in residential settings as to those in the community, and assertive inreach is as relevant as assertive outreach as an underpinning principle of the CPA. The NHS Executive (1996) also stress that CPA may be used with people who have learning disabilities.

Health Services Management and Legal Issues

The CPA has now been integrated with Care Management (NHS Executive 1999, DoH 1999b), which has previously been practised (under the NHS and Community Care Act (1990)) by local authority social services departments whilst they are undertaking their duties of assessing needs and purchasing appropriate services.

The critical incidence that is to be analysed focuses on the ethical and legal issues surrounding the use of restraining interventions with in this Case Study, if he is physically aggressive towards another individual. On this occasion in this Case Study had instigated an argument, with a fellow resident, over his football team's defeat on the previous night. He became verbally aggressive to the fellow resident who was trying pacify him. This in turn made the fellow resident angry and also verbally aggressive, which led in this Case Study to retaliate by striking out at the other resident. As in this Case Study has had various incidents involving physical aggression in the past, it was felt necessary to devise guidelines that would enable carers to restrain in this Case Study, which would help him in calming down when this behaviour puts him or others at risk. in this Case Study would only be restrained if his behavior fulfilled a set down criteria, it was felt by his carers that this criteria had been met, so they duly restrained him.

During the time that in this Case Study was being restrained it was obvious that he was in some discomfort. After this incident had taken place I noticed that, although there was a rationale for in this Case Study's guidelines, there were no references or mention of any research to back up the actions that had taken place, and upon asking if this intervention helped to modify in this Case Study's behaviour, I was informed that "it was the only way to stop him" and that "it ...