Mental Health Code of Practice
A Week In and No Agreed Regional Answer on Who Does What
A revised statutory Code of Practice for the Mental Health (Northern Ireland) Order 1986, governing how some of the most vulnerable people in Northern Ireland are treated during a mental health crisis, came into force on 1 September. A week later, the services expected to deliver it still cannot get a settled regional answer to the most basic question of all: who does what?
That is not a teething problem. It is a failure of planning, and it was entirely avoidable.
The revised Mental Health (Northern Ireland) Order Code of Practice introduced new arrangements under Article 130, the power used when police bring someone from a public place to a place of safety, normally an Emergency Department, because there are concerns for their mental wellbeing and they appear to need immediate care or support. Those new arrangements involve a second-line assurance interview by an Approved Social Worker (ASW) in relation to the care and treatment arrangements proposed by the clinical team.
Introducing that should have been straightforward: agree the pathway, agree who does what, train the staff, resource the services, then go live. Instead, the Code went live before these matters were agreed. Frontline staff are now being required to resolve them in real time while managing complex situations requiring legal clarity and organisational assurance.
A week in, there is still no settled regional answer to questions as fundamental as:
- who completes the mental health assessment;
- who develops the alternative care or treatment plan;
- when an ASW should be asked to attend;
- what happens if an ASW disagrees with the proposed plan;
- what happens when no ASW is available; and
- who carries responsibility while all of this is unresolved.
In the space of a single week, different and at times conflicting interim instructions have had to be improvised across the region and within HSC Trusts because no clear, agreed regional position existed when the Code went live. Staff are being left to work out, in the middle of a live crisis, which email, flowchart or draft pathway is supposed to apply.
That is not a safe way to operate a mental health service involving several organisations, significant statutory powers and people experiencing acute mental health crisis. It is simply not good enough.
These are not abstract questions. They affect people experiencing a mental health crisis who have been taken to a place of safety under mental health legislation. They also affect Emergency Department staff, Mental Health Liaison teams, Approved Social Workers and the Regional Emergency Social Work Service who hold the system together, very often at night, at weekends and
with the fewest staff on the ground.
These problems were foreseeable. Two months ago, NIPSA wrote formally to the Department of Health setting out concerns raised by our members about the implementation of both the revised Code and Right Care, Right Person. These included unclear responsibilities, inadequate training, service capacity, out-of-hours arrangements and the danger of placing responsibility on individual practitioners without the authority or resources to carry it.
We have had no substantive response. No meeting. Nothing. Two months on, the very problems we warned about are now playing out in Emergency Departments across Northern Ireland, exactly as we said they would.
Our members have formally raised these concerns with the Branch. We have listened, and we are acting. We are pressing for regional clarity, insisting on proper operating procedures and demanding that the staff who deliver these services are consulted before decisions are imposed on them.
While the current experience is concerning, the implications extend beyond Article 130. Right Care, Right Person is due to reshape how the police, Health and Social Care and other agencies respond to people in crisis. NIPSA supports the principle that people should receive the right response from the service best equipped to meet their needs. However, if significant changes to Mental Health Order practice cannot be implemented with clear and agreed regional arrangements, serious questions must be asked about readiness for RCRP.
There is also a wider workforce concern. The Department and SPPG have confirmed that no additional funding has been provided to deliver these responsibilities. Significant duties are being transferred to Health and Social Care staff and are expected to be absorbed within existing resources. Transferring responsibility and risk without transferring the resources required to manage
them is not sustainable reform and will add pressure to an already overstretched system. Our criticism is not directed at frontline staff or local managers attempting to hold an unclear system together. Responsibility lies with the Department of Health and SPPG, which should have resolved these fundamental questions before the Code came into operation and should have engaged
meaningfully with the trade union representing the workforce.
NIPSA supports the principle that people in crisis should receive the right response from the right service. That principle cannot be delivered through unclear roles, inadequate resources or operating procedures developed after implementation. We need urgent regional clarity, safe and agreed procedures, genuine consultation and resources proportionate to the responsibilities being transferred.
Our members have raised these concerns with us. We have listened, and we will not stand by while they are asked to carry blurred lines of responsibility and unsafe working conditions within a system that risks the rights of people experiencing mental health crisis.
The Department and SPPG should not mistake our members’ professionalism for a willingness to absorb the consequences of inadequate planning, or underestimate what their trade union will do to protect their interests.