Monday, November 3, 2008

5.2.4. Develping information and guidance materials
A guidebook (or books) can be devekoped to provide information that would be important to different role players such as health practitioners, patients and family members. This guide could give particular information about aspects of the legislation that may be difficult to understand. It could provide detail or guidance about interpretation. Algorithms could also be developed that clearly illustrate processes, such as involuntary admission and treatment, and indicate which forms are neede at which stages of the process.
Example: Birtish Columbia develops a “guide to mental health act”
In british Columbia guide to the mental health act was developed to assist implementing new kegislation. It provides an overview of the entire act and has appendices for different actors, such as how the community physician may certify an involuntary patient, how families can get help accessing physicians and the courts, and criteria and procedures for the police.

Formal guidance to profeddionals, such as a code of practice, is another important way of ensuring that legislation is properly implemented. Such guidance can re-emphasize the values and principles underpinning the legislation, explain what the various sapects of the legislation were meant to achieve, and include relevant case law.
Example : code of practice for England and wales.
In England and wales, the menal health legislations required the secretary of state for health to produce a code of practice. This guidance expands considerably on the basic text, and afford professionals and the public the opportunity to see how the legislation should be implemented (see www.doh.gov.uk/mhac1983.htm)

5.3 financial and human resources
The speed and effectiveness of implementation is likely to depend on the availability of adequate financial resources. Difficulties associated with drafting laws that cannot be implemented owing to financial constraints have already been discussed (see chapter 2, section 4). An added resource problem is that new mental health legislation ussualy requires a shift from institutional to community-base care. And this can be require additional funding. While in the long run, reallocation of funds from institutions to community-based facilities – until community-based facilities are fully developed enough to provide adequate services.
The proportion of a country’s budget or health budget that should be spent on mental health is debatable and falls outside the scope of this resource book. It is important to emphasize, however, that mental health is often given low priority vis-à-vis other health care issues, and that for effective implementation of good mental health legislation a fairer allocation of resources for mental health may be needed. Secondly, there is debate concerning potential conflict in the distribution of resources in support of the different provisions contained within the mental health law; for example, should resources be developed for employing additional personel in community based care, or for the establishment and running of a mental health review body?
Many aspects of progressive legislation will need adequate budgetary provision for the implementation activities. Funds are required for setting up and operationalizing the review body, for training mental health services as required by the legislation. Negotiation for this should be done simultaneously with the process of drafting and adopting mental health legislation
Example:
Obstacle Facilitating factors
Lack of coordinated actions in the implementation of mental health law (absence of a centralizes agency or authority overseeing the process of implementation) Appoint a coordinating agency, or ensure that agency is appointed (e.g. a mental health review body) to observe the implementation process, by having this included in the text of the law
Lack of knowledge, misunderstanding and resistance by the general public, users and carers to the changes brought about by the new mental health legislation Public education and awareness-raising campaigns could highlight the provisions and rationale of the new mental health law
Mental health, health and other professionals are unaware, or resist the provisions, of mental health legislation Training programmes for mental health, health and other professionals could include explanations on the provisions of mental health legislation
Guidance documents could inform people of the details of the legislation
Shortage of mental health human resources to implement some of the mandates of the law Mental health training should be provided to general health professionals and staff
Insufficient funding to develop the mechanisms needs to implement the law (e.g. advocacy, awareness-raising, training, visiting boards, complaint procedures Additional funding for mental health as well as protecting budgets should be allocated to mental health and for implementations of mental health legislation

Human resources issues are of particular importance for the implementation of legislation in all countries. Mental health professionals are the key to the delivery of effective mental health care within specialized mental health service, both in general health care and the community. Without sufficient numbers of professionals or adequate training, the primary objective of a mental health law, to improve mental health care, will fail. In addition, investment needs to be made in training all people who have a role to play in the implementation of the law (for example the judiciary, the police force, people who serve on mental health review body) in order to ensure that they are familiar with all aspects of the legislation, and with their own roles and responsibilities in putting its provisions into practice.
Implementing mental health legislation: key issues
• Significant preparation is required to ensure the smooth introduction of new mental health legislation. The period between the passing and the enactment of legislation can be a particularly important time for organizing implementation procedures such as establishing review boards, training people on the new legislation and preparing those who will implement it.
• Having standardized forms and other administrative process in place facilitates the transition.
• Procedures must be set up to monitor the implementation of legislation.
• Both the implementing and monitoring bodies should have timetable with measurable targets, and the powers to carry out their functions.
• Changing public attitudes and reducing stigma and discrimination is an important component in ensuring the success of the legislation.
• Users, families and advocacy groups need to have complete knowledge of the legislation in order to maximize the benefits. Training these groups is an essential aspect of implementation.
• Mental health and other professionals also need to trained to carry out the letter and the intention of the legislation.
• Financial and human resources to implement the legislation must be provided by the arelevant authorities to give substance and credibility to the legislation. Negotiation for the provision of these resources should be conducted simultaneously with the processes of drafting and adopting the legislation.
As we have seen, progressive legislation on mental health can represent an important means of protecting the rights of people with mental disorders. In this resource book we have highlighted key international and regional human rights standards that governments have the obligation to respect, protect and fulfill. The book also identifies what issues and provisions need to be included in a progressive mental health law. Finally it also examines best practice strategies for the effective drafting, adoption and implementation of mental health law, highlighting difficulties and barriers and ways in which these can be overcome.
It is every country’s responsibility to act on this information and to generate the necessary political commitment for successful initiation/development or reform of mental health law and its implementation.

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