Independent investigation: Beatrice Hughes, Harrow (1997)

Harrow & Hillingdon Healthcare NHS Trust and Harrow Social Services ensure that any history of alcohol and/or drug misuse is included in all risk assessment processes.

Individuals who have co-morbidity problems. (i.e. mental illness, substance misuse and criminal behaviour), should receive an enhanced care programme which is based on multi-disciplinary and multi-agency assessment; and care co-ordinators should ensure that joint reviews are undertaken, at least six monthly.

Harrow & Hillingdon Healthcare Trust and Harrow Social Services should ensure that quality assurance monitoring is in place and that the statutory provisions relating to the needs of carers, and standards set under the National Standards Framework for Mental Health are properly implemented.

the Department of Health should consider the preparation of national guidance on the care of those mentally diso'rdered offenders who abuse substances.

Middlesex Probation Service ensure that its staff only propose to Courts the making of a Community Service Order for a person suffering with a mental disorder after consultation with the appropriate specialist medical staff from the mental health services.

Brent & Harrow Health Authority and Harrow Social Services review operations to ensure that the co-operation of voluntary agencies with a contribution to make towards people with mental health needs who misuse drugs and alcohol is being sought pursuant to s117 of the Mental Health Act 1983.

Whenever a medical member of a clinical team assesses a person at their and their carer's urgent request for psychiatric hospital admission, (a) a consultant psychiatrist is consulted before a decision not to admit is taken, and (b) there is follow-up action to ensure that a community care assessment is undertaken by a community mental health team.

Brent and Harrow Health Authority and Harrow Council review their joint guidance on the implementation of their duties under Section 117 of the Mental Health Act 1983

ensure that Department of Health Circular LAC(93)2 and subsequent central guidance on Drug and alcohol misuse issues relating to community care assessments and service provision are being fully implemented, and that past barriers to service provision identified in this Inquiry have been removed;

Harrow Council ensure that its Housing Department and all local Social Landlords consult with the mental health services prior to issuing a Notice to Quit to a tenant who has complex needs;

Brent & Harrow Health Authority require forensic psychiatric service providers to use the same methods for denoting ethnicity as used by community mental health service providers;

Harrow Council and Brent & Harrow Health Authority give priority to the development of an integrated record and information system across all mental health service sites;

Peer review (i.e. request for review by another consultant) should be considered in cases of protracted unresponsive patients particularly those (like WM) who have escalating levels of antisocial/disorganised behaviour in the community.

they should ensure that adequate resources (staffing levels, training and information systems) are made available to support the Modernised Care Programme Approach national policy guidance, and significantly improve implementation performance compared to 1991

ensure that all staff working in specialist mental health services and community Drug and Alcohol Services have access to regular evidence-based training on substance misuse and risk assessment;

Harrow Housing and Social Services, and Harrow & Hillingdon Healthcare Trust take into account the findings of this Inquiry when producing a joint local Charter for people in need of on-going support and their carers;

Harrow Council, Brent & Harrow Health Authority, and Harrow and Hillingdon Healthcare Trust include evidence from Irish studies in staff training programmes; and

Harrow Council and Harrow & Hillingdon Healthcare Trust ensure that service user consent is encouraged for information sharing between the mental health services and housing services, particularly to facilitate notification of change of personal circumstances;

Harrow & Hillingdon Healthcare Trust and Harrow Social Services should monitor the implementation of National Standards for Mental Health for service users with a serious mental disorder who are substance misusers

put in place monitoring of the use of the new powers to deal with Drug offenders;

Harrow Social Services and Harrow & Hillingdon Healthcare Trust ensure that housing representation is considered by staff for care programme review meetings.

that quality assurance monitoring reports include analysis of the number of Care Programmes by ethnic classification of service users.

ensure that standards for record keeping are set and that management systems are in place for audit purposes, and

Harrow & Hillingdon Healthcare Trust should review the provision of clinics for depot medication in the light of the findings from this Inquiry.

develop joint strategies in conjunction with primary care and voluntary agencies to overcome the cycle of short-term in-patient admissions followed by a return to Drug and/or alcohol misuse for certain individuals like WM.

ensure that a quality assurance system is in place for correspondence addresses, particularly appointment letters to service users and reports to GPs.