What is a Non-Departmental Public Body (UK)?

Introduction

In the United Kingdom, non-departmental public body (NDPB) is a classification applied by the Cabinet Office, Treasury, the Scottish Government and the Northern Ireland Executive to public sector organisations that have a role in the process of national government but are not part of a government department.

NDPBs carry out their work largely independently from ministers and are accountable to the public through the Parliament; however, ministers are responsible for the independence, effectiveness and efficiency of non-departmental public bodies in their portfolio.

The term includes the four types of NDPB (executive, advisory, tribunal and independent monitoring boards) but excludes public corporations and public broadcasters (BBC, Channel 4 and S4C).

Types of Body

The UK Government classifies bodies into four main types, whilst the Scottish Government has five:

  • Advisory NDPBs:
    • These bodies consist of boards which advise ministers on particular policy areas.
    • They are often supported by a small secretariat from the parent department and any expenditure is paid for by that department.
  • Executive NDPBs:
    • These bodies usually deliver a particular public service and are overseen by a board rather than ministers.
    • Appointments are made by ministers following the Code of Practice of the Commissioner for Public Appointments.
    • They employ their own staff and are allocated their own budgets.
  • Tribunal NDPBs:
    • These bodies have jurisdiction in an area of the law.
    • They are co-ordinated by Her Majesty’s Courts and Tribunals Service, an executive agency of the Ministry of Justice, and supervised by the Administrative Justice and Tribunals Council, itself a NDPB sponsored by the Ministry of Justice.
  • Independent Monitoring Boards:
    • These bodies were formerly known as “boards of visitors” and are responsible for the state of prisons, their administration and the treatment of prisoners.
    • The Home Office is responsible for their costs, and has to note all expenses.
  • NHS Bodies:
    • Scotland only.

Examples include the Mental Welfare Commission for Scotland and Mental Health Tribunals.

Contrast with Executive Agencies, Non-Ministerial Departments and Quangos

NDPB differ from executive agencies as they are not created to carry out ministerial orders or policy, instead they are more or less self-determining and enjoy greater independence. They are also not directly part of government like a non-ministerial government department being at a remove from both ministers and any elected assembly or parliament. Typically an NDPB would be established under statute and be accountable to Parliament rather than to Her Majesty’s Government. This arrangement allows more financial independence since the government is obliged to provide funding to meet statutory obligations.

NDPBs are sometimes referred to as quangos. However, this term originally referred to quasi-NGOs bodies that are, at least ostensibly, non-government organisations, but nonetheless perform governmental functions. The backronym “quasi-autonomous national government organisation” is used in this usage which is normally pejorative.

Brief History

In March 2009 there were nearly 800 public bodies that were sponsored by the UK Government including:

  • 198 executive NDPBs;
  • 410 advisory bodies;
  • 33 tribunals;
  • 21 public corporations;
  • The Bank of England;
  • 2 public broadcasting authorities; and
  • 23 NHS bodies.

However, the classification is conservative and does not include bodies that are the responsibility of devolved government, various lower tier boards (including a considerable number within the NHS), and also other boards operating in the public sector (e.g. school governors and police authorities).

These appointed bodies performed a large variety of tasks, for example health trusts, or the Welsh Development Agency, and by 1992 were responsible for some 25% of all government expenditure in the UK. According to the Cabinet Office their total expenditure for the financial year 2005-2006 was £167 billion.

Criticism

Critics argued that the system was open to abuse as most NDPBs had their members directly appointed by government ministers without an election or consultation with the people. The press, critical of what was perceived as the Conservatives’ complacency in power in the 1990s, presented much material interpreted as evidence of questionable government practices.

This concern led to the formation of a Committee on Standards in Public Life (the Nolan Committee) which first reported in 1995 and recommended the creation of a “public appointments commissioner” to make sure that appropriate standards were met in the appointment of members of NDPBs. The Government accepted the recommendation, and the Office of the Commissioner for Public Appointments was established in November 1995.

While in opposition, the Labour Party promised to reduce the number and power of NDPBs. The use of NDPBs continued under the Labour government in office from 1997 to 2010, though the political controversy associated with NDPBs in the mid-1990s for the most part died away.

In 2010 the UK’s Conservative-Liberal coalition published a review of NDPBs recommending closure or merger of nearly two hundred bodies, and the transfer of others to the private sector. This process was colloquially termed the “bonfire of the quangos”.

Classification in National Accounts

NDPBs are classified under code S.13112 of the European System of Accounts (ESA.95). However, Statistics UK does not break out the detail for these bodies and they are consolidated into General Government (S.1311).

What are the Principles for the Protection of Persons with Mental Illness?

Introduction

The Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care (MI Principles) were adopted by the United Nations General Assembly in 1991.

Background

The MI Principles provide agreed but non-legally-binding basic standards that mental health systems should meet and rights that people diagnosed with mental disorder should have.

Although the document underwent extensive drafting for 20 years and remains the international human rights agreement most specifically concerned with mental health, it has been criticised for not offering stronger protections in some areas.

It should now be read in the context of the United Nations Convention on the Rights of Persons with Disabilities.

The Principles

There are 25 principles:

  1. Fundamental freedoms and basic rights.
  2. Protection of minors.
  3. Life in the community.
  4. Determination of mental illness.
  5. Medical examination.
  6. Confidentiality.
  7. Role of community and culture.
  8. Standards of care.
  9. Treatment.
  10. Medication.
  11. Consent to treatment.
  12. Notice of rights.
  13. Rights and conditions in mental health facilities.
  14. Resources for mental health facilities.
  15. Admission principles.
  16. Involuntary admission.
  17. Review body.
  18. Procedural safeguards.
  19. Access to information.
  20. Criminal offenders.
  21. Complaints.
  22. Monitoring and remedies.
  23. Implementation.
  24. Scope of principles relating to mental health facilities.
  25. Saving of existing rights.

What is the Fixated Threat Assessment Centre?

Introduction

The Fixated Threat Assessment Centre (FTAC) is a UK police/mental health unit, whose function is to manage the risk to public figures from stalkers and others fixated on celebrity.

It was formed in 2006 in acknowledgement that such offenders overwhelmingly suffered from psychosis, and could often be identified in advance from behavioural signs. Preventive treatment could then be applied, for the protection of the relevant public figures as well as the families and neighbours of the sufferer.

Refer to Chronology of UK Mental Health Legislation.

Rationale

The rationale for a joint police/mental health unit was the finding that the main danger of death or serious injury to politicians in Western Europe came from attacks by people suffering from a mental health illness, who had given warnings of what they might do in the form of inappropriate, harassing or threatening communications or approaches towards the politicians in question. A similar picture was found in a study of historical attacks on the British royal family. A separate detailed study of recent inappropriate communications and approaches to members of the royal family found that 83% of the individuals concerned were suffering from psychosis.

Similar findings have come from the United States, where Park Dietz has written: “Every instance of an attack on a public figure by a lone stranger in the United States for which adequate information has been made publicly available has been the work of a mentally disordered person who issued one or more pre-attack signals in the form of inappropriate letters, visits or statements….” The role of FTAC in the UK is to detect such signals, to evaluate the risks involved and to intervene to reduce them. Such intervention often entails the obtaining of treatment and care for the fixated individual from psychiatric and social services and general practitioners in their town of residence.

The Fixated

The word ‘fixated’ in the name of the unit indicates that the main motivational drives behind the stalking of public figures are pathologically intense fixations on individuals or causes, these being obsessive pre-occupations pursued to an abnormally intense degree. In the case of those pursuing the Royal Family, these fixations divide between beliefs that the individual was a member of the family or married to a member of the family; that the royal personage was involved in plots to persecute them; and that the Royal Family were culpable for failing to redress a particular grievance, often delusional, with which the individual was angrily obsessed.

Staffing and Role

FTAC was set up in 2006, jointly managed by the Home Office, the Department of Health and Metropolitan Police Service. It is staffed by ten police officers, three full-time senior forensic nurses, a full-time senior social worker and a number of senior forensic psychiatrists and psychologists from the Barnet Enfield and Haringey NHS Trust and the Oxleas NHS Foundation Trust. FTAC receives around 1,000 referrals a year of people who have engaged in threatening or harassing communications towards politicians or the Royal Family. Around half are assessed as being of low risk after initial enquiries. The remainder are investigated by FTAC staff. They may then be referred to local health services for further assessment and potential involuntary commitment. In some cases, they may be detained by police under the section 136 powers of the Mental Health Act 1983 prior to referral.

Although run by London’s Metropolitan Police Service, FTAC is responsible for dealing nationally with the stalking or harassment of public figures by lone individuals. According to its founder, David James, it attempts not only to provide protection for the subjects of obsessive attention, but also to help people with obsessions who have mental illnesses that might otherwise have gone undiagnosed or untreated. The basis of the approach arises from the fact that the majority of the fixated are driven by delusional beliefs based in potentially treatable mental disorders. Treating those with evident mental illness will have an important effect in reducing the level of risk to public figures, whilst at the same time improving the health and welfare of the individuals concerned. The strap-line on FTAC’s stationery is ‘Preventing Harm and Facilitating Care’.

According to a statement made in June 2007 by the then Minister of State at the Home Office, Tony McNulty,

“FTAC does not detain people in psychiatric hospitals. When it encounters an individual in need of mental health care it alerts their general practitioners and psychiatrists, who then provide appropriate help under existing legislation. FTAC may make use of police powers under section 136 of the Mental Health Act 1983 to take a person who appears to be suffering from mental disorder, and in immediate need of care or control, to a place of safety. When people are removed to hospital under section 136, they are examined by a registered medical practitioner and interviewed by an approved social worker, not associated with FTAC, in order to make any necessary arrangements for their treatment or care.

Activity

In a parliamentary reply made in June 2009, the then Minister of State for Security, Counter-Terrorism, Crime and Policing, David Hanson said: “Since 2006, when FTAC began operation, 246 people have been detained under the Mental Health Act following a referral from FTAC and a subsequent decision by local health services. No individual has received a custodial sentence as a result of FTAC involvement.”

He also stated that during that same period, 27 people had been conveyed to a “place of safety” by FTAC staff under section 136 of the Mental Health Act 1983.

FTAC published the details of its interventions in its first 100 cases in the Journal of Forensic Psychiatry & Psychology in 2010. Eighty-six per cent of those assessed by FTAC were diagnosed as suffering from psychotic illness; 57% of the sample group were subsequently admitted to hospital, and 26% treated in the community. In 80% of cases, the risk level was reduced to low by FTAC intervention, the remainder of cases remaining under continued FTAC management

In protection terms, FTAC’s activities are said to benefit the families of the fixated individuals and the general public as much as the public figures that they are hounding. This is because those close to the fixated are more regularly exposed to their irrational and threatening behaviour than the public figures they target. This finding is similar to that made in the USA by Dietz and Martell in a report prepared for the National Institute of Justice:

“The persons most at risk of violence from the individual mentally ill person who pursues public figures are not the public figures or those that protect them – assuming they have the necessary security arrangements – but rather the private citizens who are the family members and neighbours of the mentally disordered subject.”

Origins

The setting up of FTAC was the main recommendation of the report of Fixated Research Group (FRG) which undertook a major research project on behalf of the Home Office between 2003 and 2006. This looked at inappropriate communications and approaches to members of the Royal Family, and systematically examined 8,000 files held by SO14, the royalty protection division of the Metropolitan Police Service’s Protection Command. The Fixated Research Group was composed of forensic psychiatrists and psychologists from the UK, Australia and the USA, who are experts in the field of stalking. They included Paul Mullen and Michele Pathé from Australia, co-authors of ‘Stalkers and their Victims’, and J. Reid Meloy from San Diego, editor of The Psychology of Stalking. The series of research papers published by the group in peer-reviewed scientific journals forms the evidence base for the FTAC.

Other Applications of the Model

The researchers at FTAC contend that the joint police-NHS model has other possible applications within the UK, such as in police responses to stalking of ordinary people and in homicide prevention. In their view, a logical further development would be the modification of the role of NHS police-liaison psychiatric nurses, so that they become embedded in police responses at borough or county level in order to perform an enabling role, to the benefit of individual patients and of public protection.

Awards

FTAC won an Association of Chief Police Officers’ Excellence Award in 2009.

Book: A Manifesto for Mental Health

Book Title:

A Manifesto for Mental Health: Why We Need a Revolution in Mental Health Care.

Author(s): Peter Kinderman.

Year: 2019.

Edition: First (1st).

Publisher: Palgrave Macmillan.

Type(s): Paperback and Kindle.

Synopsis:

A Manifesto for Mental Health presents a radically new and distinctive outlook that critically examines the dominant ‘disease-model’ of mental health care. Incorporating the latest findings from both biological neuroscience and research into the social determinants of psychological problems, Peter Kinderman offers a contemporary, biopsychosocial, alternative. He warns that the way we care for people with mental health problems is creating a hidden human rights emergency and he proposes a new vision for the future of health organisations across the globe.

The book highlights persuasive evidence that our mental health and wellbeing depend largely on the society in which we live, on the things happen to us, and on how we learn to make sense of and respond to those events. Kinderman proposes a rejection of invalid diagnostic labels, practical help rather than medication, and a recognition that distress is usually an understandable human response to life’s challenges. Offering a serious critique of establishment thinking, A Manifesto for Mental Health provides a well-crafted demonstration of how, with scientific rigour and empathy, a revolution in mental health care is not only highly desirable, it is also entirely achievable.

What is the Impact of COVID-19 & Lockdown on the Mental Health of Children & Adolescents?

Research Paper Title

Impact of COVID-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations.

Background

COVID-19 pandemic and lockdown has brought about a sense of fear and anxiety around the globe. This phenomenon has led to short term as well as long term psychosocial and mental health implications for children and adolescents. The quality and magnitude of impact on minors is determined by many vulnerability factors like developmental age, educational status, pre-existing mental health condition, being economically underprivileged or being quarantined due to infection or fear of infection.

This paper is aimed at narratively reviewing various articles related to mental-health aspects of children and adolescents impacted by COVID-19 pandemic and enforcement of nationwide or regional lockdowns to prevent further spread of infection.

Methods

The researchers conducted a review and collected articles and advisories on mental health aspects of children and adolescents during the COVID-19 pandemic. They selected articles and thematically organized them.

Results

The researchers put up their major findings under the thematic areas of impact on young children, school and college going students, children and adolescents with mental health challenges, economically underprivileged children, impact due to quarantine and separation from parents and the advisories of international organisations. They have also provided recommendations to the above.

Conclusions

There is a pressing need for planning longitudinal and developmental studies, and implementing evidence based elaborative plan of action to cater to the psycho social and mental health needs of the vulnerable children and adolescents during pandemic as well as post pandemic. There is a need to ameliorate children and adolescents’ access to mental health support services geared towards providing measures for developing healthy coping mechanisms during the current crisis.

For this innovative child and adolescent mental health policies with direct and digital collaborative networks of psychiatrists, psychologists, paediatricians, and community volunteers are deemed necessary.

Reference

Singh, S., Roy, D. Sinha, K., Parveen, S., Sharma, G. & Joshi, G. (2020) Impact of COVID-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations. Psychiatry Research. 293, pp.113429. doi: 10.1016/j.psychres.2020.113429. Online ahead of print.

Mental Health Care, Policy, and COVID-19: The Renewed Role for Psychiatric and Addiction Nursing

Research Paper Title

Mental Health Care, Policy, and COVID-19: The Renewed Role for Psychiatric and Addiction Nursing.

Background

Kovner (2020) has importantly highlighted the role that health care workers play in the 21st century to fight pandemics, such as the recent COVID-19 outbreak, in Canada and around the world. The heroic actions, determination, selflessness, and compassion of nurses and many health care providers worldwide have become the highlighted story of COVID-19 pandemic (Kovner, 2020). This is particularly significant, as 2020 has been called the Year of the Nurse and the Midwife by the World Health Organization and the International Council of Nurses to celebrate the birth of renowned nurse Florence Nightingale on her 200th anniversary. While this year has already signified the critical position of nurses in primary care, policy, and clinical practice, the role of psychiatric nurses and their contributions to primary care have often been overlooked by society, government policy makers, and many academics.

This is particularly true, as most provinces/states do not have dedicated bachelors’ degrees in psychiatric nursing, except for British Columbia (BC), Alberta, Saskatchewan, and Manitoba in Canada. Additionally, BC remains the only province/State in North America that has a fellowship program in Addiction nursing (Jozaghi & Dadakhah-Chimeh, 2018). Momentously, it was also the first province/state in North America to enact a provincial ministry dedicated to mental health and addiction (BC Gov News, 2017). This is remarkably significant in the current pandemic as many North American are asked to work from home, have been laid off, ordered to self-isolate, or practice social distancing. The cumulative effects of financial strain and self-isolation have already been reflected in a higher frequency of police calls for mental health and domestic assault cases in many provinces, territories, and states (Hong, 2020; Seebruch, 2020). The latest research also highlights a projected increase in suicide cases in North America linked to the COVID-19 pandemic (McIntyre & Lee, 2020). Self-isolation measures and the ongoing opioid crisis have also caused sharp increases in mortalities linked to synthetic opioids to their highest levels (Johnston, 2020). Finally, some researchers have warned about the potential misuse of alcohol during the current pandemic (Clay & Parker, 2020).

Therefore, the rise in mental health and domestic abuse calls, potential suicides, overdose deaths, and alcohol abuse serves as a reminder that COVID-19 is not our only health crisis. We must tackle and plan for the potential tsunami of mental health and addiction cases. While the Federal government in Canada has promised investment to improve long-term care, Kovner (2020) rightly pointed out that COVID-19 pandemic is about politics and policy and we similarly urge the governments and municipalities to invest to improve public health. More importantly, dedicated mental health care and training in psychiatric and addiction nursing is long overdue. We also recommend that cities, states, and federal housing agencies to increase funding for dedicated mental health and harm reduction programs during the current pandemic for people who have mental health or substance use disorders.

Reference

Dadakhah-Chimeh, Z. & Jozaghi, E. (2020) Mental Health Care, Policy, and COVID-19: The Renewed Role for Psychiatric and Addiction Nursing. Policy, Politics& Nursing Practice. doi: 10.1177/1527154420957305. Online ahead of print.

Book: London and Its Asylums, 1888-1914 – Politics and Madness

Book Title:

London and Its Asylums, 1888-1914 – Politics and Madness.

Author(s): Robert Ellis.

Year: 2020.

Edition: First (1ed).

Publisher: Palgrave Macmillan.

Type(s): Hardcover and Kindle.

Synopsis:

This book explores the impact that politics had on the management of mental health care at the turn of the nineteenth and twentieth centuries. 1888 and the introduction of the Local Government Act marked a turning point in which democratically elected bodies became responsible for the management of madness for the first time.

With its focus on London in the period leading up to the First World War, it offers a new way to look at institutions and to consider their connections to wider issues that were facing the capital and the nation.

The chapters that follow place London at the heart of international networks and debates relating to finance, welfare, architecture, scientific and medical initiatives, and the developing responses to immigrant populations.

Overall, it shines a light on the relationships between mental health policies and other ideological priorities.

A Review of Effective/Cost Effective Interventions of Child Mental Health Problems in Low- and Middle-Income Countries (LAMIC)

Research Paper Title

Effective/cost effective interventions of child mental health problems in low- and middle-income countries (LAMIC): Systematic review.

Background

This systematic review protocol aims to examine the evidence of effectiveness and cost-effectiveness of interventions for children and adolescents with, or at risk of developing mental disorders in low- and middle-income countries (LAMICs).

Methods

The researchers will search Medline Ovid, EMBASE Ovid, PsycINFO Ovid, CINAHL, LILACS, BDENF and IBECS. We will include randomised and non-randomised controlled trials, economic modelling studies and economic evaluations.

Participants are 6 to 18 year-old children and adolescents who live in a LAMIC and who present with, or are at high risk of developing, one or more of the conditions: depression, anxiety, behavioural disorders, eating disorders, psychosis, substance abuse, autism and intellectual disabilities as defined by the DSM-V.

Interventions which address suicide, self-harm will also be included, if identified during the extraction process.

The researchers will include in person or e-health interventions which have some evidence of effectiveness (in relation to clinical and/or functional outcomes) and which have been delivered to young people in LAMICs.

They will consider a wide range of delivery channels (e.g., in person, web-based or virtual, phone), different practitioners (healthcare practitioners, teachers, lay health care providers) and sectors (i.e., primary, secondary and tertiary health care, education, guardianship councils).

In the pilot of screening procedures, 5% of all references will be screened by two reviewers.

Divergences will be resolved by one expert in mental health research.

Reviewers will be retrained afterwards to ensure reliability. The remaining 95% will be screened by one reviewer.

Covidence web-based tool will be used to perform screening of references and full text paper, and data extraction.

Results

The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences.

The results will be presented descriptively and, if possible, meta-analysis will be conducted. Ethical approval is not needed for anonymised secondary data.

Conclusions

The systematic review could help health specialists and other professionals to identify evidence-based strategies to deal with child and adolescents with mental health conditions.

Reference

Grande, A.J., Ribeiro, W.S., Faustino, C., de Miranda, C.T., Mcdaid, D., Fry, A., de Moraes, S.H.M., de Oliveira, S.M.D.V.L., de Farias, J.M., de Tarso Coelho Jardim, P., King, D., Silva, V., Ziebold, C. & Evans-Lacko, S. (2020) Effective/cost effective interventions of child mental health problems in low- and middle-income countries (LAMIC): Systematic review. Medicine (Baltimore). 99(1):e18611. doi: 10.1097/MD.0000000000018611.

What are the Factors Associated with Anxiety Disorders among Patients with Substance Use Disorders

Research Paper Title

Factors associated with anxiety disorders among patients with substance use disorders in Lebanon: Results of a cross-sectional study.

Background

Estimate the rate of anxiety disorders (AD) and associated factors among patients with substance use disorder (SUD) in Lebanon.

Methods

A cross-sectional study, conducted between April and September 2017, enrolled 57 inpatients with SUD.

Results

The rate of AD in patients with SUD was 61.4%. The university level of education compared to the primary level of education (ORa = 0.221) was significantly associated with lower anxiety among patients with SUD. Being sexually abused and having a family history of depression tended to significance.

Conclusions

AD is widespread in Lebanon and high rates of anxiety in patients with SUD were found, warranting the implementation of strategic interventions and establishing national policies and legislation for mental health services to provide optimal care.

Reference

Haddad, C., Darwich, M.J., Obeid, S., Sacre, H., Zakhour, M., Kazour, F., Nabout, R., Hallit, S. & Tahan, F.E. (2019) Factors associated with anxiety disorders among patients with substance use disorders in Lebanon: Results of a cross-sectional study. Perspectives in Psychiatric Care. doi: 10.1111/ppc.12462. [Epub ahead of print].

Health Policies: Consider the Direct & Indirect Cross-effects between Mental Health & Physical Health

Research Paper Title

The relationship between physical and mental health: A mediation analysis.

Background

There is a strong link between mental health and physical health, but little is known about the pathways from one to the other.

The researchers analyse the direct and indirect effects of past mental health on present physical health and past physical health on present mental health using lifestyle choices and social capital in a mediation framework.

Methods

They use data on 10,693 individuals aged 50 years and over from six waves (2002-2012) of the English Longitudinal Study of Ageing.

Mental health is measured by the Centre for Epidemiological Studies Depression Scale (CES) and physical health by the Activities of Daily Living (ADL).

Results

The researchers find significant direct and indirect effects for both forms of health, with indirect effects explaining 10% of the effect of past mental health on physical health and 8% of the effect of past physical health on mental health.

Physical activity is the largest contributor to the indirect effects.

There are stronger indirect effects for males in mental health (9.9%) and for older age groups in mental health (13.6%) and in physical health (12.6%).

Conclusions

Health policies aiming at changing physical and mental health need to consider not only the direct cross-effects but also the indirect cross-effects between mental health and physical health.

Reference

Ohrnberger, J., Fichera, E. & Sutton, M. (2017) The relationship between physical and mental health: A mediation analysis. Social Science & Medicine (1982). 195, pp.42-49. doi: 10.1016/j.socscimed.2017.11.008. Epub 2017 Nov 8.