Reece Lapina-Amarelle

From Nadine Dorries MP

Parliamentary Under Secretary of State for Mental Health,
Department i 7 7

Suicide Prevention and Patient Safety
of Health &
Social Care 39 Victoria Street

London
SW1H 0EU

Your Ref: ARC/LEH/Lapina-Amarelle/01252-2018 920 7210 4850
Our Ref: PFD-1186842

Mr Alan Craze

HM Senior Coroner, East Sussex
HM Coroner's Office

31 Station Road

Bexhill-On-Sea TN40 IRG

Derr Man,

Thank you for your correspondence of 12 August to Matt Hancock about the death of
Mr Reece Lapina-Amarelle. I am responding as Minister with responsibility for
mental health and I am grateful for the additional time in which to do so.

St November 2019

Firstly, I would like to say how very sorry I was to read of the tragic circumstances of
Reece’s death. I can appreciate how devastating his loss, at such a young age and in
such circumstances, must be for his family and loved ones and offer my most
heartfelt condolences to them.

I note that the Sussex Partnership NHS Foundation Trust conducted a Serious
Incident Review into Reece’s death that made important recommendations for action,
including steps to improve communication with families and carers. I welcome the
action taken by the Trust. However, it is vital that the Trust does consider carefully
learnings that can be taken from Reece’s tragic death to reduce the chance of such a
situation from ever happening again.

In view of the serious nature of this case, I have asked my officials to make your
report and the circumstances of this case known to the Care Quality Commission, the
independent regulator of healthcare services in England.

I will now turn to specific matters of concern in your report about the Mental Health
Act and treatment for people with co-occurring substance misuse and mental health
conditions. In preparing this response, my officials have made enquiries with NHS
England and NHS Improvement to whom you also issued your report. I will not
repeat the detail of their response. However, I note that it explains the work that is

taking place to strengthen the provision of integrated care across the NHS, social care
and public health, and transform the support for those with severe mental illness and
co-occurring substance misuse through the actions outlined in the NHS Mental Health
Implementation Plan 2019/20 — 2023/24'. The response also sets out the
commitment to improve information sharing in the NHS through digitisation and
programmes such as Local Integrated Health and Care Records’, which aims to
enable the safe and secure sharing of information to support improvements in care.

Drug misuse is common among people with mental health problems and we
understand that people with co-occurring substance misuse and mental health
conditions can find it difficult to access the care they need. We recognise that we
need to do more to tackle this issue and ensure that those affected receive treatment
that meets their needs in relation to both mental health and drug dependency.

We are clear that commissioners and providers of services have a joint responsibility
to work collaboratively to meet the needs of people with co-occurring

conditions. Public Health England has developed guidance’ to support
commissioning and provision of joined up services for people with a dual diagnosis
of mental health and substance misuse problems. The guidance sets out tangible
principles for how services should work, including that each person should have
access to a care co-ordinator to help ensure all their needs are addressed.

In addition, the National Institute for Health and Care Excellence (NICE) has
published a guideline on ‘Coexisting severe mental illness and substance misuse’,
that aims to support improvements in the provision of co-ordinated services. A
Quality Standard*, published in August 2019, provides further guidance to healthcare
professionals on the assessment, management and care of those with co-occurring
severe mental illness and substance misuse.

The Government continues to support the ‘no wrong door’ approach when people
present to services with co-occurring conditions. Commissioning guidance
encourages services to respond collaboratively, effectively and flexibly, offering

' https://www.longtermplan.nhs.uk/wp-content/uploads/2019/07/nhs-mental-health-implementation-plan-2019-20-
2023-24. pdf

1 zovernment/uploads/system/uploads/attachment_data/file/625809/Co-
occurring mental health _and_alcohol_drug_use_conditions.pdf

* https://www.nice.org.uk/guidance/ng58

5 https://www.nice.org.uk/guidance/gs188

compassionate and non-judgemental care centred around the persons needs which is
accessible from every access point.

Turning to treatment, under the Mental Health Act, dependence on alcohol or drugs is
not considered to be a disorder or disability of the mind. The Act’s Code of Practice®
does, however, allow for drug and alcohol treatment to be given “if that is an
appropriate part of treating the mental disorder which is the primary focus of the
treatment” (Mental Health Act Code of Practice, paragraph 2.13) and it also allows
for disorders caused by alcohol and substance misuse to be considered as mental
disorders for the purposes of the Act.

The Act allows for the detention and treatment of people with a mental disorder when
there is a concern for a person’s health and safety or that of other people and, where a
patient is at risk of suicide, there is an expectation that the Act is used to protect the
patient. A practitioner may prefer to try to keep the patient in hospital informally or
use the Mental Capacity Act’s Deprivation of Liberty Safeguards to detain the
patient. The Act does not, however, set out recommendations for therapy or other
treatments, as these are matters for healthcare professionals.

More generally, as you are aware, we commissioned a full and independent review of
the Mental Health Act. The Independent Review of the Mental Health Act was
published on 6 December 2018’. The Review made 154 recommendations. If
implemented they would give more legal weight to people’s choices, make the use of
compulsion more targeted and transparent, and modernise services to provide patient-
centred care which respects the patient’s dignity.

We will publish a White Paper which will set out the Government’s response, in full,
to the Independent Review of the Mental Health Act, and pave the way for new
legislation.

I hope this response is helpful. Thank you for bringing these concerns to my

Nad. .

NADINE DORRIES

attention.

7 https://www.gov.uk/government/publications/modemising-the-mental-health-act-final-report-from-the-independent-
review

INHS

Professor Stephen Powis
National Medical Director
Skipton House
80 London Road
SE1 6LH
Alan Romilly Craze
Senior Coroner for Area of East Sussex
Coroner's Office (East Sussex)
Unit 56
Innovation Centre
Highfield
St Leonards on Sea
East Sussex

TN38 9UH October 2019

Dear Mr Romilly Craze,

Re: Regulation 28 Report to Prevent Future Deaths — Mr Reece Tristan Lapina-Amarelle,
deceased 25.06.2018

Thank you for your Regulation 28 Report (hereinafter the ‘report’) dated 9" August 2019
concerning the death of Mr Reece Lapina-Amarelle on 25" June 2018. Firstly, | would like to
express my deep condolences to Mr Amarelle’s family.

Your report confirms that, following the inquest which concluded earlier this year, Mr Lapina-
Amarelle died by suicide as a result of multiple injuries. An incident occurred at Beachy Head
on the same day Mr Lapina-Amarelle was discharged from Bodiam Ward, which is part of
Sussex Partnership NHS Foundation Trust.

Alongside your report you have shared a key witness statement and the Serious Incident
Review report, and you have raised concerns in your report to both the Secretary of State for
Health and NHS England regarding the following:

1) The unavailability of resources and a system of treatment for people with serious mental
illness and alcohol or drug misuse histories;

2) The insufficient sharing of information between the Mental Health Trust and CGL (the
Substance and Alcohol Misuse Service);

3) The fact that CGL (the Substance and Alcohol Misuse Service) is voluntary and that,
outside the criminal justice system, the subject cannot be forced to access and receive
help from that service;

4) The fact that, in your opinion, the Mental Health Act is out of date and does not
recognise or accept responsibility for providing a plan of action to deal with people such
as Mr Reece;

5) The fact that, in your opinion, the Mental Health Act still concentrates on therapy without
giving enough emphasis to safety and preventative measures, particularly in a context of
a history of substance misuse.

NHS England and NHS Improvement

| note that a copy of your report has been sent to the Trust for a response on the specific
circumstances relating to Mr Lapina-Amarelle’s death, which | acknowledge is a particularly
tragic and difficult case. However, | wanted to highlight some key national policies and priorities
which | believe are relevant to the concerns you have raised in your report as both having a
bearing on Mr Lapina-Amarelle’s death and ongoing concerns for patient safety.

Concern 1 - The unavailability of resources and a system of treatment for people with
Serious mental iliness and alcohol or drug misuse histories.

Concern 3 — The fact that CGL (the Substance and Alcohol Misuse Service) is voluntary
and that, outside the criminal justice system, the subject cannot be forced to access and
receive help from that service.

The Health and Social Care Act 2012 transferred statutory responsibility for the commissioning
of public health services, including drug and alcohol services, to local authorities. NHS England
and NHS Improvement do recognise it is a very important issue, with significant implications for
the mental health of individuals, particularly for those affected by coexisting severe mental
illnesses (SMI) and substance misuse, like Mr Lapina-Amarelle. We also recognise the
importance of ensuring closer working between mental health services and substance misuse
services to ensure people’s needs are met in an integrated, holistic and timely manner. As
such, the ongoing move towards Integrated Care Systems (ICSs) across England is intended to
help address some of these issues and to provide joined up health and care to whole
populations across the NHS, social care and public health.

In recognition of the above, we are taking specific steps to improve access to, and quality of,
support for people with co-existing SMI and substance misuse. The NHS Long Term Plan,
published earlier this year, details how new and integrated models of primary and community
health services will transform the delivery of mental health care for adults and older adults with
SMI, including people with a ‘personality disorder’ and those with co-existing substance misuse.
As the NHS Mental Health Implementation Plan 2019/20 — 2023/24 sets out, this new
community-based offer, backed by significant investment over the next five years, will include
access to psychological therapies, improved physical health care, employment support,
personalised and trauma-informed care, medicines management and support for self-harm and
coexisting substance use. The — Implementation Plan is available _ here:

https://Awww.longtermplan.nhs.uk/wp-content/uploads/2019/07/nhs-mental-health-
implementation-plan-2019-20-2023-24 pdf.

By 2023/24, the new models of care, underpinned by improved information sharing, will give at
least 370,000 adults and older adults per year greater choice and control over their care, and
support them to live well in their communities — including dedicated provision for groups with
specific needs, such as adults with a ‘personality disorder diagnosis.

To support improvements in the commissioning and provision of services for people with co-
existing SMI and substance misuse, the National Institute for Health and Care Excellence
(NICE) published a national guideline (NG58) in November 2016, which is available online here:
httos://Awww.nice.org.uk/quidance/ng58. NICE is also expected to publish a new quality
standard on this topic soon to provide further detail to clinical teams as to how they can best
meet the needs of this group of people. Its draft standard is available online here:

https://www.nice.org.uk/guidance/gid-qs10078/documents/draft-quality-standard. Public Health
NHS England and NHS Improvement

England, as the lead organisation responsible for supporting local government with its public
health responsibilities, has'also published guidance for commissioners and service providers on
co-occurring mental health and alcohol/drug use conditions, which is available online here:

httos://assets publishing .service.gov.uk/government/uploads/system/uploads/attachment_ data/f
ile/625809/Co-occurring mental health and alcohol drug use conditions.pdf

Concern 2 — The insufficient sharing of information between the Mental Health Trust and
CGL (the Substance and Alcohol Misuse Service);

The NHS Long Term Plan is committed to ensuring that by 2024 secondary care providers in
England, including acute, community and mental health care settings, will be fully digitised,
including clinical and operational processes across all settings, locations and departments.
Data will be captured, stored and transmitted electronically, supported by robust IT
infrastructure and cyber security, and Local Health and Care Records will cover the whole
country.

As part of this, a number of steps are being taken, led by NHS England and NHS Improvement,
and NHSX, to enable the safe and secure sharing of digital records. The Local Integrated
Health and Care Records programme will provide a strategic vision for safely and securely
sharing data across different NHS and partner organisations (including substance misuse
services). The aim of the programme is to create an information sharing environment that helps
our health and care services to continually improve the care that we deliver.

This includes: ensuring that health and care professionals have access to a comprehensive
care record with the information they need to inform their care decisions, when and where they
need it; empowering people to look after themselves better and make informed choices about
their own health and care; and being able to analyse the data to enable more precise and
actionable interventions and support the development of population health management. NHS
England is also working with the mental health trust Global Digital Exemplar programmes to
develop a range of basic and more advanced tools to support decisions on care across the
pathway; this includes the identification of need, detection of risk and the application of best
practice.

In parallel to this, NHS England and NHS Improvement and NHSX are working to improve the
availability of mental health information and evidence-based resources online. This includes
local crisis service directories,

Concern 4 ~ The fact that, in your opinion, the Mental Health Act is out of date and does
not recognise or accept responsibility for providing a plan of action to deal with people
Such as Mr Reece;

Concern 5 — The fact that, in your opinion, the Mental Health Act still concentrates on
therapy without giving enough emphasis to safety and preventative measures,
particularly in a context of a history of substance misuse.

The Independent Review of the Mental Health Act (MHA) 1983 has set out recommendations
for the Government on how the MHA and associated practice needs to change. Its report can

be accessed online here: https:/Awww.gov.uk/government/publications/modernising-the-mental-
NHS England and NHS Improvement

health-act-final-report-from-the-independent-review

As the government department responsible for this legislation, the Department of Health and
Social Care is currently developing a response to the Independent Review's recommendations,
and NHS England and NHS Improvement are involved in, and supporting this process. The
Government has committed to publishing a White Paper before the end of the year.

Thank you for bringing these important patient safety issues to my attention and please do not
hesitate to contact me should you need any further information.

Yours sincerely,

)

Professor Stephen Powis
National Medical Director
NHS England and NHS Improvement

NHS Engiand and NHS Improvement

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