MHRTs and Discharge

Powers to Discharge Patients from Compulsion - Changes Power of Discharge is given to non-medical RC as well as medical RCPower of Discharge is given to non-medical RC as well as medical RC Power of Discharge for Patients on SCT is given to RC, Hospital Managers, MHRT & NRPower of Discharge for Patients on SCT is given to RC, Hospital Managers, MHRT & NR

Criteria for Discharge Changes The criteria for discharge reflect the criteria for detention [change in exclusions & treatability test]The criteria for discharge reflect the criteria for detention [change in exclusions & treatability test] Therefore the new criteria for detention, i.e. ‘Mental Disorder’ and for treatment sections ‘appropriate treatment’ being available will need to be considered.Therefore the new criteria for detention, i.e. ‘Mental Disorder’ and for treatment sections ‘appropriate treatment’ being available will need to be considered. SCT section 17a will require consideration of the nature of the Mental Disorder rather than the degreeSCT section 17a will require consideration of the nature of the Mental Disorder rather than the degree ( Re Smith 1997)

‘Amend the Act to achieve earlier access to the Mental Health Review Tribunal for all civil patients’ Changes under MHA 2007 Rules & Regulations:

These changes are as follows: Reference to the MHRT by Hospital Managers after the first six months for patients on section 3, who have not lodged an appeal to the MHRT during that period, will take into account any time they may have been detained under section 2 Reference of minors who have not appealed to the MHRT during their annual renewal must be made on an annual basis instead of the 3 yearly basis that remains the case for adult patients, those 18 and over.

Automatic referrals to the MHRT by Hospital Managers of community patients who have their CTO revoked under section 17F Automatic referrals to the MHRT by Hospital Managers of patients returned from guardianship to hospital The Tribunal Panel for children and young people under 18 years shall have a medical specialist in CAMHS (Child and Adolescent Mental Health Service) on the panel The Secretary of State will be able to reduce the current reference period to the MHRT as and when he thinks fit. These changes are as follows (cont):

Changes to the organisation of the MHRT There will now be one MHRT for England and one for Wales.There will now be one MHRT for England and one for Wales. Patients subject to section 17A Community Treatment Order will be able to apply or be referred to the MHRTPatients subject to section 17A Community Treatment Order will be able to apply or be referred to the MHRT There shall be one President of the Tribunal in England and one in WalesThere shall be one President of the Tribunal in England and one in Wales The legal member of the Tribunal Panel shall be known as the Chairman rather than the President of the TribunalThe legal member of the Tribunal Panel shall be known as the Chairman rather than the President of the Tribunal The current Rules of the Tribunal are being reviewed. (Rule 6 that reports must be submitted within 3 weeks of receipt of an application will not be changed)The current Rules of the Tribunal are being reviewed. (Rule 6 that reports must be submitted within 3 weeks of receipt of an application will not be changed)

Organisation of the MHRT The organisation of the MHRT is currently undergoing changes brought about by a review of the Tribunals system in England and Wales. These will be implemented by the Ministry of Justice These changes include the introduction of a two tier Tribunal system. Tier two This tier will act as 1) a point of appeal; and 2) a place to clarify points of law. Tier One This tier will hear the majority of cases. Cases will be divided by ‘type’ and each group will have it’s own president

The Role of the Hospital Manager The managers of the hospital or registered establishment in which a patient is detained are responsible for making sure that a patient who is subject to compulsion (in hospital or on SCT) understands what this means, and what their rights to appeal are. This should happen as soon as possible once the patient is placed on section. Managers need to consider the new legal requirements around “appropriate treatment” and how it effects the decision making Hospital Managers

The wider role of the hospital managers Hospital Managers For example: Responsibility for age appropriate accommodation for young people Responsibility for the ways in which the hospital as a whole operates mental health law Making sure that where they delegate duties to other people (for example, to nurses who receive papers on their behalf) that those people are able to exercise those duties competently.

Hospital Managers Responsibilities of Managers of Foundation Trusts In the case of an NHS foundation trust, a panel can consist of any three or more people appointed for the purpose by the trust whether or not they are members of the trust itself or any of its committees or sub-committees.

The Legal Basis for Hospital Managers Hospital Manager’s function arises from the following sections: Section 23 - power of discharge; Section duty to inform a detained patient of their rights, and Section duty to inform a detained patient’s nearest relative of their rights under the MHA. Hospital Managers

Tribunal / Managers Hearing process Civil hearing Civil hearing ‘Burden’ on detaining authority to prove criteria for detention met ‘Burden’ on detaining authority to prove criteria for detention met ‘Standard’ of proof is ‘balance of probability’ ‘Standard’ of proof is ‘balance of probability’ Witnesses on behalf of DA (incl RC) provide evidence (written and oral expert evidence ; fact and opinion connected by strict logic ) Witnesses on behalf of DA (incl RC) provide evidence (written and oral expert evidence ; fact and opinion connected by strict logic ) Evidence now of why SCT not approp Evidence now of why SCT not approp Patient usually represented (not nec sol) Patient usually represented (not nec sol) Detaining authority not usually represented legally Detaining authority not usually represented legally RC may rep DA – consider role of representative RC may rep DA – consider role of representative