THE MENTAL HEALTH ACT 1983 ALISON WHEELTON SENIOR MHA ADMINISTRATOR JAG BARHA DEPUTY SENIOR MHA ADMINISTRATOR

The Code of Practice

It is important that we have a modern legal framework within which clinicians can intervene where necessary to protect people with mental disorders themselves and, sometimes, to protect other people as well. But with the power to intervene compulsorily comes the responsibility to do so only where it is right and to the highest standards possible. Alan Johnson Secretary of State for Health (2007) Code of Practice

GUIDING PRINICIPLES  Purpose principle  Least restriction principle  Respect principle  Participation principle  Effectiveness, efficiency and equity principle

PURPOSE PRINCIPLE Decisions under the Act must be taken with a view to minimising the undesirable effects of mental disorder, by maximising the safety and well being (mental and physical) of patients, promoting their recovery and protecting other people from harm.

People taking action without a patient’s consent must attempt to keep to a minimum the restriction they impose on the patient’s liberty, having regard to the purpose for which the restrictions are imposed. LEAST RESTRICTION PRINCIPLE

RESPECT PRINCIPLE People taking decisions under the Act must recognise and respect the diverse needs, values and circumstances of each patient, including their race, religion, culture, gender, age, sexual orientation and any disability. They must consider the patient’s views, wishes and feelings (whether expressed at the time or in advance), so far as they are reasonably ascertainable, and follow those wishes wherever practicable and consistent with the purpose of the decision. There must be no unlawful discrimination.

PARTICIPATION PRINCIPLE Patients must be given the opportunity to be involved, as far as is practicable in the circumstances, in planning, developing and reviewing their own treatment and care to help ensure that it is delivered in a way that is as appropriate and effective for them as possible. The involvement of carers, family members and other people who have an interest in the patient’s welfare should be encouraged (unless the are particular reasons to the contrary) and their views taken seriously.

EFFECTIVENESS, EFFICIENCY AND EQUITY PRINCIPLE People taking decisions under the Act must seek to use the resources available to them and to patients in the most effective, efficient and equitable way, to meet the needs of patients and achieve the purpose for which the decision was taken.

For this session YOU are the patient, yes YOU! The Mental Health Act in Practice Following the Patient’s Pathway

 Remember - You are the patient  What questions would you want to ask?  What information would you need?  What does a section mean?  What rights do you have? The Mental Health Act in Practice Following the Patient’s Pathway

You have been admitted to Mental Health Unit as an informal patient The Mental Health Act in Practice Following the Patient’s Pathway Q – What does ‘informal’ mean? As an informal patient you have agreed to come into hospital voluntarily and be a patient on the ward – it is likely that you know you are unwell and need to be given help and support As an informal patient you are not subject to any restrictions on leaving the ward – while you are an inpatient we continue to have a duty of care towards you.

You become agitated and insist you are going to leave the ward with the intent of self harm The Mental Health Act in Practice Following the Patient’s Pathway Q – What happens next? The nurse has expressed concerns about you leaving the ward, however you are insistent. The nurse decides to use section 5(4) of the Mental Health Act. A doctor soon arrives and you are placed on section 5(2).

The Mental Health Act in Practice Following the Patient’s Pathway Section 5(4) The use of section 5(4) is the decision of the nurse (of the prescribed class) and provides emergency detention for up to six hours whilst awaiting the arrival of a doctor. Section 5(2) Section 5(2) is applied by the doctor and provides for emergency detention for up to 72 hours to allow for further assessment.

You are now detained under the Mental Health Act The Mental Health Act in Practice Following the Patient’s Pathway Q – What information will I be given? You should continually be informed about what is happening to you and the implications for you legally. The information should be provided to you both orally and in writing and in a format that you understand. This will be the case whenever there are changes to your legal status.

The Mental Health Act in Practice Following the Patient’s Pathway Section 132 –Duty to give information to detained patients (and relatives) Effective communication is essential in ensuring appropriate care and respect for patients’ rights. How do we do this? By involving the patient Using leaflets – Department of Health, Trust Leaflets e.g. IMHAs, CQC Recording information – Trust forms and patients’ healthcare records

Your ‘Responsible Clinician’ arrives on the ward within the 72 hour period and together with another doctor makes a further assessment. The two doctors complete recommendations for a section 2. An Approved Mental Health Practitioner (AMHPs) arrives, assess you and completes an application. The nurse accepts these documents and you are now subject to section 2 for up to 28 days for further assessment. During this period a further assessment takes place and your section status is changed to a section 3 for treatment, with an initial period of 6 months detention, this may be followed by a further 6 months and then annually renewed if appropriate. The Mental Health Act in Practice Following the Patient’s Pathway Q – What rights do I have? As with any changes to your status you will be kept informed as described previously.

The Mental Health Act in Practice Following the Patient’s Pathway Rights under sections 2 and 3 Rights of appeal for discharge – Managers’ Panel Members – Lay people who are appointed and trained to undertake this role specifically. The Panel Members also have a duty to review the decision to renew a section. Tribunal Service – Body with statutory functions who are independent of the Trust. The Tribunal may also be involved in the decision to renew the section. The patient’s nearest relative (under section 26 of the Act) also has rights of appeal on behalf of the patient to the above.

Now you are detained under section 3 and your doctor wants to give you treatment, which you are unhappy about. The Mental Health Act in Practice Following the Patient’s Pathway Q – What will happen next? You should always be involved in your treatment and care plans. Under section 3 the doctor can give you treatment without your consent for the first three months and this will include the time you were detained under section 2. If, following consultation, the doctor wishes to continue to treat you but you do not (or cannot because of capacity issues) consent to that treatment, the doctor will request a second opinion from the Care Quality Commission doctor who will subsequently visit you. It will then be the decision of this second doctor as to whether or not your treatment continues.

You have been on section 3 now for some time and your mental health is improving. The Mental Health Act in Practice Following the Patient’s Pathway Q – What options are there for me now? The clinical team will continue to assess your condition and working in partnership will plan towards discharge from both the section and the hospital. Part of this plan may be the use of section 17 Leave of Absence which is authorised by your doctor and provides for periods of time outside of the hospital whilst still on section. In longer term planning for your discharge, the doctor may also consider the use of a Community Treatment Order. This provides a framework of care for you within the community, but also provides for the ability for the doctor to recall you to hospital should your condition deteriorate at which point the original section 3 may be reinstated.

The Mental Health Act in Practice Following the Patient’s Pathway Statutory forms required 2Nearest Relative ApplicationForm A1or 2AMHP ApplicationForm A2and 2Joint Medical RecommendationForm A3or 2Medical Recommendation (x2)Form A4and 2Record of DetentionForm H3 3Nearest Relative ApplicationForm A5or 3AMHP ApplicationForm A6and 3Joint Medical RecommendationForm A7or 3Medical Recommendation (x2)Form A8and 3Record of DetentionForm H3 3Renewal FormForm H5 4Nearest Relative ApplicationForm A9or 4AMHP ApplicationForm A10 and 4Medical recommendationForm A11 5(4)Nurse’s Holding Power Form H2 5(2) ReportForm H1

The Mental Health Act in Practice Following the Patient’s Pathway Statutory forms required CTOCommunity Treatment OrderForm CTO1 CTOVariations of ConditionsForm CTO2 CTONotice of Recall to HospitalForm CTO3 CTORecord of Patient’s Detention in Hospital after Recall Form CTO4 CTORevocation of CTOForm CTO5 CTOReport Extending the CTOForm CTO7 CTO S64c(4) Certificate of Appropriateness of Treatment to be given to Community PatientForm CTO11 S25Report barring Discharge by Nearest Relative Form M2

The Mental Health Act in Practice Following the Patient’s Pathway Statutory forms required S57Certificate of Consent to Treatment & 2 nd OpinionForm T1 S58Consent to TreatmentForm T2 S58Second OpinionForm T3 S58Consent to Treatment (patients at least 18 yrs old)Form T4 S58Certificate of Consent to Treatment & 2 nd Opinion (patient under 18) Form T5 S58Certificate of 2 nd Opinion Form T6

The Mental Health Act in Practice Following the Patient’s Pathway Part 3 of the MHA – Forensic Sections Forensic sections refer to the part of the Act that is dealt with through the Criminal Justice System. The Court, on advise from a doctor, decide that a hospital setting would be more appropriate than a custodial sentence, or following a period of custodial sentence. The most common of these used within this Trust is a section 37 which mirrors a section 3.

The Mental Health Act in Practice Following the Patient’s Pathway Independent Mental Health Advocates (IMHAs) IMHA services provide an additional safeguard for patients who are subject to the Act. IMHAs are specialist advocates who are trained specifically to work within the framework of the Act to meet the needs of patients. In Leicestershire these services are provides by LAMP in the City and County. N.B. – not to be confused with IMCAs (this will not be a spelling mistake)! - IMCAs – Mental Capacity Act

The Mental Health Act in Practice Following the Patient’s Pathway IMHAs – WHO IS ELIGIBLE? Detained – certain categories Conditionally discharged Guardianship SCT IMHAs do not replace other advocacy services but work in conjunction. IMHAs do not replace solicitors of the patients rights to legal aid.

The Mental Health Act in Practice Following the Patient’s Pathway IMHAs – the Role To help patients obtain information and understand : their rights and the rights of others (e.g. the nearest relative) the parts of the Act that relate to them any conditions or restrictions medical treatment and the reasons why the legal authority under which treatment is being given In order to do the above the IMHA will require relevant and up to date information for which they have the authority to access the patient’s healthcare record, this should be done so in a constructive and inclusive manner – i.e. relative to the purpose for which the access is intended.

The Mental Health Act in Practice Following the Patient’s Pathway Where does the MHA Office fit into this Pathway? The Office has two distinct roles: To ensure that patients rights under the Act are upheld To provide a monitoring system on behalf of clinical staff to ensure the timescales laid down in the Act are met Thereby playing our part in protecting the Trust from litigation!

THANK YOU FOR ATTENDING ALISON WHEELTON SENIOR MHA ADMINISTRATOR JAG BARHA DEPUTY SENIOR MHA ADMINISTRATOR