Making Decisions Dr Sue Browning Professional Roles Nearest Relative Advocacy

Clear policy steer from Government that : “The Bill will allow staff who have the right skills and experience to carry out key roles instead of restricting roles automatically to particular professional groups…and supports a competence based approach to professional practice” DOH Improving Mental Health Law

Professional Roles These changes are: Approved Social Worker (ASW)– Approved Mental Health Professional (AMHP) Responsible Medical Officer (RMO) – Approved Clinician (AC) / Responsible Clinician ( RC) One of the major changes is the broadening of the professional groups trained to take on the professional roles

Professional Roles (cont) Approved Social Worker – Approved Mental Health Professional: Principal change is that entry to this role is extended to include – social workers Nurses Psychologists occupational therapists

The role and training of the AMHP will be fundamentally the same as those of the ASW, with expectations that those taking on the role are able to work within a social work value base, but with additional functions relating to supervised community treatment Approved Mental Health Professionals

The Local Authority retains ultimate responsibility for AMHPs Is responsible for training, legal advice, legal indemnity cover Approved Mental Health Professionals

AMHPs assess on behalf of the Local Authority agreements between Trusts and LAs are needed before other professionals can be nominated to train as an AMHP AMHP training courses must be approved by the General Social Care Council (GSCC)‏ The AMHP is approved by the Local Authority The AMHP assesses a person under the MHA on behalf of the LA and is expected to maintain an independent point of view The LA is expected to support AMHPs taking on this role Approval processes for AMHP require stringent evidence of competence Approved Mental Health Professionals

Functions and Responsibilities of the AMHP Coordination of initial MHA examination process, along with two doctors (one of whom must be Section 12 approved) No change from functions and responsibilities (pre MHA 2007)

Functions and Responsibilities of the AMHP To interview the patient, in a suitable manner, prior to any applications being made No change from functions and responsibilities (pre MHA 2007)

Functions and Responsibilities of the AMHP The AMHP must be satisfied that all the criteria are met (as should the doctors) No change from functions and responsibilities (pre MHA 2007)

Functions and Responsibilities of the AMHP Consider whether the use of compulsion is necessary and appropriate, and how that should be reflected in the care that proposed. For example, is there appropriate treatment, and is it available? Change to functions and responsibilities (pre MHA 2007)

Functions and Responsibilities of the AMHP To make applications for admission to hospital or a guardianship order, and ensure that a detained patient arrives safely at the hospital where they are detained elsewhere. No change from functions and responsibilities (pre MHA 2007)

Functions and Responsibilities of the AMHP In an emergency setting AMHP may assess with one doctor. No change from functions and responsibilities (pre MHA 2007) Section 4

Functions and Responsibilities of the AMHP To agree whether Supervised Community Treatment (SCT) is appropriate and if the RC wants to revoke the SCT, the AMHP must also agree to this. Change to functions and responsibilities (pre MHA 2007)

To ensure that a 24hr AMHP service is available for their respective area, including reaching agreements within local mental health trusts, if the service is to be provided on an operational level by the trust. To approve AMHPs, and keep records of all AMHPs who are approved or acting on their behalf within their area. To ensure that there is a sufficient number of AMHPs to meet the needs of their local community To ensure the professional competence of the AMHPs they approve and to end their approval if necessary. To ensure that AMHPs meet the mandatory training requirements of 18 hours annually, and the other conditions required for re- approval. Responsibilities of Local Social Services Authority in connection with AMHPs

An overall view of circumstances including social and situational issues that are affecting the patient and contributing to the need for the assessment. To therapeutically engage - as best possible - with the patient in the context of all other influences that are apparent. To apply the best possible resources available at any given time or opportunity. To ensure that any intervention is the least restrictive necessary in the circumstances. The AMHP will have regard to the following when exercising their role:

To ensure strict compliance with the law for example, it is the business of the AMHP, rather than that of the doctor, to see that statutory powers are not used for the purpose [of hospital treatment] unless the circumstances warrant it. To apply an approach that takes into account a ‘social’ perspective as well as the ‘medical’ perspective and also takes into account a social model that offers alternatives to detention. To consider and take into account the wishes of relatives and all other relevant circumstances when considering whether to proceed with an application. The AMHP will have regard to the following when exercising their role (cont):

Change 1: Civil Partners are given equal status with married partners in the nearest relative hierarchy list from Dec 2007 Nearest Relative

Husband, wife or civil partner son or daughter father or mother brother or sister grandparent grandchild uncle or aunt nephew or niece NR defined in MHA in descending order as

These include the right to: apply for detention or guardianship object to AMH Ps making applications for admission to hospital for treatment or for guardianship ask that their relative be assessed under the MHA and receive written information if the decision is taken not to admit that person and (with various exceptions) to discharge patients or (in certain cases) to apply to the Mental Health Review Tribunal (MHRT) instead Nearest Relative Powers and Responsibilities

Change 2: How to change the Nearest Relative - processes for displacement Nearest Relative

Who can displace a Nearest Relative? There are a number of people who can apply to County Court to displace a nearest relative: The patient = change Any relative of the patient Anyone who lives with the patient An AMHP The Process for Displacement

That there is no Nearest Relative (NR) That the NR is too ill to take on the role That the NR has unreasonably objected to admission That the NR has discharge the patient without regard to that person’s (or other people’s) safety. That the NR is ‘otherwise unsuitable’ What are the grounds for displacement?

Unsuitable? Abused by NR Evidence of distress to patient at involvement of NR Patient unknown to NR Not exhaustive COP 8.13

No change in process whereby a NR can delegate to another relative Delegating the role of the Nearest Relative

From April 2009 there will be a duty upon the Secretary of State: “ to provide Independent Mental Health Advocacy (IMHA) services for all patients who are subject to compulsion (except those held under sections 4, 5, 135 or 136’’ Being commissioned by |PCT’s Advocacy

Qualifying patients Detained ( not s5,s4,s136,135) Conditionally discharged restricted patients on guardianship s7 On SCT s17A

IMHA will be made available to qualifying patients. Independent of any person who is professionally concerned with the patient’s medical treatment. Advocates will be regulated and may be paid. Key aspects of Independent Mental Health Advocate

IMHA help obtaining information about and understanding their rights and how to exercise those rights. In order to provide this help, IMHA will be able to: visit and interview a patient in private; visit and interview any person who is concerned with his/her medical treatment; require the production and inspection of any records relating to the detention or treatment in any hospital or registered establishment or to any after-care services provided under section 117; require the production of and inspection of any social services authority records which relate to the patient. Key aspects of IMHA

IMHA will have a duty to visit a patient when a reasonable request is made by a nearest relative, responsible clinician or approved mental health professional, however, the patient can decline support from the advocate. Responding to referrals

A duty is placed on hospital managers, responsible clinicians and social services (in the case of guardianship) to inform patients about the advocacy service and to take all steps practicable to ensure they understand what is available to them and how they can obtain help. Informing patients about IMHA